Epidural lysis of adhesions

Epidural lysis of adhesions (LOA), also known as percutaneous adhesiolysis or the Racz procedure, is a minimally invasive spine surgery 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 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] (Sometimes hyaluronidase (an enzyme) is also injected to dissolve the adhesions.)

Epidural lysis of adhesions
Other namesPercutaneous adhesiolysis
Specialtyneurology

It was developed at Texas Tech University Health Sciences Center (TTUHSC) in 1989 by Gabor B. Racz.

The procedure was assigned a Current Procedural Terminology (CPT) code in 2000.[3]

Etymology

Epidural administration: injection into the epidural space of the spinal cord. Epidural, (Greek): situated on or outside the dura mater, from epi- "on top of" + dura mater + -al. Adhesion (Latin) adhēsiōn- for Latin adhaesiōn- (stem of adhaesiō) a clinging, equivalent to adhaes(us), past participle of adhaerēre to adhere + -iōn- -ion. The act, state or quality of adhering.[4][5] Lysis, (Greek) lýsis a loosening, releasing; combining form as with adhesiolysis means breaking down, loosening, decomposition.

Complications

While the procedure is effective in removing fibrous tissue in the epidural space, the procedure may create complications.[6] The Racz procedure[7] was only considered after conservative treatments had failed to help patients with low back and cervical pain.[6] 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."[6]

See also

References
  1. D.E. Jamison; E. Hsu; S.P. Cohen (June 2014). "Epidural Adhesiolysis: An Evidence-based Review". Journal of Neurosurgical 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 (2): E129–E139. PMID 24658484.
  3. Bradford, Billie C. (February 2000). "HCFA announces 2000 Medicare anesthesia conversion factor increases and other changes" (PDF). American Association of Nurse Anesthetists. 68 (1): 59–65. PMID 10876453.
  4. url=http://www.etymonline.com/index.php?allowed_in_frame=0&search=Lysis |Online Etymology Dictionary
  5. url=http://www.wordreference.com/definition/adhesion |WordReference.com
  6. 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. S2CID 22617713.
  7. 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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