Racz Procedure (Percutaneous 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 the procedure done?

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.

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.

The injection consists of the following:

  • A mixture of local anesthetic (such as Lidocaine or Bupivacaine)

  • Steroid medication (Triamcinolone)

  • X-ray contrast (Nonionic DYE) so that the scarred space can be clearly visualized

  • Concentrated sterile salt solution to soften scar tissue
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.
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 cortisone 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.
SI joint Injection

A sacroiliac injection places a pain-numbing medicine and steroid directly into the sacroiliac (SI) joint.

The benefit of this procedure is to reduce inflammation, help confirm the SI joint as the source of pain, and better allow a physical therapist to treat the joint.

If successful in relieving pain, repeated injection every few months gap can be done to maintain pain free status.

Prolotherapy can be offered for such patients.