MINIMALLY INVASIVE PROCEDURES

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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 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.

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.