Surgical procedures | Pain therapeutic use of the Racz catheter

Surgical procedures

In principle, the surgical procedure can be performed on the cervical spine, thoracic spine, and lumbar spine in modification of the access technique. By far the most frequent application is that on the lumbar spine. Under sterile conditions, a natural opening point of the spinal canal in the area of the sacrum is sought (sacral canal/Hiatus sacralis).

This point is located along the gluteal fold above the arch-shaped transition to the coccyx. A local anesthetic is applied in the entry area of the catheter. First, a rod sleeve (trocar) is inserted and the correct position is checked under X-ray control and with the use of contrast medium.

Then the special catheter is inserted and placed in the desired position. The position is checked again by X-ray with contrast medium (epidurography). Then the medication is injected (local anaesthetic, 10% saline solution, cortisone, hyaluronidase). After rinsing the catheter, it is securely fixed to the skin, a bacterial filter is applied and a sterile dressing is applied. In the following two days, the catheter is further rinsed with medication and then removed.

Advantages

The Racz catheter is a minimally invasive surgical procedure, which does not cause any new soft tissue damage (muscles, ligaments, etc.) and thus prevents new scarring. Therefore, the indication for catheter technology is given before a possible open surgical intervention.

The reason for this is the moderate to poor results in follow-up interventions (revisions) due to persistent radiculopathy after open disc surgery. Pain relief can only be achieved in about 50% of all patients who have undergone open surgery for the first time. With the 2nd follow-up operation the success rate is reduced to approx.

20%. The idea of the Racz catheter is understandable. By the precise application of the connective tissue dissolving enzyme hyaluronidase to the affected nerve root, existing scar tissue (connective tissue) should be dissolved. By injecting 10% saline solution, a herniated disc protrusion can be shrunk by osmotic dehydration, thus releasing the nerve root from the disc pressure. Additional injections of cortisone and local anesthetic have a pain-relieving and anti-inflammatory effect and should lead to a swelling of the nerve root, resulting in a relative gain in space.