MINIMALLY INVASIVE PROCEDURES

Peak Health and Wellness physicians are highly trained in the latest, minimally invasive techniques to diagnose and relieve spine & arthritis pain.

Procedures for spine, pain and arthritis care

EPIDURAL STEROID INJECTIONS (ESI)

Definition & Procedure

Epidural steroid injections are often used in the treatment of sciatica, cervical radiculopathy, pain related to degenerative disc disease (bulges and tears), and stenosis.

Using x-ray guidance, medication is placed precisely into the epidural space which is an area within the spinal canal near the painful discs, nerve roots or stenotic (tight) area. The steroids work to directly shrink the inflammation within the spinal canal to alleviate pain and swelling.

Epidural steroid injections are often performed in a series.

EXPECTATIONS

What to expect after an epidural steroid injection

  • Improvement
  • No difference (common)
  • Mild short-term increase in pressure or pain

All of these responses can occur and are considered “normal”. Patients should not expect an immediate improvement. The steroid medication that is injected can take 3-7 days to take effect. At times, patients may not feel much improvement until a second or third injection is completed. Informing your provider of any changes in symptoms after an injection is important.

FACET JOINT INJECTIONS (FJI) OR MEDIAL BRANCH BLOCKS (MBB)

Definition & Procedure

Patients who have arthritic pain of the neck, mid-back and the low back commonly suffer from facet joint pain. Facet joints are the small joints at the back of the spine that allow the spine to flex, extend and rotate. These joints can become arthritic or damaged and can commonly result in chronic neck, mid-back and low back pain.

A facet injection uses both numbing medication and steroid and can be both diagnostic (confirming the diagnosis of facet joint pain) and therapeutic (treating the pain).

A similar injection, a medial branch block uses numbing medication only to confirm the diagnosis of facet joint pain.

The medial branch nerve communicates pain information from a painful facet joint to the brain, therefore, a medial branch block is a diagnostic injections that acts to “block” this pain.

If a patient receives hour(s) of pain relief after a facet joint injection or a medial branch block, the injections helps to confirm the diagnosis of facet joint pain.

Your provider will direct which injection (facet joint injection or medial branch block) is better suited for your condition.

If you have two positive diagnostic injections (hours of relief after a FJI or MBB), your diagnosis of facet joint pain is confirmed. Therefore, you will likely benefit from a radiofrequency ablation (RFA) procedure that aims to provide patients with 6 to 18 months of relief from facet joint pain.

EXPECTATIONS

What to expect after a facet joint injection or medial branch block

  • Hours of improvement (this confirms the diagnosis of facet joint pain and suggests that a patient may benefit from a radiofrequency ablation to achieve long term pain relief)
  • A pain diary is given to patients after the procedure. Patients should use this form to record the detailed response to these injections.
  • No difference whatsoever (can confirm that facet joint pain may not be the case of pain)
  • Long term pain relief

RADIOFREQUENCY ABLATION (RFA)

Definition & Procedure

Radiofrequency Ablation is a procedure performed with small needles placed under x-ray guidance near the medial branch nerves (which sends painful information from the joint to the brain). This procedure is also completed in the office procedure room with a quick recovery.

Using radiofrequency technology and specialized equipment, these small pain nerves are heated gently to stop the transmission of pain signals.

EXPECTATIONS

What to expect after a radiofrequency ablation

  • Patients may experience hours of relief from the numbing medication that is used during the procedure.
  • Patients may experience a mild increase in muscle pain and ache at the treated sight. For most patients, the increase in pain is tolerable and can be treated with ice (10-15 minutes at a time) and over the counter NSAIDs (ibuprofen, etc). Some patients continue their prescription medications during this time.
  • Patients often enjoy 6 to 18 month of substantial pain relief after a radiofrequency ablation.
  • However, relief can take as long as 3 to 4 weeks to start after a radiofrequency ablation.

SACROILIAC JOINT (SIJ) INJECTIONS

Definition & Procedure

Sacroiliac joint pain is a common cause of buttock and upper leg pain. Using x-ray guidance, local anesthetic and steroid medication is precisely placed into the sacroiliac joint.

EXPECTATIONS

What to expect after a facet joint injection or medial branch block

  • Hours of improvement (this can confirm the diagnosis of SIJ pain)
  • The steroid medication that is injected into the joint can take 3-7 days to take effect. Once the inflammation is reduced in the SIJ, patients can experience long term relief.
  • Often SIJ injections are performed in conjunction with ongoing physical therapy to maximize recovery and restore normal movement to the joint.

TRIGGER POINT INJECTIONS

Definition & Procedure

Overstressed or chronically tense muscle groups can become tender and painful, leading to more spasm and pain. Injections into the muscle help to reduce muscle spasms and break this pattern of pain.

EXPECTATIONS

What to expect after a trigger point injection or medial branch block

  • Relaxation of muscle – leading to pain relief

KYPHOPLASTY/VERTEBROPLASTY

Definition & Procedure

Vertebroplasty is an minimally invasive procedure used to treat continued and severe pain after a new compression fractures of the spine. In the office procedure room with anesthesia, a specialized needle is carefully placed into the compressed vertebral body. A cavity is created using a specialized medical balloon to create space for bone cement. The bone cement helps to stabilize the fracture and relieve pain.

EXPECTATIONS

What to expect after a trigger point injection or medial branch block

  • After a kyphoplasty/vertebroplasty, patients will typically feel a reduction or resolution of the compression fracture pain.
  • Patients may experience some mild pain and/or muscle spasms around the area of the pain. This discomfort can be treated with NSAIDs (ibuprofen, etc) and ice or heat. Some patients continue their prescription medications during this time.

