- Racz – Pain catheter
- Pain catheter after Racz
- Spinal catheter
- Racz – Spinal catheter
- Minimally invasive spinal catheter according to Prof. Racz
Definition Racz Catheter
The Racz catheter was developed in 1982 by the Texas anesthesiologist and pain therapist Prof. Gabor Racz. The Racz-catheter technique is a minimally invasive method for the treatment of chronic back pain of different origin. The Racz catheter is a special catheter (thin tube), which, in contrast to conventional catheters, has a metal guide wire and can be directed precisely to the site of pain in the spine.
Indication
The Racz catheter is a not uncontroversial procedure, both in terms of the technology of the procedure and the therapeutic applications. It is not a universal remedy for chronic back pain and should be reserved for all root irritation symptoms (radiculopathies). A radiculopathy is a painful irritation (mechanical, chemical) of a nerve root of the spinal cord.
Clinically, such an irritation is manifested, for example, by sciatic pain in the area of the nerve roots of the lumbar spine, also known as lumboischialgia. Lumboischialgia is a back pain in the spinal column, which radiates from there through the buttocks into the leg, and sometimes into the foot and toes. Depending on the nerve root affected, typical symptoms of reflexes, sensation and strength development can also occur.
Often, leg pain is felt more painful than back pain. Even though many wear-related (degenerative) changes can lead to nerve root pain, the Racz catheter should be reserved for the following diseases, according to the consensus of renowned orthopedic specialists: In case of a herniated disc protrusion (nucleus pulposus prolapsus protusion), leaked disc tissue presses on the nerve root and leads to mechanical and chemical irritation with inflammatory reaction of the affected nerve root and corresponding radiculopathy. Perineural scarring often occurs after disc surgery (post-nucleotomy syndrome).
The scars caused by the surgical trauma can surround nerve roots or the spinal cord and lead to irritation of the nerves through tension and pressure.
- Herniated disc with root irritation symptoms
- Disc protrusion with root irritation symptoms
- Perineural scarring (around the nerve-spinal cord) (medically known as postnucleotomy syndrome) with root irritation symptoms
Gerdesmeyer et al. 2005 also formulated the following inclusion criteria (indication) for the use of the Racz catheter: The exclusion criteria (contraindication) include Gerdesmeyer et al:
- Unsuccessfully conservatively treated chronic radiculopathy in case of disc protrusion or herniation or after disc surgery
- Minimum age: 18 years
- Proof of root irritation in imaging (MRT)
- 3 months of unsuccessful conservative therapy
- Time window of > 6 weeks after last peridural infiltration (injection).
- Pain assessment of >4 on the Visual Analgesic Pain Scale (VAS) (Note: the patient should give a subjective assessment of his pain with a range of 0=no pain and 10=most severe, unbearable pain)
- Indication for surgery for neurological deficits (loss of strength, loss of sensation, etc. )
- Rheumatic diseasesmetabolic disorders
- Relevant inflammations
- Known neoplasias (tumor diseases) in the surgical area
- Vertebral body fracture
- Immunosuppressive therapy (e.g. methotrexate)
- Long-term cortisone intake
- Lack of evidence of the disease in imaging
- Coagulation disorders/taking of anticoagulant drugs (Marcumar ®, ASS ®, Plavix ® and others)
- Clinically relevant spinal canal stenosis
- Time window of < 6 weeks after last peridural infiltration (injection).
- Allergies to local anesthetics, hyaluronidase, X-ray contrast media
- Pregnancy or breastfeeding
- Clinically relevant urogenital (draining urinary tract) or sexual dysfunction
