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

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Comprehensive Treatment of Chronic Pain by Medical, Interventional, and Integrative Approaches

Abstract

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.

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Author information

Authors and Affiliations

  1. 4608-15TH Street, Lubbock, TX, 79416, USA

    Gabor B. Racz M.D., DABIPP, FIPP

  2. Department of Anesthesiology, Texas Tech University School of Medicine, Lubbock, TX, USA

    Gabor B. Racz M.D., DABIPP, FIPP, Miles R. Day M.D., DABIPP, FIPP & James E. Heavner DVM, Ph.D.

  3. International Pain Center, Texas Tech University Health Sciences Center, Lubbock, TX, USA

    Gabor B. Racz M.D., DABIPP, FIPP & Miles R. Day M.D., DABIPP, FIPP

  4. 3601 4th Street MS: 8182, Lubbock, TX, 79430, USA

    Miles R. Day M.D., DABIPP, FIPP

  5. Department of Anesthesia, University Medical Center, 3601 4th Streest MS: 8182, Lubbock, TX, 79430, USA

    James E. Heavner DVM, Ph.D.

  6. Department of Anesthesiology and Pain Management, Texas Tech University School of Medicine, Lubbock, TX, USA

    Jeffrey P. Smith M.D., MBA

  7. 221 Genoa Avenue, Lubbock, TX, 79415, USA

    Jeffrey P. Smith M.D., MBA

Authors
  1. Gabor B. Racz M.D., DABIPP, FIPP
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  2. Miles R. Day M.D., DABIPP, FIPP
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  3. James E. Heavner DVM, Ph.D.
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  4. Jeffrey P. Smith M.D., MBA
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Corresponding author

Correspondence to Miles R. Day M.D., DABIPP, FIPP .

Editor information

Editors and Affiliations

  1. The Center for Pain Relief, Inc., West Virginia University, 400 Court Street, Suite 100, Charleston, 25301, West Virginia, USA

    Timothy R. Deer

  2. Stanford Pain Management Center, Redwood City, CA, Clinic Chief, Stanford University School of Medicine, Stanford, 94065, California, USA

    Michael S. Leong

  3. Department of Anesthesiology, Rush Medical College, Professor, Rush University Medical Center, Chicago, 60612, Illinois, USA

    Asokumar Buvanendran

  4. Pennsylvania State University, College of Medicine, Department of Anesthesiology, Milton S. Hershey Medical Center, Hershey, 17033-0850, Pennsylvania, USA

    Vitaly Gordin

  5. Center for Interventional Pain and Spine, Newark, DE USA, Medical Director, Bryn Mawr Hospital, Bryn Mawr, 19010, Pennsylvania, USA

    Philip S. Kim

  6. President, National Institute of Pain, Tampa, 33558, Florida, USA

    Sunil J. Panchal

  7. The LITE Center, Clinical Associate Professor, Medical Director, School of Medicine, Miami, 33143, Florida, USA

    Albert L. Ray

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© 2013 American Academy of Pain Medicine

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Racz, G.B., Day, M.R., Heavner, J.E., Smith, J.P. (2013). The Racz Procedure: Lysis of Epidural Adhesions (Percutaneous Neuroplasty). In: Deer, T., et al. Comprehensive Treatment of Chronic Pain by Medical, Interventional, and Integrative Approaches. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-1560-2_50

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  • DOI: https://doi.org/10.1007/978-1-4614-1560-2_50

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-1559-6

  • Online ISBN: 978-1-4614-1560-2

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