SYMPATHETIC NERVE BLOCKS

Definition & Procedure

The sympathetic nerves run in chains down the spine and branch out to multiple organs and structures in the body. These nerves are important for the regulation of blood flow, sweating, and glandular function. Sympathetic nerve dysfunction can cause chronic pain as in complex region pain syndrome (CRPS). Blocking the sympathetic nerves can be useful to desensitize the nerves, improve pain, and diagnose a source of chronic pain.

Stellate Ganglion Block: An injection in which local anesthetic medication is injected through the front of the neck to block the sympathetic nerves innervating the face and upper extremity. Blocking these nerves helps end pain in the face, arms, and hands.

Lumbar Sympathetic Block: An injection in which local anesthetic medication is placed along the nerve plexus in front of the lumbar spine. This block treats pain in the legs and feet.

Superior Hypogastric Block: This injection blocks a particular plexus of nerves at the L5 vertebra. These nerves are responsible for sensation in the bladder, prostate, rectum, and other organs of the pelvis. It is a procedure can be effective in the treatment of pelvic pain.

EXPECTATIONS

What to expect after a sympathetic nerve block

  • After a sympathetic nerve block, patients can feel a change in the temperature of the affected limb/area.
  • Patients may experience significant pain relief of the affected limb/area. The pain relief can be substantial and long-lasting. However, some patients require a series of sympathetic blocks to achieve long term pain relief.

PERIPHERAL NERVE BLOCKS

Definition & Procedure

Nerve Block Types

Peripheral

Peripheral nerves (those outside the brain and spinal cord) transmit sensation and motion. Use of either steroids (to decrease inflammation) or local anesthetic can alleviate pain along these nerves effectively.

Occipital

The occipital nerves stretch from the neck up to the back of the head and scalp. Arthritic changes in the spine, muscle spasm, and neck injuries can result in headaches that start at the back of the head and radiate upwards (occipital neuralgia). Injection of steroids and local anesthetic along these nerves can improve this pain.

Ilioinguinal

The ilioinguinal nerve is wraps around the rim of the pelvis and runs to the groin (inguinal) area. Damage can arise from incisions or scars that can occur during or after surgery to the region. An ilioinguinal nerve blocks can be effective treatment.

EXPECTATIONS

What to expect after any listed nerve block

  • The injection of local anesthetic medication along the nerve can result in hours of pain relief.
  • Patients may experience long term pain relief after 3 to 7 days, once the steroid starts taking effect.

DIAGNOSTIC INJECTIONS

Definition & Procedure

Finding the source of pain is one of the greatest challenges in pain management. While imaging studies and diagnostic testing narrow down the likely causes of pain, often diagnostic injections are required to confirm the diagnosis.

Types of Injections

Discogram

A provocative discogram can help determine if a degenerative disc is the major cause of pain. Medical dye is injected into several discs and the spread of the contrast is viewed under x-ray. It is common for patients to have more than one degenerative disc. This diagnostic injection allows us to identify the problematic disc.

Selective Nerve Root Block (SNRB)

This procedure is used to help determine the exact nerve root that is transmitting pain and the amount of relief can be achieved by blocking a nerve. Response from a SNRB is helpful to identify the source of pain and is often used in conjunction with surgical planning.

EXPECTATIONS

What to expect after a discogram

  • The goal of this procedure is to re-create the pain that is caused by a specific disc.
  • Patients may experience an increase pain for a few days. Often patients continue prescribed pain medications as needed after this procedure.

What to expect after a Selective Nerve Root Block

  • The injection of local anesthetic medication along the nerve can result in hours of pain relief. The amount of relief and the number of hours of relief are very important to monitor and record.
  • A pain diary is given to patients after the procedure. Patients should use this form to record the detailed response to these injections.
  • Patients may experience long term pain relief after 3 to 7 days, once the steroid starts taking effect.

SPINAL CORD STIMULATION (SCS)

Definition & Procedure

For pain severe spine and/or extremity pain that is resistant to previous treatments (such as physical therapy, medications, surgery, and pain procedures), a spinal cord stimulator trial may be considered.

Pain information from the extremities or the spine travel along the posterior portion of the spinal cord. By placing specialized electrodes/medical leads into the epidural space, we can then send controlled, electrical stimulation to the spinal cord. The stimulation interferes with the transmission of pain information and can be very effective in treating pain that has failed other conservative treatments or have failed surgical intervention.

The Spinal Cord Stimulator is used in two stages

SCS Trial

The trial is a minimally invasive procedure completed in the office procedure room. During the trial, temporary electrodes are place with x-ray guidance into the epidural space. The wires are then connected to an external, temporary battery/generator and tested to ensure proper coverage of the patient’s pain. instructions are given and special programs are created to maximize use and pain relief. Patients use the device at home to have “real world” test of this technology and determine how much it reduces their pain and improves functionality. After 5-7 days patients return to the office to have the temporary wires removed. Removal of the trial is a quick and painless process.

SCS Permanent Implant

If patients have significant improvement in their pain and functionality during the SCS trial, they can elect to have a permanent device implanted. The permanent implant is often completed by a spine surgeon. Once the permanent version is implanted, the device is completely internal and self-contained. Patients can swim and bath normally.

RESOURCES


Boston Scientific

Boston Scientific Spinal Cord Stimulator (SCS) Systems with SmoothWave™ Technology have been helping patients worldwide control their pain and recapture the little things. Learn more

St. Jude Medical

A resource for people living with chronic pain. Learn more