What is Lysis of Adhesions?
Lysis of Adhesions Performed by Las Vegas, Summerlin, and Henderson Nevada’s Top Pain Doctors
How is Lysis Of Adhesions Performed?Lysis of adhesions is also known as the Racz procedure. In the course of this procedure, a local anesthetic is injected into the affected area to numb it. Visualization methods, most often fluoroscopy or magnetic resonance imaging (MRI), locate the scar tissue and the area to be injected. Endoscopy, where a thin camera probe is inserted into the region to be treated, is also often incorporated in lysis of adhesions procedure’s and give additional accuracy and visualization.
A catheter is guided to the precise location of the scar tissue and delivers a combination of compounds into the scar tissue to break up or dissolve it. The compounds injected are saline (the injection vehicle) and hyaluronidase, an enzyme that breaks up scar tissue at a molecular level. Omnipaque, which improves the visibility of the area under fluoroscopy, anesthetics to relieve the pain, and steroids to treat inflammation are also included in the injected formulation.
The risks of lysis of adhesions are mainly related to the placement of the needles in the course of the procedure. The needles are directed at the dural space, a specific location within a bone of the spine (i.e. a vertebra). If this is somehow off-target, the drugs could be injected into other areas, such as the subarachnoid space. If this occurs, it could result in nerve damage. Other complications include temporary spinal blockade that may cause temporary movement problems or a decrease in sensation. A headache, known as a lumbar puncture headache, is more common following the lysis of adhesion procedure, but this again is temporary and usually doesn’t require treatment. Catheter shear, or damage to nerves, skin, or muscles occurring as the catheter supplying the medications is used is also possible.
The drugs injected have a low incidence of producing side effects as a result of their use in lysis of adhesions. Steroids can cause arthritis, elevated blood sugar, and weight gain. They can also result in stomach ulcers and deficiencies in the immune system. The local anesthetics used may cause nerve desensitization and interact with other medications taken by the patient to produce adverse effects. In some cases, temporary neurological deficits, or reactions to local anesthetics, such as chest pain, respiratory depression, and nausea can occur.
Conditions Related to Lysis of Adhesions
Lysis of adhesions is used to treat scarring left by surgeries performed on the spine. It is most often employed when procedures on the lower back (the iliosacral joint) result in scarring. This results in irritation or inflammation caused by the scar tissue and thus a new source of pain. Scarring can also result in stenosis, or compression of the spinal nerves. Stenosis can cause pain, abnormal sensation, or even a lack of sensation, which can lead to paralysis in extreme cases. Lysis of adhesions results in significant pain relief and at least a 50% regain of normal function in approximately 70% of patients.
The effects of the procedure are reported to last for four to twelve weeks after treatment. Though it is most strongly associated with lower back pain, a clinical trial evaluating the use of lysis of adhesions for treating cervical stenosis showed good results. Cervical stenosis is a compression of spinal nerves in the neck that causes chronic pain in that area. The use of lysis of adhesions resulted in pain relief for 77% of patients in this trial after six months of treatment.
ConclusionLysis of adhesions is a treatment designed to reduce scar tissue (adhesions) left by spinal surgeries. This scarring can result in inflammation or irritation of the nearby nerves, thus causing pain. Lysis of adhesions, also known as the Racz procedure, involves epidural, or direct, injections into the region(s) of the spine affected by scarring. These injections deliver anesthetics to relieve pain, compounds that dissolve the scar tissue, and steroids to reduce inflammation.
The main risks of Racz are related to misplacement of the needles used; however, this risk can be reduced by the use of visualization methods, such as fluoroscopy or endoscopy, to ensure accuracy. Lumbar puncture headaches and sensory deficits are more common side-effects associated with lysis of adhesions, but they are not serious or long-lasting.
Lysis of adhesions is most commonly used to treat lower back pain or stenosis resulting from surgery, but has also shown potential in treating cervical stenosis, which causes neck pain. This procedure is safe, effective, and relieves pain in the short and medium term.
- Racz GB, Heavner JE, Trescot A. Percutaneous lysis of epidural adhesions–evidence for safety and efficacy. Pain practice : the official journal of World Institute of Pain. Jul-Aug 2008;8(4):277-286.
- Manchikanti L, Singh V, Cash KA, Pampati V. Assessment of effectiveness of percutaneous adhesiolysis and caudal epidural injections in managing post lumbar surgery syndrome: 2-year follow-up of a randomized, controlled trial. Journal of pain research. 2012;5:597-608.
- Helm Ii S, Benyamin RM, Chopra P, Deer TR, Justiz R. Percutaneous adhesiolysis in the management of chronic low back pain in post lumbar surgery syndrome and spinal stenosis: a systematic review. Pain physician. Jul-Aug 2012;15(4):E435-462.
- Helm S, Hayek SM, Colson J, et al. Spinal endoscopic adhesiolysis in post lumbar surgery syndrome: an update of assessment of the evidence. Pain physician. Apr 2013;16(2 Suppl):Se125-150.
- Park CH, Lee SH, Lee SC. Preliminary results of the clinical effectiveness of percutaneous adhesiolysis using a Racz catheter in the management of chronic pain due to cervical central stenosis. Pain physician. Jul-Aug 2013;16(4):353-358.
- Manchikanti L, Cash KA, McManus CD, Pampati V. Assessment of effectiveness of percutaneous adhesiolysis in managing chronic low back pain secondary to lumbar central spinal canal stenosis. International journal of medical sciences. 2013;10(1):50-59.
- Manchikanti L, Abdi S, Atluri S, et al. An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part II: guidance and recommendations. Pain physician. Apr 2013;16(2 Suppl):S49-283.