Racz Procedure: Peridural Adhesiolysis
Scar tissue in the epidural space can cause intractable pain.
One treatment is the Racz procedure, in which a wire catheter is placed through the tailbone and advanced into the caudal canal and into the lumbar epidural space where most scar tissue exists after surgery.
Another approach uses the same wire catheter, but uses a lateral approach, through the side of the spine. The plastic sheath demonstrated above is placed initially through the tailbone with the wire inserted through its center. The tip of the wire is soft in order to avoid injuring nerve tissue, but is firm enough to help lyse (cut) scar tissue.
Once the scar tissue is cut or channels cut through the scar tissue with the wire catheter, hyaluronidase (an enzyme), and hypertonic saline (pain reliever and used to help dissolve scar tissue) are injected followed by steroids. Many procedures are performed over a 3 day period with another injection of materials through the catheter each day.
Overall, the results are good, but the relief is transient (weeks, months). Repeat procedures are possible intermittently. The Navicath system is a stiffer guidable catheter which may have advantages over the Racz wire catheter system. It was released in the US in September 2001 and serves as an intermediate step between the Racz system and epiduroscopy.
The complications of either system are bleeding, infection, rare nerve injury, etc.