The Racz Procedure: Lysis of Epidural Adhesions (Percutaneous Neuroplasty)

  • Gabor B. Racz
  • Miles R. Day
  • James E. Heavner
  • Jeffrey P. Smith


Back pain is an exceedingly common condition and is often treated with surgery when patients have failed traditional conservative treatment. Despite the best efforts of treating surgeons, these patients are often left with significant postoperative pain, and reoperation or chronic opiate therapy is frequently felt to be the only alternative. A large portion of pain in this patient population is directly attributable to epidural adhesions that prevent normal nerve root movement along with adhesions affecting the ventral epidural structures. Lysis of adhesions is a minimally invasive procedure that was initially developed to spare patients from an additional surgery. Since its inception, the procedure has proved effective for a variety of additional etiologies beyond postsurgical back pain. Through site-specific targeting, lysis of adhesions involves the placement of a catheter in the neuroforamen of the affected nerve root. A fluid foraminotomy is performed when hyaluronidase, local anesthetic, corticosteroid, and hypertonic sodium chloride are injected through the catheter. This releases the nerve root from epidural adhesions and increases neuroforaminal cross-sectional area. Additionally, adhesiolysis opens venous runoff and decompresses high-pressure epidural veins.


Nerve Root Hypertonic Saline Epidural Space Spinal Cord Stimulation Posterior Longitudinal Ligament 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© American Academy of Pain Medicine 2015

Authors and Affiliations

  • Gabor B. Racz
    • 1
    • 2
    • 3
  • Miles R. Day
    • 2
    • 3
    • 4
  • James E. Heavner
    • 2
    • 5
  • Jeffrey P. Smith
    • 6
    • 7
  1. 1.LubbockUSA
  2. 2.Department of AnesthesiologyTexas Tech University School of MedicineLubbockUSA
  3. 3.International Pain CenterTexas Tech University Health Sciences CenterLubbockUSA
  4. 4.LubbockUSA
  5. 5.Department of AnesthesiaUniversity Medical CenterLubbockUSA
  6. 6.Department of Anesthesiology and Pain ManagementTexas Tech University School of MedicineLubbockUSA
  7. 7.LubbockUSA

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