Epidural lysis of adhesions (LOA), also known as

percutaneous {{More citations needed, date=January 2021 In surgery, a percutaneous procedurei.e. Granger et al., 2012 is any medical procedure or method where access to inner organs or other tissue is done via needle-puncture of the skin, rather than by using ...

adhesiolysis or the Racz procedure, is a minimally invasive spine surgery which involves the dissolution of

epidural Epidural administration (from Ancient Greek ἐπί, , upon" + ''dura mater'') is a method of medication administration in which a medicine is injected into the epidural space around the spinal cord. The epidural route is used by physicians and ...

scar tissue by mechanical means to facilitate the spread of

analgesic An analgesic drug, also called simply an analgesic (American English), analgaesic (British English), pain reliever, or painkiller, is any member of the group of drugs used to achieve relief from pain (that is, analgesia or pain management). It ...

s in an effort to alleviate pain. It is a type of

adhesiolysis procedure commonly used to treat

chronic pain Chronic pain is classified as pain that lasts longer than three to six months. In medicine, the distinction between Acute (medicine), acute and Chronic condition, chronic pain is sometimes determined by the amount of time since onset. Two commonly ...

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 Spinal stenosis is an abnormal narrowing of the spinal canal or neural foramen that results in pressure on the spinal cord or nerve roots. Symptoms may include pain, numbness, or weakness in the arms or legs. Symptoms are typically gradual in on ...

and

radicular pain Radicular pain, or radiculitis, is pain "radiated" along the dermatome (sensory distribution) of a nerve due to inflammation or other irritation of the nerve root (radiculopathy) at its connection to the spinal column. A common form of radiculit ...

caused by a

herniated disc Spinal disc herniation is an injury to the cushioning and connective tissue between vertebrae, usually caused by excessive strain or trauma to the spine. It may result in back pain, pain or sensation in different parts of the body, and physical ...

. (Sometimes

hyaluronidase Hyaluronidases are a family of enzymes that catalyse the degradation of hyaluronic acid (HA). Karl Meyer classified these enzymes in 1971, into three distinct groups, a scheme based on the enzyme reaction products. The three main types of hyal ...

(an enzyme) is also injected to dissolve the adhesions.) It was developed at

Texas Tech University Health Sciences Center The Texas Tech University Health Sciences Center (TTUHSC) is a public medical school based in Lubbock, Texas, with additional campuses in Abilene, Amarillo, Dallas, El Paso and the Permian Basin. TTUHSC serves more than 100 counties in the ...

(TTUHSC) in 1989 by Gabor B. Racz. The procedure was assigned a

Current Procedural Terminology The Current Procedural Terminology (CPT) code set is a procedural code set developed by the American Medical Association (AMA). It is maintained by the CPT Editorial Panel. The CPT code set describes medical, surgical, and diagnostic services and ...

(CPT) code in 2000.

Etymology

Epidural administration Epidural administration (from Ancient Greek ἐπί, , upon" + ''dura mater'') is a method of medication administration in which a medicine is injected into the epidural space around the spinal cord. The epidural route is used by physicians and ...

: injection into the

epidural space In anatomy, the epidural space is the potential space between the dura mater and vertebrae ( spine). The anatomy term "epidural space" has its origin in the Ancient Greek language; , "on, upon" + dura mater also known as "epidural cavity", "ext ...

of the

spinal cord The spinal cord is a long, thin, tubular structure made up of nervous tissue, which extends from the medulla oblongata in the brainstem to the lumbar region of the vertebral column (backbone). The backbone encloses the central canal of the spi ...

. Epidural, (Greek): situated on or outside the

dura mater In neuroanatomy, dura mater is a thick membrane made of dense irregular connective tissue that surrounds the brain and spinal cord. It is the outermost of the three layers of membrane called the meninges that protect the central nervous system. ...

, from epi- "on top of" + dura mater + -al.

Adhesion Adhesion is the tendency of dissimilar particles or surfaces to cling to one another ( cohesion refers to the tendency of similar or identical particles/surfaces to cling to one another). The forces that cause adhesion and cohesion can be ...

(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.url=http://www.wordreference.com/definition/adhesion , WordReference.com

Lysis Lysis ( ) is the breaking down of the membrane of a cell, often by viral, enzymic, or osmotic (that is, "lytic" ) mechanisms that compromise its integrity. A fluid containing the contents of lysed cells is called a ''lysate''. In molecular bio ...

, (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. The Racz procedure was only considered after conservative treatments had failed to help patients with low back and cervical pain. 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."

References

{{Reflist Minimally-invasive surgery

Etymology

Complications

See also

References