Epidural lysis of adhesions, also called the Racz catheter procedure, may be considered for selected persistent spine-related nerve pain when standard care has not provided enough relief.
Learn how Dr. Siefferman performs epidural lysis of adhesions using a Racz catheter to help relieve chronic nerve pain caused by scar tissue and improve function.
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Hi, I’m Dr. Jason Siefferman, medical director at Manhattan Pain Medicine and interventional pain specialist. One of the more enjoyable procedures for me is doing what’s called an epidurolysis procedure, which is really just a fancy epidural. When a patient has had surgery or there is some other reason for scar tissue to develop in the epidural space, we will enter distal from that site of scar tissue and use a catheter, drive it to that site of adhesion and use scar-dissolving medicine to release the adhesions from that scar tissue. What this does is it then frees up the nerve to move more freely as the nerve is really meant to move freely in and out through the spinal canal and it releases the tension on that nerve so that any of that chronic nerve pain, muscle guarding, tension can also be released.
When we do the epidurolysis procedure, we’re first evaluating with imaging and with physical exam to make sure we know which nerves need to be targeted. And then during the procedure with the catheter, with contrast, we make sure under live X-ray guidance that we are actually getting coverage of that area and we can see in real time where the contrast doesn’t go to. I use the scar-dissolving medicine to open up that space and then we can see extension beyond. So we know we’ve actually released that scar tissue and allowed the fluid to fill up the space.
This can be tremendously helpful for a patient who’s had regular epidurals where the steroid was just dropped off and that was it. Steroid is not generally helpful in this situation. You do need a more robust, mechanically scar-resolving procedure to actually cause the mechanical change to release the scar tissue so that nerve is not being constantly irritated by the adhesion. The epidurolysis procedure can do that. If this is something that you may find helpful, I’m happy to discuss it with you and we can talk through what that would look like.
Epidural lysis of adhesions is an advanced interventional spine procedure used in selected patients with persistent spine-related nerve pain. It is also known as epidural adhesiolysis, epidural neuroplasty, epidural neurolysis, or the Racz catheter procedure. The procedure uses a specialized catheter to reach targeted areas of the epidural space where scar tissue, adhesions, inflammation, or restricted medication flow may be contributing to nerve irritation.
At Manhattan Pain Medicine, epidural lysis of adhesions NYC care begins with diagnosis-first evaluation. The goal is to determine whether symptoms are related to nerve root irritation, disc disease, spinal stenosis, epidural scar tissue, prior spine surgery, or another pain generator before considering this procedure.
MPM specialists evaluate whether epidural lysis of adhesions or a Racz catheter procedure may be appropriate by reviewing symptoms, neurological findings, prior imaging, prior epidural injection response, surgical history, medication history, and safety factors. Persistent back, neck, arm, or leg pain may come from nerve root irritation, disc herniation, spinal stenosis, epidural scar tissue, facet-mediated pain, SI joint dysfunction, peripheral nerve pain, instability, inflammation, or central sensitization.
MPM uses this evaluation to determine whether epidural adhesiolysis, standard epidural injection, spinal cord stimulation, medication management, surgical referral, or another treatment pathway may be more appropriate.
Patients often search for epidural lysis of adhesions in Manhattan when sciatica, radicular pain, spinal stenosis symptoms, disc-related nerve pain, or post-surgical spine pain has not improved enough with medication, physical therapy, standard epidural injections, or other spine procedures.
MPM approaches the Racz catheter procedure as an advanced option, not a routine back pain injection. It may be considered when symptoms, imaging, and prior treatment response suggest that targeted epidural access may be clinically useful. Evidence, indications, and insurance coverage can vary, so careful patient selection and realistic expectations are essential.
Epidural lysis of adhesions fits within MPM’s Complex Chronic Pain and Musculoskeletal issues expertise because persistent spine-related nerve pain often involves overlapping structural, inflammatory, neurologic, and chronic pain mechanisms. A patient may have disc-related pain, spinal stenosis, radicular symptoms, post-surgical changes, epidural fibrosis, spondylosis, spondylolisthesis, scoliosis, or chronic nerve sensitivity.
MPM uses epidural adhesiolysis as one possible part of a broader spine pain pathway. Depending on the diagnosis and prior treatment response, care may also include epidural injections, medication management, physical therapy, SI joint treatment, peripheral nerve blocks, spinal cord stimulation, pain psychology, surgical evaluation, or other coordinated next steps.
Before epidural lysis of adhesions, MPM reviews the suspected pain generator, imaging, prior injections, prior surgery, medications, allergies, bleeding risk, medical history, risks, alternatives, and post-procedure instructions. The procedure is performed with image guidance. A specialized catheter is guided into the epidural space to reach the targeted area. Medication or solution may then be delivered around the suspected irritated nerve region.
