Adhesiolysis

What is adhesiolysis?

Adhesiolysis is also known as epidural lysis of adhesions or the Racz procedure (after the doctor who created it). The procedure’s name is a combination of “adhesion” (scar tissue) and “lysis” (to dissolve or destroy).

Epidural lysis of adhesions is a minimally-invasive procedure that was developed in the late 1980s by Dr. Gabor Racz. It’s an effective way to treat chronic back and neck pain from scar tissue formation.

Why do we develop scar tissue? Any injury or trauma to the body can lead to scar tissue. This includes surgery. After injury or over time, scar tissue forms around nerve roots, which can lead to unrelenting nerve pain.

Adhesiolysis uses medications to dissolve scar tissue to relieve pain. This procedure is considered safe and effective for patients with excessive scar tissue and is an alternative to more invasive surgical procedures.

What conditions can adhesiolysis help with?

The presence of scar tissue, even from an old and healed injury, can irritate still-healthy nerves.

One of the most common causes of excessive scar tissue (and the accompanying radiating back pain) is prior back surgery. After spinal surgery, adhesions develop and may cause recurrent, intractable pain. These inflamed nerves can cause pain that radiates from your lower back into the legs.

Prolonged neck or back pain (i.e., the pain of spinal stenosis) can also result in scarring in the epidural space, particularly if other interventions have been met with minimal success. The scarring caused by disc herniation can also cause pain, even after repairing the damage.

Further, patients who experience pain from adhesions may suffer twice, as scar tissue can also prevent other pain treatments from working effectively. Scar tissue can block the medication delivered in an epidural steroid injection to both the epidural space and to other tissues or affected areas.

Instead, adhesiolysis dissolves scar tissue to reduce pressure on irritated nerves. Essentially, any back pain condition that has become chronic, or the treatment of which has resulted in scarring that has aggravated the pain and inflammation, could benefit from lysis of adhesions.

An overview of the adhesiolysis procedure

The presence of scar tissue, even from an old and healed injury, can irritate still-healthy nerves.

One of the most common causes of excessive scar tissue (and the accompanying radiating back pain) is prior back surgery. After spinal surgery, adhesions develop and may cause recurrent, intractable pain. These inflamed nerves can cause pain that radiates from your lower back into the legs.

Prolonged neck or back pain (i.e., the pain of spinal stenosis) can also result in scarring in the epidural space, particularly if other interventions have been met with minimal success. The scarring caused by disc herniation can also cause pain, even after repairing the damage.

Further, patients who experience pain from adhesions may suffer twice, as scar tissue can also prevent other pain treatments from working effectively. Scar tissue can block the medication delivered in an epidural steroid injection to both the epidural space and to other tissues or affected areas.

Instead, adhesiolysis dissolves scar tissue to reduce pressure on irritated nerves. Essentially, any back pain condition that has become chronic, or the treatment of which has resulted in scarring that has aggravated the pain and inflammation, could benefit from lysis of adhesions.

An overview of the adhesiolysis procedure

Before performing the adhesiolysis procedure, your doctor will review your medical history, including any imaging that can help accurately locate the adhesions.

Your doctor may also recommend a test series of epidural steroid injections as a diagnostic confirmation tool. If scar tissue is the cause for your pain, your response to the epidural steroid injections may be limited, confirming the need for the Racz procedure.

To start the procedure, talk to your healthcare team. Your comfort is important, so make sure to discuss your options for pillows, props, and other padding to make you feel at ease. The epidural lysis of adhesions procedure uses only a local anesthetic, but you may still feel nervous about the procedure. If this is the case, talk to your doctor beforehand to see if they recommend a mild sedative on the morning of the procedure. However, most people are comfortable without sedatives.

Once you are comfortable on the table, your doctor injects local anesthetic with a small needle into the skin above the affected space. A larger needle follows, placing a catheter/guide wire into the appropriate area (using X-ray guidance for proper placement).

Multiple medications are then injected into the space in order to dissolve the scar tissue. These are typically steroids and anesthetic medications.

This procedure can be performed over a two-day period with another injection of medications the following day to ensure the lysis of your scar tissue. The entire procedure takes less than an hour and is performed on an outpatient basis, so you are able to go home within a few hours of the procedure.

You can learn more about the procedure in the following video.

Side effects and risks

As with all medical interventions, there are potential side effects and risks. The most common complaint is mild to moderate back pain at the injection site shortly after the procedure. This should resolve shortly.

Other more serious and rare complications include the following:

• Spinal cord compression
• Excessive intracranial pressure
• Bleeding
• Subdural injection
• Hematoma
• Infection

These risks are reduced with the use of X-ray guidance, sterile techniques, and specialized training in the procedure itself.

As always, your level of risk depends on your overall health as well. Talk to your doctor about any concerns you have. Make sure they know all of the other medications you are taking, including over-the-counter medications and supplements.

Recovery

Take the day of your injection off to rest. Immediately after the injection you may notice that your legs feel heavy and have some sensory changes, but these are temporary. Until you feel sensation return completely, refrain from any vigorous exercise or activity.

The local numbing anesthetic usually wears off in a few hours, so you may feel some discomfort at the injection site after this. If approved by your doctor, you can manage this with over-the-counter non-steroidal anti-inflammatory drugs and a cold pack to the area. The inflammation-reducing steroid generally starts working at about 48 hours and should provide relief.

If your pain increases after 48 hours, or you experience any sign of infection or complications – bleeding, swelling, pain, or just a feeling of being unwell – call your doctor.

Could adhesiolysis help me?

The American Society of Interventional Pain Physicians developed a large evidence-based practice guideline for the management of chronic spinal pain with interventional techniques. In regards to adhesiolysis, the guidelines state that there is strong evidence to indicate effectiveness of adhesiolysis with epidural steroids for short- and long-term pain control in pain that is both recurring and hard-to-treat.

Another review of studies found good evidence for long-term pain relief in patients with untreated spinal stenosis as well as failed back surgery syndrome.

Patients who have a well-identified area of pain are most likely to experience relief from lysis of adhesions, but study after study continues to confirm both long- and short-term pain relief for a variety of patients who suffer from chronic lower back pain.