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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.
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