Lysis of Epidural Adhesions (also know as the Racz Procedure) is a technique involving site-specific catheter placement and fluid injection intended to "open up" the perineural space with various therapeutic medications. The injected medications are designed to free the nerve root from restrictions and reduce inflammation associated with swollen, painful nerve roots exiting the spinal canal in the epidural space.
In earlier Racz EDU sessions we addressed the Lumbar region and Scarring Triangle. While there are many similarities with the Cervical region, a higher level of skill is needed when performing procedures in this region.
Below you will find the step-by-step guide for Cervical Lysis of Adhesions. We've also included serval videos covering:
- Cervicogenic Headaches Walkthrough with Dr. Gabor Racz
- Cervical Lysis and Suboccipital Decompression with Dr. Gabor Racz on a live patient
- Cervical Interlaminar Lysis with Dr. Raul Mishra on a Cadaver
- Cervical Spine Pain lecture with Dr. Vikram Patel



A. Remove the LOR syringe and insert the second interlocking stylet. It is extremely dangerous to rotate the needle tip without the atraumatic stylet fully inserted, as the dura can be easily cut.
B. Rotate the tip cephalad, then remove the stylet. Next, inject 1-2 mL of contrast to confirm entry and to check for filling defects. If there is no evidence of contrast runoff, then flexion with rotation of the head and neck should be performed to open up the foramen to intitate runoff.







- Diagnostic: 1-2 mL OMNIPAQUE™240* - outline filling defect and place catheter to target site
- To show runoff and absence of loculation, contrast 0.5-1 mL OMNIPAQUE™ 240* injected through the catheter
- 1-2 mL OMNIPAQUE™240* through catheter for verification of enzyme effectiveness
- Spreading Factor: Hylenex® 150-300 units (human recombinant) diluted in 5 mL of preservative-free saline
- Steroid Injection: 4 mg dexamethasone or 40 mg triamcinolone
- Local Anesthetic: 6 mL 0.2% ropivacaine or 10 mL of 0.25% bupivacaine
- Depending on the physician’s lysis technique, wait 20-30 min. Evaluate for motor block. If no motor block is present, with the patients painful side down, inject 5 mL of 10% hypertonic saline over 5-10 minutes. If the patient experiences pain, inject 2-3 mL of local anesthetic.
One Day Cervical Lysis of Adhesions Step by Step: Poster Presentation, 4th Croatian Congress on the Treatment of Pain, Osijek, Croatia, May 2018
- Gerdesmeyer L, Wagenpfeil S, Birkenmaier C, Veihelmann A, Hauschild M, Wagner K, Al Muderis M, Gollwitzer, H, Diehl P, Toepfer A. Percutaneous Epidural Lysis of Adhesions in Chronic Lumbar Radicular Pain: A Randomized, Double-Blind, Placebo-Controlled Trial. Pain Physician 2013; 16: 185-196
- Racz G, Heavner J, Smith J, Noe C, Al-Kaisy A, Matsumoto T, Lee S, Nagy L. Epidural Lysis of Adhesions and Percutaneous Neuroplasty Racz Procedure. Intech - Pain and Treatment; Chapter 10: 289-333
- Racz G, Day M, Heavner J, Smith J. The Racz Procedure: Lysis of Epidural Adhesions (Percutaneous Neuroplasy). Comprehensive Treatment of Chronic Pain by Medical, Interventional, and Integrative Approaches (Deer Ed.) 2013; Chapter 50: 521-534
- Park E, Park S, Lee S, Kim N, Koh D. Clinical Outcomes of Epidural Neuroplasty for Cervical Disc Herniation. Journal Korean Medical Science 2013; 28: 461-465
- Dunn A, Heavner J, Racz G, Day M. Hyaluronidase: a review of approved formulations, indications and off-label use in chronic pain management. Expert Opinion on Biological Therapy 2010; 10(1): 127-131
- Veihelmann A, Devens C, Trouillier H, Birkenmaier C, Gerdesmeyer L, Refior H. Epidural neuroplasty versus physiotherapy to relieve pain in patients with sciatica: a prospective randomized blinded clinical trial. Journal of Orthopaedic Science 2006; 11: 365-369
- Heavner J, Racz G, Raj P. Percutaneous Epidural Neuroplasty: Prospective Evaluation of 0.9% NaCl Versus 10% NaCl With or Without Hyaluronidase. Regional Anesthesia and Pain Medicine 1999; 24(3): 202-207
- Racz G, Heavner J. Complications Associated with Lysis of Epidural Adhesions and Epiduroscopy. Complications in Regional Anesthesia and Pain Medicine, 2nd Edition; Chapter 33: 373-384
- Moon DE, Park HJ, Kim YH. Assessment of Clinical Outcomes of Cervical Epidural Neuroplasty Using a Racz-Catheter and Predictive Factors of Efficacy in Patients with Cervical Spinal Pain. Pain Physician 2015; 18:E163-E170
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Cervical Lysis
Cervicogenic Headaches
Cervical Interlaminar Lysis
Cervical Spine Pain
Cervical Lysis and Sub Occipital Decompressure
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