Adhesiolysis aka Epidural Lysis of Adhesions:
Before performing a procedure your pain physician will review your MRI in order to identify which nerves are likely affected and are responsible for your pain. Initially a series of epidural steroid injections are often performed to localize and treat your pain. If scar tissue is the cause of your pain or inhibits free access of the solution to the appropriate nerves then the response to the epidural steroid injections may be limited. If scar tissue is thought to be the cause of your pain or the reason that the injections aren’t working you will be scheduled for the Racz Procedure. Epidural Lysis of Adhesions is performed by injecting a local anesthetic with a small needle into the skin above your buttock. Once the area is numb, then using a larger needle a catheter/guide wire is placed into the epidural space using x-ray guidance for proper placement. Once the catheter is in the proper location where the scar tissue is affecting the nerve root, multiple medications (omnipaque, hyaluronidase, local anesthetics, and steroids) are injected into the space in order to dissolve the scar tissue and reduce the inflammation and irritation on the nerve. The entire procedure typically is finished in less than an 30 minutes and is performed on an outpatient basis, so typically you are able to go home within a few hours of the procedure. Immediately after the injection you may notice that your legs feel heavy and may have some sensory changes, but these are temporary. The local numbing anesthetic wears off in a few hours so you may feel some discomfort once that wears off at the injection site. The inflammation-reducing steroid generally starts working at about seventy two hours.