River North Pain Management Consultants, S.C.,
Fax: (888) 961-6471 Clinical Coordinator: (312) 961-6471
Regional Anesthesiology and Interventional Pain Management.
CAUDAL DECOMPRESIVE NEUROPLASTY (Racz Procedure)
Frequently Asked Questions
The following material is given as general information only. It is not to be
considered as medical advice or consultation.
What is an Epidurolysis (RACZ) Procedure?
Epidurolysis (RACZ) Procedure is used
to dissolve some of the scar tissue around entrapped nerves in the epidural space of
spine so that medications, such as cortisone, can reach the affected areas. Dr. Gabor
Racz pioneered this procedure.
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?
To allow medications to reach affected nerves so that pain and
other symptoms may be diminished.
How long does the procedure take?
The procedure requires a series of three or four
injections. First, a catheter (small tubing) is inserted in the epidural space up to the area
of scarring. This is done in the operating room under sterile conditions using fluoroscopy
There are two different ways to perform this:
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1. The catheter is secured to the skin with dressings and tapes. The first injection of
medications is made via this catheter. Patients are hospitalized overnight. The second injection is done the following day. On the third day, the catheter is injected and then removed. The actual injections only take a few minutes.
2. A more convenient outpatient approach is to place the catheter, deliver the
medications intra-operatively and then remove the catheter and discharge you home with instructions to return within a couple weeks for a second procedure.
What is actually injected?
The injection consists of a mixture of local anesthetic (like
Lidocaine or Ropivacaine) and the steroid medication (triamcinolone - Aristocort® or
methylprednisolone - Depo-medrol®), as well as x-ray contrast dye to visualize scarred
space and hyalurodinase and concentrated sterile salt solution to soften scar tissue.
Will the injection hurt?
The procedure involves inserting a needle through skin and
deeper tissues therefore there is some discomfort involved. However, the skin and
deeper tissues are anesthetized with a local anesthetic using a very thin needle prior to
inserting the RACZ needle. Patients also may receive intravenous sedation and
analgesia, which makes the procedure easy to tolerate.
Will I be "put out" for this procedure?
you may. This procedure is done under
Monitored anesthesia care (MAC). This approach makes the procedure easy to tolerate.
The amount of sedation given generally depends upon the individual patient tolerance.
We like to communicate with patients during the procedure to help assess the proper
location of the catheter tip.
How is the procedure performed?
It is done with the patient lying on their
stomach. Patients are monitored with EKG, blood pressure cuff and blood oxygen-
monitoring device. The skin on the back is cleaned with antiseptic solution and then the
procedure is carried out. After the procedure, the patient is placed on their back or on
their side. An x-ray (fluoroscopy) is used to assist the placement of the catheter and
perform the epidurogram.
What should I expect after the injection?
Immediately after the injection, your legs
may feel heavy and numb for a period of time that may vary between minutes to a
couple hours. Also, you may notice that your pain has diminished or it may be gone
completely. This is due to the injected local anesthetic and will only last a few hours.
When can I return to work?
Unless there are any complications, you should be able to
return to work the very same day of the procedure.The most common discomfort is a
How long do the effects of the medication last?
The immediate effect is usually from
the local anesthetic injected. This will wear off within a few hours. The cortisone starts
working in about five to seven days; its effect can last for several days to a several
How many times do I need to have this procedure performed?
If the first procedure
does not relieve your symptoms in one to two weeks, it may be recommended that you
have one more procedure. If you respond to the second procedure and still have residual pain, a third procedure may be recommended.
Can I have more than three procedures?
We generally do not perform more than
three or four procedures within a six-months. If three procedures have not provided
much relief, it is very unlikely that you will benefit from more procedures. Additional
procedures increase the likelihood of side effects from steroids.
Will the Epidurolysis (RACZ) Procedure help me?
It is very difficult to predict if the
procedure will help you or not. Generally speaking, patients who have recent scarring
(e.g. following back surgery) respond better.
What are the risks and side effects?
Generally speaking, this procedure is safe.
However, as with any procedure, there are risks, side effects, and a possibility of
complications. The most common side effect is pain - which is temporary. Other risks
involve spinal puncture with headaches, infection, bleeding inside the epidural space
with nerve damage, worsening of symptoms etc. The risks are related to the side effects
of cortisone such as weight gain, increase in blood sugar (mainly in diabetics), water
retention, suppression of body's own natural production of cortisone, etc. Some patients
may develop allergic reaction to hyaluronidase. Fortunately, the serious side effects and
complications are uncommon.
Who should not have this procedure?
You should not have the injection 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.
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