Epidural adhesions or scar tissue can form after lumbar surgery or inflammatory conditions involving the epidural space and entrap the spinal nerve roots causing pain and discomfort in the back and legs. The modified RACZ procedure can be used to break up or loosen the scar tissue, freeing the nerve roots to decrease or eliminate this pain.

Epidural lysis of adhesions is done in the operating room. An intravenous line will be started by nursing personnel for administration of fluids and sedation. Vital signs will be closely monitored throughout the procedure. You will be lying on your stomach and your lower back will be cleaned with an aneseptic solution and draped sterilely to prevent infection. You will also receive prophylactic IV antibiotics. Local anesthetic will be injected into the skin and deeper tissues to numb the site where the epidural space will be entered. A balloon-tipped (Fogarty) catheter will be threaded into the epidural space and used to break up the scar tissue. After this, the usual epidural medications will be administered to help with post-procedure discomfort, which should be minimal. Afterwards, you will go to the recovery room for about one hour where you will continue to be monitored and IV fluids given.

• The procedure may not help your pain.
• Backache from bruising.
• Small risk of bleeding or infection at entrance site or in the epidural space, which may necessitate a hospital admission and surgical procedure to remove the blood or drain the infection.
• Spinal headache if the dura is punctured.
• Although very rare, damage to the spinal cord or spinal nerves may result in paralysis or partial muscle weakness or numbness.
• Allergic reactions to medications may cause your heart and breathing to stop or may cause death.
• Rarely, reactions to local anesthetic drugs can cause flushing, ringing in your ears, or dizzy feeling.

• Your legs may feel weak or numb for a short time after the procedure or you may feel pressure in your back or hips. These sensations will be gone within a short time. Should these symptoms continue or become worse after arriving home or if you begin running a fever of 100 or greater, please call the Pain Treatment Center or the on-call doctor.

It is not possible to predict to what extent, if any, this procedure will improve your pain. However, epidural lysis of adhesions is known to produce dramatic relief in some patients suffering from back and leg pain following previous back surgery. In many individuals, pain will gradually return. When this occurs, the procedure may be repeated if indicated.