Epidural lysis of adhesions

Epidural lysis of adhesions (LOA), also known as the Racz procedure, is an interventional technique which involves the dissolution of epidural scar tissue by mechanical means to facilitate the spread of analgesics in an effort to alleviate pain.[1] It is a minimally invasive medical procedure developed at Texas Tech University Health Sciences Center (TTUHSC) in 1989 by Gabor B. Racz. It is a type of percutaneous adhesiolysis procedure[2] commonly used to treat chronic pain resulting from failed back surgery syndrome wherein scar tissue has formed around the nerves and causes pain. Evidence suggests the procedure may also be effective in treating spinal stenosis and radicular pain caused by a herniated disc.[1]

Etymology

Epidural, (Gk) situated on or outside the dura mater, from epi- "on top of" + dura mater + -al. The noun meaning injection into the epidural region. Lysis, (Gk) lýsis a loosening, releasing; combining form as with adhesiolysis means breaking down, loosening, decomposition. Adhesion (Latin) adhēsiōn- for Latin adhaesiōn- (stem of adhaesiō) a clinging, equivalent. to adhaes(us), past participle of adhaerēre to adhere + -iōn- -ion. Defined as the act, state or quality of adhering.[3][4]

Complications

While the procedure is found to be effective in removing fibrous tissue in the epidural space, the procedure may create complications.[5] The Racz procedure[6] was only considered after conservative treatments had failed to help patients suffering from low back and cervical pain.[5] According to an evaluation in the Journal of Neuromodulation, "possible known complications include bending of the tip of the introducer needle, shearing/tearing of the catheter, misplacement of the catheter, inadvertent blockage of the catheter or catheter tip, migration of the catheter, hypotension, respiratory depression, urinary and/or fecal incontinence, urinary hesitancy, sexual dysfunction, paresthesia, epidural abscess, and meningitis."[5]

References

  1. 1 2 D.E Jamison, E. Hsu, S.P. Cohen (June 2014). "Epidural Adhesiolysis: An Evidence-based Review". Journal of Neurological Sciences 58 (2): 65–76. PMID 24819483.
  2. ↑ Laxmaiah Manchikanti, Stanford Helm II, Vidyasagar Pampati, Gabor B. Racz (March 2014). "Percutaneous Adhesiolysis Procedures in the Medicare Population: Analysis of Utilization and Growth Patterns from 2000 to 2011". Pain Physician 17: E129–E139. PMID 24658484.
  3. ↑ url=http://www.etymonline.com/index.php?allowed_in_frame=0&search=Lysis | Online Etymology Dictionary
  4. ↑ url=http://www.wordreference.com/definition/adhesion | WordReference.com
  5. 1 2 3 Gul K. Talu, Serdar Erdine (October 2003). "Complications of Epidural Neuroplasty: A Retrospective Evaluation". Neuromodulation: Technology at the Neural Interface 6 (4): 237–247. doi:10.1046/j.1525-1403.2003.03031.x. PMID 22151070.
  6. ↑ D. K. Baheti, R. P. Gehdoo (August 8, 2009). Interventional Pain Management: A Practical Approach. Jp Medical Publications. p. 218. ISBN 9788184483192.
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