joneskurian.com - Racz Catheter
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Racz Procedure (Epidural Neurolysis)
What is the Racz Catheter Procedure
(Epidural Neurolysis)?
The Racz Catheter Procedure (Epidural Neurolysis) is
used to release some of the scar tissue from around
entrapped nerves in the epidural space of the spine, so
that medications such as cortisone can reach the
affected areas. It is used to decrease the pain caused by
the scarring. This procedure is named for the physician
who pioneered it, Dr. Gabor Racz.
What causes epidural scarring?
Epidural scarring most often occurs from bleeding into
the epidural space following back surgery and the
subsequent healing process where epidural fat is
replaced with fibrotic tissue. It is a natural occurrence
following surgical intervention. Sometimes scarring can
also occur when a disc ruptures and its contents leak
out.
How long does the procedure take?
The procedure generally takes between 30 and 60 minutes. It can be done once, or in a series of up to
three injections in a twelve-month period. A catheter is inserted in the caudal epidural space and steered
up to the area of scarring. This is done in our fluoroscopy suites under sterile conditions with IV sedation.
What is actually injected?
The injection consists of the following:
A mixture of local anesthetic (such as Lidocaine or
Bupivacaine)
Steroid medication
X-ray contrast so that the scarred space can be
clearly visualized
Concentrated sterile salt solution to soften scar
tissue
Will the injection hurt?
The procedure involves inserting a needle through
skin and deeper tissues. There is some discomfort
involved, which will feel like getting a tetanus shot
or skin prick. The skin and deeper tissues are
numbed with a local anesthetic prior to insertion of
the spinal needle and catheter.
Will I receive any sedation for this procedure?
This procedure is done under a combination of local anesthesia and IV sedation, which makes the
procedure easy to tolerate. The amount of sedation given will generally depend upon the patient’s
tolerance. Communication with the patient during the procedure is important to help assess the proper
placement of the catheter.
What should I expect during and after
the procedure?
This procedure is done with the patient lying on his
or her stomach. The patient is monitored with EKG,
blood pressure cuff, and blood oxygen-monitoring
devices. The skin is prepped with an antiseptic
solution before the procedure is performed under Xray
guidance (fluoroscopy), which is used to assist
the placement of the catheter and perform the
epidurogram.
After the procedure you will be able to gradually get
up and walk into the recovery area. Your legs might
feel slightly heavy or numb. You may also notice
that your pain may be gone or significantly reduced.
This is due to the local anesthetic injected. Although
this will last only for a few hours, driving is
prohibited following the procedure that day.
When can I return to work?
Unless there are complications, you should be able to return to work the day after the procedure. The
most common thing you may feel is a sore back.
How long will the effects of the
medication last?
The immediate effect is usually from the local
anesthetic that was injected. This effect will usually
wear off in a few hours. The steroid usually starts
working in about 3 to 7 days and the effect can last
for several days up to a few months.
Will the Racz procedure (Epidural
Neurolysis) help me?
It is very difficult to predict if the procedure will help
you or not. Overall, patients who have recent
scarring, such as scarring following recent back
surgery, will respond better than those with more
long-term scarring. Patients with leg pain and low
back pain often report excellent relief of leg pain
and some relief of low back pain.
What are the risks and side effects?
Overall, this procedure is safe. However, with any
procedure there are risks, side effects, and the
possibility of complications. Fortunately, the serious
side effects and complications are uncommon. Risks
and side effects may include the following:
Pain/soreness – the most common side effect,
and it is temporary
Urinary difficulty – Occasionally, people report
some difficulty urinating for the first several hours post procedure, but this is temporary.
Other risks associated with the Racz procedure can include:
Spinal puncture risk/side effects, such as:
Headaches
Infection
Bleeding inside the epidural space with nerve damage
Worsening of symptoms
Steroid injection risks/side effects, such as:
Weight gain
Increase in blood sugar (mainly in diabetics)
Water retention
Suppression of the body’s own natural production of cortisone
Who should not have this procedure?
You should not have this procedure performed if:
You are allergic to any of the medications to be injected.
You are on a blood-thinning medication like Warfarin.