Epidural Lysis of Adhesions (Racz Procedure): A Minimally Invasive Option for Radicular Pain

Chronic back or leg pain can persist even after medications, physical therapy, injections, or surgery. In some cases, the cause may be epidural scar tissue—also known as adhesions—surrounding spinal nerves.

Epidural Lysis of Adhesions (LOA), also referred to as the Racz Procedure, is a minimally invasive procedure designed to gently release this scar tissue, reduce inflammation, and restore nerve mobility. For patients who have undergone prior spine interventions or are exploring the next step in their treatment pathway, LOA may offer meaningful relief without open surgery.

Who May Benefit from Epidural Lysis of Adhesions?

It is typically considered for patients who continue to experience chronic spine-related pain despite conservative treatment. It may be recommended for individuals with:

Failed back surgery syndrome
Persistent radicular pain (pain radiating into the legs or arms)
Spinal stenosis
Herniated discs with ongoing nerve irritation
Epidural adhesions (scar tissue around nerve roots)
Chronic back pain related to excessive scarring
Pain that has not responded to epidural steroid injections

Your physician will determine if LOA is appropriate based on your medical history, imaging studies, and response to prior treatments.

How Epidural Lysis of Adhesions Works?

Scar tissue can restrict the natural movement of spinal nerves and limit the spread of medications from traditional epidural injections. When nerves cannot move freely, inflammation and pain may persist. It works by:

Mechanically releasing scar tissue
Delivering targeted medications directly to affected nerve roots
Reducing inflammation
Improving nerve mobility within the spine

By “opening up” the space around the nerve (the perineural space), the procedure helps restore a healthier environment for nerve function and interrupt ongoing pain cycles.

How is the Procedure Performed?

Epidural Lysis of Adhesions is performed as an outpatient procedure using fluoroscopic (real-time X-ray) guidance to ensure precise placement.

Accessing the Epidural Space
A specialized needle is carefully inserted, typically through the sacral hiatus at the base of the spine, to reach the epidural space.
Catheter Placement
A thin, flexible, soft-tipped catheter is guided under imaging toward the affected nerve root. Its design allows safe navigation around sensitive structures.
Targeted Treatment Delivery
Medications are delivered directly to the site of scar tissue and inflammation. These medications help reduce swelling and improve nerve movement.
Completion
Once treatment is complete, the catheter is removed. The procedure is minimally invasive and does not require large incisions. Most patients return home the same day.

Watch the step-by-step clinical procedure in this detailed clinical video demonstrating epidural lysis of adhesions:

Benefits of Epidural Lysis of Adhesions for Patients

The Racz Procedure offers a targeted, minimally invasive approach for patients with chronic spinal nerve pain caused by scar tissue. By delivering treatment directly at the source of nerve irritation, it helps reduce inflammation, improve nerve mobility, and restore normal function.

For appropriate candidates, epidural lysis of adhesions may offer several advantages:

Minimally invasive alternative to open spine surgery
Performed on an outpatient basis
Targets the specific source of pain
May provide relief when other treatments, such as injections, have failed
Short recovery time and faster return to daily activities
Can improve mobility and overall quality of life
May delay or prevent the need for additional surgery

This technique is supported by decades of clinical use and research, including randomized controlled studies demonstrating its safety and effectiveness. More than 1.5 million procedures have been performed worldwide, reflecting its established role in treating chronic back and nerve pain.

Post Procedure Care and Recovery

Patients may experience mild soreness at the injection site, which typically resolves within a few days. Most individuals can return to light activities shortly after the procedure, depending on their physician’s recommendations.

Physical therapy and gentle stretching are often encouraged following LOA. Healthy nerves need to move freely to maintain proper blood flow, fluid exchange, and nutrition. Ongoing movement and rehabilitation play an important role in supporting longer-term outcomes.

Your care team will provide specific instructions tailored to your condition.

*These details are not a substitute for professional medical advice. Always rely on the instructions provided by your care team.

FAQs

Q1: Am I a good candidate for the Racz Procedure?

Patients with chronic back or leg pain caused by scar tissue, spinal stenosis, herniated discs, or persistent symptoms after surgery may benefit. Your physician will review your history, imaging, and prior treatments to determine eligibility.

Q2: What is the typical recovery after the procedure?

Patients may experience mild soreness at the injection site. Most return to light daily activities the same day, while physical therapy and gentle stretching help maintain nerve mobility and support longer-term outcomes.

Q3: What are the possible risks or side effects of the Racz Lysis of Adhesions?

The most common risks are local pain from the needle and catheter which is a mild to moderate burning sensation lasting 2-7 days. More serious but extremely rare risks are bleeding, infection, nerve injury, paralysis and weakness in the lower extremities.