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What difference in outcome is expected when using hypertonic saline for lysis?

Anonymous on December 31, 2020 at 8:17 pm
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    • Anonymous

      I’ve read that using hypertonic saline during lysis with hyaluronidase results in better outcomes than just using the enzyme alone. If I’m using Hylenex (hyaluronidase) during lysis, what does hypertonic saline do to increase efficacy in the procedure? Will I get better results if I’m using hypertonic?

      • Gabor B RaczGabor B Racz
        Joined: Mar 28, 2016
        Posts: 30

        Hell Yes! Why do I say it, because of our studies on large numbers of patients. We published the first study on Hyaluronidase at the IASP World Congress in Paris, we looked at 50 patients where we did not use Hyaluronidase and allowed them paralleled to 50 patients doing Lysis of Adhesions vs. the other 50 patients similarly followed for 12 months. We looked at the difference of the outright failures. When we did not use hyaluronidase the outright failures were 18%, we did use the animal extract Hyaluronidase 1500 units, we chose this amount because that was how much was in the bottle. The failure rate dropped to 6.1 percent. In the beginning we were terrified, because of the concern of anaphylactic reactions. It was recommended that you had to do a skin test, but it added half to one hour to get it accomplished……. we never saw a reaction and eventually after a number of years I stopped. Meanwhile, I was invited by the American Society of Ophthalmic Anesthesiology to lecture and I asked 500 clinicians how many use Hyaluronidase….everyone raised their hand. Then I asked how many do skin tests …….Nobody. How many have seen an anaphylactic reaction…..Nobody. No longer is it recommended anywhere that the skin test is required, before it was mentioned in the PDR. Animal studies have shown that animal extract and the synthetic recombinant Hyaluronidase have similar actions of inhibiting neutrophil infiltration. Neutrophil infiltration will lead to edema triggering the inflammatory cascade, swelling and pain.

        Hypertonic Saline disconnects non-myelinated C fibers which inevitably causes back pain. Hypertonic saline inhibits fibroblast regeneration which softens and disconnects the scar tissue and inhibits more on the side where you injecting it previously. It has been proven that the 3 times hypertonic injections, which we developed were proven to be more effective and longer lasting than the 1 time injection.

        Hypertonic Saline has been known to be very painful during the injections, now we have developed a pain free hypertonic injection mixture with a local anesthetic. The first publication was 3 times hypertonic on a patient which was a multi level degenerative patient with a post traumatic tear and leaky disk, leading to severe radiculopathy because of scarring. The patient had 22 years improvement after the 3 time hypertonic injection followed by a discogram and infusion of the L5 S1 leaky disc space . He re-scarred the same area 22 years later in 2008 and we repeated and published the identical scarring that originally developed in 1986. The patient was not happy because we did not know at the time about the Scarring triangle pain or the provocative testing and he only received a few months of pain relief. Most physicians pay no attention today about new developments like provocative testing and neural flossing. I was once asked: “Why do I not get the same results as you Dr. Racz?” My response: ” Because you don’t listen and you are not doing the procedure correctly which includes provocative testing to name one!”

        There has been better understanding over the years, which has led to the improvement of long term outcomes and functional recovery to patients after having the Lysis of Adhesions procedure. Some of these improvements include the Dural Tug, Dural Flossing, Lumbar and Cervical Neural Flossing, Scarring Triangle Lysis, Pain Free Hypertonic and the fear of Hypertonic Saline in the Sub-Dural space.

        I do hope this has answered your question and I wish you the best of luck.

        Gabor B. Racz, M.D., FIPP, DABIPP

        • Anonymous

          Dr. Racz,

          Thank you for the clarification! You mentioned a new and pain free hypertonic/anesthetic mixture. Do you know where I can get this, or is this mixture something I can make on my own?

          Thank you

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