Epidurolysis (RACZ Procedure)
What is an Epidurolysis (RACZ) Procedure?
Epidurolysis (RACZ) Procedure is used to dissolve some of the scar tissue from around entrapped nerves in the Epidural space of spine, so that medications such as cortisone can reach the affected areas.
What causes scarring (adhesions)?
Scarring is most commonly caused from bleeding into the Epidural space following back surgery and the subsequent healing process. It is a natural occurrence following surgical intervention. Sometimes scarring can also occur when a disk ruptures and its contents leak out.
What is the purpose of it?
To allow medications to reach affected nerves so that pain and other symptoms may be diminished.
How long does the procedure take?
This procedure takes up to 30 minutes.
What is actually injected?
The injection consists of a mixture of local anesthetic (like lidocaine or bupivacaine) and the steroid medication (triamcinolone—Kenalog or methylprednisolone—Depo-medrol®, as well as x-ray contrast dye to visualize scarred space and hyaluronidase—and concentrated sterile salt solution to soften scar tissue.
Will the injection hurt?
The procedure involves inserting a needle through skin and deeper tissues (like a "tetanus shot"). So, there is some discomfort involved. However, we numb the skin and deeper tissues with a local anesthetic using a very thin needle prior to inserting the RACZ needle. The patients also receive intravenous sedation and analgesia, which makes the procedure easy to tolerate.
How is the procedure performed?
It is done with the patient lying on their stomach. The patients are monitored with EKG, blood pressure cuff and blood oxygen-monitoring device. The skin in the back is cleaned with antiseptic solution and then the procedure is carried out.
What should I expect after the injection?
Immediately after the injection, you may feel your legs slightly heavy and may be numb. Also, you may notice that your pain may be gone or quite less. This is due to the local anesthetic injected. This will last only for a few hours.
When can I return to work?
You should be able to return to your work the day after the procedure. The most common thing you may feel is a sore back.
How long the effects of the medication last?
The immediate effect is usually from the local anesthetic injected. This wears off in a few hours. The cortisone starts working in about 24 to 48 hours and its effect can last for several days to a few months.
How many times do I need to have this procedure performed?
If the first procedure does not relieve your symptoms in about a week to two weeks, you may be recommended to have one more procedure. If you respond to the second procedure and still have residual pain, you may be recommended for a third procedure.
Who should not have this procedure?
If you are allergic to any of the medications to be injected, if you are on a blood thinning medication (e.g. Coumadin®), or if you have an active infection going on, you should not have the injection.