Patients may feel pressure, soreness, temporary numbness, or a short pain flare after the procedure. Relief can vary. Some patients experience temporary improvement, some experience longer benefit, and some do not respond. MPM reviews the response to determine whether the targeted nerve pathway appears clinically meaningful and whether additional care such as rehabilitation, medication management, spinal cord stimulation evaluation, or surgical consultation should be considered.
I cannot say enough good things about Manhattan Pain Medicine. From the moment I walked in, I felt truly cared for and taken seriously. Dr. Nino Mikaberidze, Director of Rheumatology, is exceptional — knowledgeable, compassionate, and incredibly thorough. She takes the time to listen, explains every...
The best care I've received as a chronic pain patient. I traveled from out of state to visit Manhattan Pain Medicine because I could not find knowledgeable doctors in my hometown for my hypermobility, and Ehlers-Danlos syndrome symptoms and comorbidities. Let me tell you, it was worth every travel e...
I was injured in a bicycle accident over 8 years ago. I’ve suffered throughout the years since my accident with nothing seeming to work. PT, Yoga, lifestyle changes, NOTHNG! I finally made an appointment with Dr Kane and I’m feeling an improvement in my life. I no longer stay up all night in pain, a...
One of the best experiences, if not the best, I have ever had at the doctor’s office. From the front desk to the nurses to the PA assisting the doctor this was a great experience. Dr.Nino actually listened to me and came up with a game plan. Would recommend this practice to as many people as I could...
I have very unique & severe nerve pain from CRPS which has no known specific cure. Dr. Siefferman has a huge tool box, far greater than the other 23 Drs. I have seen. He saved me from jumping off a bridge and continues to help me with both treatments and advice. Dr. S. is in a different league!
After two years of searching and feeling lost and let down, I finally found real help at Manhattan Pain Medicine. With Dr. Siefferman, Adam Rosenberg, Dr. Mikaberidze, and the whole team, I feel heard, supported and understood. Every symptom is being considered and I’m finally getting answers with m...
Why is Dr Dr. Tayyaba Ahmed one of the top pevic Floor specialists - 1- She wants to know a full history of what led the patient to get to this point. 2 - She listens intensley to the patient 3- She does not rush you 4- Extremely skilled at giving pelvic floor injections 5- I thank my luck stars she...
The staff was friendly and helpful. Dr. Siefferman was thoughtful, listened, asked questions and proposed simple safe ways to come to further conclusions regarding my pain and discomfort. The office staff including Dr. Siefferman is responsive even after the initial in-person visit. Very pleased.
Dr. Siefferman is a brilliant provider. While my pain is still a work in progress, Dr Siefferman always gives me options and explains his reasoning behind things. He listens to my feedback and concerns. I never feel rushed; and am grateful he works to meet me where I am. I highly recommend him.
What a great find! They listen to me, I listen to them and the diagnosis is made and a plan developed to develop an approach to treat all of my chronic pain. I wish I could have discovered this type of treatment sooner. This doctor and group give me hope.
Epidural lysis of adhesions is an advanced spine procedure used in selected patients with persistent spine-related nerve pain. It involves placing a catheter into the epidural space to help deliver medication or solution near areas where scar tissue, adhesions, or restricted epidural flow may be contributing to nerve irritation. At MPM, this procedure is considered only after diagnosis-first evaluation.
A Racz catheter is a specialized catheter used during epidural lysis of adhesions. It allows the physician to access targeted areas of the epidural space under image guidance. The goal is to deliver medication or solution closer to a suspected irritated nerve region. The procedure is not appropriate for every spine pain condition and requires careful selection.
Yes. Epidural lysis of adhesions is also commonly called epidural adhesiolysis. Other terms may include percutaneous epidural adhesiolysis, epidural neuroplasty, epidural neurolysis, or the Racz catheter procedure. These terms generally refer to a catheter-based epidural procedure used in selected spine-related nerve pain cases.
The Racz procedure is often described as a form of epidural neuroplasty or epidural adhesiolysis. The terminology may vary by clinician, insurer, or medical literature. At MPM, the focus is less on the name and more on whether the patient’s symptoms, imaging, prior injection response, and safety profile support this type of advanced epidural procedure.
A standard epidural steroid injection places medication into the epidural space to reduce inflammation around irritated spinal nerves. Epidural adhesiolysis uses a catheter to reach more specific areas of the epidural space, often when prior epidural injections did not provide enough relief or when scar tissue or adhesions may be contributing to persistent nerve irritation. It is generally considered a more advanced procedure.
Candidates may include selected patients with persistent radicular pain, sciatica, post-surgical spine pain, suspected epidural scar tissue, spinal stenosis-related symptoms, or disc-related nerve irritation after appropriate conservative treatment and standard injections have not provided enough relief. MPM evaluates each case carefully because not all spine pain is appropriate for epidural adhesiolysis.
