Conditions such as herniate discs, epidural scarring and spinal stenosis can compress nerves, causing inflammation and pain. The steroid injected helps decrease swelling of the nerves and provide pain relief.

Epidural Steroid Injections (ESI) use an anesthetic and steriod medication injected into the patient’s epidural space to relieve or diagnose a specific spinal condition. This injection is indicated to relieve pain in the back or neck and radicular symptoms caused by pinched nerves in the cervical spine, thoracic, lumbar or caudal spine.

The Racz Catheter Procedure (Epidural Neurolysis) is used to release some of the scar tissue from around entrapped nerves in the epidural space of the spine, so that medications such as cortisone can reach the affected areas. It is used to decrease the pain caused by the scarring. This procedure is named for the physician who pioneered it, Dr. Gabor Racz.

What causes epidural scarring?

Epidural scarring most often occurs from bleeding into the epidural space following back surgery and the subsequent healing process where epidural fat is replaced with fibrotic tissue. It is a natural occurrence following surgical intervention. Sometimes scarring can also occur when a disc ruptures and its contents leak out.

How long does the procedure take?

The procedure generally takes between 30 and 60 minutes. It can be done once, or in a series of up to three injections in a twelve-month period. A catheter is inserted in the caudal epidural space and steered up to the area of scarring. This is done in our fluoroscopy suites under sterile conditions with IV sedation.

Overall, this procedure is safe. However, with any procedure there are risks, side effects, and the possibility of complications. Fortunately, the serious side effects and complications are uncommon. Risks and side effects may include the following:

  • Pain/soreness – the most common side effect, and it is temporary
  • Urinary difficulty – Occasionally, people report some difficulty urinating for the first several hours post procedure, but this is temporary.
  • Other risks associated with the Racz procedure can include:
    • Spinal puncture risk/side effects, such as:
      • Headaches
      • Infection
      • Bleeding inside the epidural space with nerve damage
      • Worsening of symptoms
    • Cortisone injection risks/side effects, such as:
      • Weight gain
      • Increase in blood sugar (mainly in diabetics)
      • Water retention
      • Suppression of the body’s own natural production of cortisone

Testimonies

I am a 67yo female, who had multiple major back surgeries. Dr Tubbs was suspicious of the potential epidural scar tissue causing my chronic back and leg pain. Together we decided to try the Racz procedure, and I am excited to say that for the first time in years I can get out of bed near pain free. I use to take 4 pain medications everyday, yet since the procedure, I have decreased my pain medications by nearly 100%!

 

Sacroiliac Joint Injections

The sacroiliac joints are located at the bottom of the spine, below the lumbar spine and above the tailbone. There are two of them, located on each side of the lower spine. Using x-rays to assist in guiding the injection, the physician will then insert a needle into the sacroiliac joint. The needle delivers a local anesthetic directly into the source of the pain. The injection may also include an anti-inflammatory medication, such as a corticosteriod.