Epidural adhesiolysis may be considered for selected patients with persistent sciatica or radicular pain when symptoms suggest ongoing nerve root irritation and standard care has not been enough. It is not a universal sciatica treatment. MPM evaluates whether symptoms match the suspected nerve pathway and whether another cause, such as SI joint pain, hip pathology, or peripheral nerve entrapment, may be involved.
The Racz catheter procedure may be considered in selected spinal stenosis patients when nerve irritation and persistent radicular symptoms remain despite other treatment. Relief varies, and the procedure does not reverse stenosis. MPM evaluates stenosis severity, walking tolerance, neurological findings, imaging, prior treatment response, and surgical considerations before recommending an advanced epidural procedure.
Epidural adhesiolysis may be considered for selected patients with persistent nerve-related pain after spine surgery, especially when epidural scar tissue or post-surgical changes may be contributing to symptoms. It is not appropriate for every post-surgical pain pattern. MPM reviews prior operative history, imaging, symptoms, neurological findings, and prior injection response before recommending treatment.
Epidural adhesiolysis is intended to help address selected cases where epidural scar tissue or adhesions may restrict medication spread or contribute to nerve irritation. It does not remove all scar tissue or guarantee relief. Suspected epidural fibrosis is only one possible contributor to persistent spine pain, so MPM evaluates the full clinical picture before recommending the procedure.
Yes. Epidural adhesiolysis is performed with image guidance to support catheter placement, target confirmation, and procedural safety. Image guidance does not guarantee relief, but it is important for planning and performing this type of advanced epidural procedure.
Relief varies by patient, diagnosis, anatomy, prior surgery, severity of nerve irritation, and treatment response. Some patients may have temporary improvement, while others may experience longer benefit. Some patients do not respond. MPM reviews the degree, timing, and location of relief to determine whether the targeted nerve pathway was clinically meaningful.
Temporary relief can still provide useful diagnostic information. It may suggest that the targeted epidural nerve pathway is contributing to symptoms. Depending on the response, MPM may consider medication management, rehabilitation, repeat evaluation, spinal cord stimulation evaluation, surgical consultation, or another treatment pathway. If relief is limited or absent, the diagnosis may need to be refined.
Epidural adhesiolysis is a catheter-based procedure intended to deliver medication or solution around selected irritated nerve regions in the epidural space. Spinal cord stimulation is a neuromodulation treatment that uses an implanted device to alter pain signaling. Epidural adhesiolysis may be considered before spinal cord stimulation in selected cases, but the best pathway depends on diagnosis, response to prior care, and long-term goals.
Insurance coverage varies. Some insurers may cover epidural adhesiolysis in selected cases when medical necessity criteria are met, while others may consider catheter-based epidural adhesiolysis investigational or require additional documentation. MPM reviews coverage considerations when relevant and helps patients understand that evidence, indications, and payer requirements can vary.
Risks may include pain flare, bruising, bleeding, infection, allergic reaction, temporary numbness or weakness, dizziness, vasovagal reaction, elevated blood sugar if steroid is used, dural puncture headache, catheter-related complications, nerve irritation, vascular injury, local anesthetic toxicity, rare neurologic injury, incomplete relief, temporary relief only, or no relief. New weakness, bowel or bladder dysfunction, saddle anesthesia, fever, sudden severe headache after the procedure, chest pain, shortness of breath, severe allergic reaction, or rapidly worsening symptoms require urgent evaluation.
Before care begins, our team helps patients understand the practical side of treatment, including insurance verification, out-of-network benefits, cost-share estimates, self-pay options, and billing questions. We believe patients should have as much clarity as possible before moving forward.
If you are considering epidural lysis of adhesions in NYC for persistent sciatica, radicular pain, spinal stenosis symptoms, disc-related nerve pain, post-surgical spine pain, or incomplete relief from prior epidural injections, MPM can help determine whether this advanced procedure may be appropriate. Your evaluation will consider your symptoms, imaging, prior treatments, safety factors, coverage considerations, and broader care goals before any recommendation is made.
Epidural lysis of adhesions is an advanced interventional spine procedure used in selected patients with persistent nerve-related spine pain. It is also called epidural adhesiolysis, percutaneous epidural adhesiolysis, epidural neuroplasty, epidural neurolysis, or the Racz catheter procedure.
At Manhattan Pain Medicine (MPM), epidural lysis of adhesions NYC care begins with diagnosis-first evaluation. The goal is to determine whether symptoms are related to persistent nerve root irritation, disc disease, spinal stenosis, epidural scar tissue, prior spine surgery, or another spine-related pain generator before considering this procedure.
Epidural adhesions are areas of scar tissue or restricted tissue planes in the epidural space. They may occur after spine surgery, inflammation, trauma, chronic irritation, or other spine-related changes. In some patients, adhesions or scar tissue may contribute to persistent nerve irritation or may limit the ability of medication to reach an inflamed nerve region during a standard epidural injection.
Not every patient with chronic back or leg pain has clinically meaningful adhesions. Not every adhesion causes pain. This is why MPM evaluates symptoms, exam findings, imaging, prior procedures, surgical history, and response to prior injections before considering epidural lysis of adhesions.
During the Racz catheter procedure, a specialized catheter is guided into the epidural space under image guidance. The catheter allows the physician to reach a targeted area near the suspected irritated nerve region. Medication or solution may then be delivered to help reduce inflammation, improve medication spread, or address selected adhesions.
The exact technique and medication plan depend on the patient’s anatomy, diagnosis, prior surgery, safety profile, and treatment goals. The procedure is more advanced than a standard epidural steroid injection and is not appropriate for every spine pain condition.
A standard epidural steroid injection places anti-inflammatory medication into the epidural space around irritated spinal nerves. It may be considered for selected cases of sciatica, disc herniation, spinal stenosis, or nerve root inflammation.
Epidural lysis of adhesions is usually considered later, particularly when symptoms persist despite appropriate conservative care and standard epidural injections. It may be relevant when a catheter-based approach is needed to access a more specific epidural region or when scar tissue or adhesions may be contributing to symptoms.
The decision is not based only on pain severity. It depends on whether the suspected target fits the patient’s pain pattern, imaging, prior response, and safety profile.
Epidural adhesiolysis may be considered for selected patients with persistent radicular pain, sciatica, post-surgical spine pain, suspected epidural fibrosis, spinal stenosis-related symptoms, or disc-related nerve irritation. Many patients considering this procedure have already tried physical therapy, medication, activity modification, epidural steroid injections, spine injections, or surgical consultation.
MPM evaluates whether symptoms are truly nerve-root-related. Pain that comes from facet joints, SI joint dysfunction, hip pathology, peripheral nerve entrapment, instability, inflammation, or central sensitization may require a different approach.
After spine surgery, some patients continue to experience pain due to persistent nerve irritation, recurrent disc disease, stenosis, scar tissue, altered biomechanics, adjacent segment issues, or central sensitization. Epidural adhesiolysis may be considered in selected post-surgical cases when symptoms and imaging suggest that epidural scarring or restricted epidural medication spread may be contributing.
This does not mean scar tissue is always the cause of post-surgical pain. MPM reviews the full history and may coordinate with spine surgery, neurology, rehabilitation, medication management, or neuromodulation pathways when appropriate.
Epidural adhesiolysis and spinal cord stimulation are different types of advanced spine pain care. Epidural adhesiolysis is a catheter-based procedure that targets selected epidural regions. Spinal cord stimulation uses an implanted device to modify pain signaling and may be considered for selected chronic nerve-related pain patterns when less invasive treatments have not provided enough relief.
A patient’s response to epidural injections or epidural adhesiolysis may help guide whether spinal cord stimulation should be discussed. MPM evaluates diagnosis, prior treatment response, functional goals, medical history, and patient preferences before recommending escalation.
Epidural lysis of adhesions has been studied in selected chronic spine and radicular pain populations, including patients with persistent low back and lower extremity pain or post-surgical spine pain. Evidence varies by study quality, diagnosis, technique, and patient selection. Insurance coverage can also vary. Some payers may consider catheter-based epidural adhesiolysis investigational or require specific documentation.
MPM discusses realistic expectations before treatment. The procedure may provide temporary or meaningful relief for selected patients, but it is not a cure and does not repair discs, reverse stenosis, remove all scar tissue, or guarantee long-term improvement.
Risks may include pain flare, bruising, bleeding, infection, allergic reaction, temporary numbness or weakness, dizziness, vasovagal reaction, elevated blood sugar if steroid is used, dural puncture headache, catheter-related complications, nerve irritation, vascular injury, local anesthetic toxicity, rare neurologic injury, incomplete relief, temporary relief only, or no relief.
Patients should seek urgent evaluation for new or worsening weakness, bowel or bladder dysfunction, saddle anesthesia, fever, severe back pain after trauma, unexplained weight loss, cancer-related red flags, severe infection symptoms, sudden severe headache after the procedure, chest pain, shortness of breath, severe allergic reaction, or rapidly worsening symptoms.
For selected patients, epidural lysis of adhesions may be an important step in a diagnosis-first spine pain pathway. MPM’s role is to determine whether the procedure is clinically appropriate, how it compares with other options, and how the response should guide the next stage of care.
