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Procedures We Perform

Epidural Blocks

An epidural block is an injection of pain medication into the epidural space, the area around your spinal cord and spinal nerves. The medicine stops the nerves from transmitting pain signals, providing pain relief.

Epidural blocks can be used for neck, mid-back or the low back pain.

 

How it's performed

This block is performed after numbing the area with a local anesthetic. Using fluoroscopy, a moving X-ray for guidance, the physician directs a needle toward the epidural space. The entire procedure takes between 15-30 minutes.

 

When should this be used?

Epidural injections can be used for a variety of pain conditions including disk herniation, degenerative disc disease, sciatica, spinal stenosis, nerve root compression and inflammation in the spine.

 

Results

Epidural injections successfully relieve many pain symptoms. They may be used to delay or even eliminate the need for surgery or other procedures, particularly in patients with severe pain caused by a herniated disc, degenerative disc disease or spinal stenosis.

Facet Nerve Blocks

Facet joints are located along the entire length of the spine from the neck to the lower back, where one vertebra slightly overlaps another. These joints guide the spine’s movement. A facet block is performed to determine whether a facet joint is a source of pain, and/or to treat pain.

 

How it’s performed

After the patient is given a local anesthetic, a needle is inserted in the area of the facet joint(s). Using fluoroscopic guidance, a small amount of anesthetic and anti-inflammatory medication is injected in the area.

 

What patients are candidates?

Pain (neck, back or leg) caused from inflammation, irritation or arthritis of your facet joints can be treated with a facet injection.

 

Results

If the facet joints are cause of the pain, the patient will experience pain relief. The pain may be relieved for several hours to several months. Radiofrequency lesioning may be needed to provide longer relief.

Transforaminal Epidural Steroid Injection

Transforaminal Epidural Steroid Injection is a more selective injection technique into the epidural space targeting the area where the nerves emerge from the nerve root canals. The tranforaminal approach allows more targeted placement of the medication.

 

How it's performed

This block is performed after numbing the area with a local anesthetic. Using fluoroscopy, a moving X-ray for guidance, the physician directs a needle toward the epidural space targeting the nerve root canals.

 

What patients are candidates?

Patients with pain that travels from the low back area into the legs. 

 

Results

The effects of Transforaminal Epidural Steroid Injections may be temporary, providing relief from one week up to years, or in some cases permanently.

 

Sacroiliac And Other Joint Injections

A diagnostic and therapeutic injection into the sacroiliac or other joint can provide short or long-term pain relief.

 

How it’s performed

Usually using a fluoroscope for guidance, a needle is introduced into the correct portion of the sacroiliac or other joint. The position may be confirmed by injecting a small amount of contrast dye. The local anesthetic and anti-inflammatory steroid is injected. Local injections into the ligaments may be helpful. The procedure last 10-20 minutes.

 

What patients are candidates?

Patients with pain caused by arthritis, injury, or strain of the sacroiliac joint or other joints are good candidates for the procedure.

 

Results

The effects of sacroiliac or other joint injections may be temporary, providing relief from one week up to years, or in some cases permanently.

Occipital Nerve Block

The most common symptoms related to occipital nerve injury are local tenderness or a tension type of headache.

 

What patients are candidates?

A headache located at the top of the head and occipital area that is usually described as a sustained, low intensity aching. The headache can be bilateral or only one side. It is associated with stiffness of the muscles of the neck. Migraine headaches may also be related to occipital neuralgia.

 

How it is performed

The nerve is identified under the scalp by palpation. Typical pain or headache may be reproduced with pressure over the nerve. After cleaning the scalp, a small amount of local anesthetic and a small dose of long acting steroids are injected.

 

Results

Numbness over the top and back of the head, after the injection, is a sign of a successful block. The numbness may last several hours. Relief of pain can be immediate and is occasionally permanent. The block can be repeated if necessary.

Sympathetic Nerve Blocks

Performed to determine if there is damage to the sympathetic nerve chain. This is a network of nerves extending the length of the spine. These nerves control some of the involuntary functions of the body and sometimes carry painful impulses.

 

How it’s performed

Unlike other blocks, sympathetic nerve blocks involve injecting anesthetic into different nerves. These may include stellate ganglion, celiac plexis, hypogastric plexis, ganglion of impar and lumbar sympathetic nerve blocks. The procedure lasts 10-20 minutes.

 

What patients are candidates?

Patients with nerve (neurogenic) pain, most commonly the constant burning pain of Reflex Sympathetic Dystrophy (RSD) Complex Regional Pain Syndrome (CRPS) in the arm or leg are candidates for the procedure.

 

Results

Multiple blocks are often required, but there is usually a progressive increase in the interval between when blocks are needed due to the pain relief provided by the procedure.

Stellate Ganglion Block

The stellate ganglion is a group of sympathetic nerves in the neck area. Stellate ganglion block is performed to determine if there is damage to the sympathetic nerve chain. This is a network of nerves extending the length of the spine. These nerves control some of the involuntary functions of the body and sometimes carry painful impulses.

 

How it’s performed

A stellate ganglion block is an injection of a local anesthetic around this group of nerves to relieve pain on the side of the head or neck, the upper arm, or the upper part of the chest. It involves inserting a needle through the skin and deeper tissues of the neck. Most patients receive intravenous sedation and pain medication to make the procedure easy to tolerate. After the injection, you may feel warmth in the arm, some hoarseness of the voice, a droopy eyelid, a larger pupil, or nasal congestion.

 

What patients are candidates?

Conditions such as reflex sympathetic dystrophy, phantom limb pain, Herpes Zoster and causalgia can be treated with a stellate ganglion block.

 

Results

Multiple blocks are often required, but there is usually a progressive increase in the interval between when blocks are needed due to the pain relief provided by the procedure.

Lysis of Adhesions

A procedure involving passing epidural catheter (usually Racz) into the epidural space and injecting medicine directly at the site of nerve injury or adhesion to decrease the pain and break up adhesions. The epidural space is the area around your spinal cord.

 

How it’s performed

A catheter is placed in the epidural space and medication is delivered directly into the space. It is optimal to place the epidural catheter close to the patient’s painful dermatome as possible. The procedure lasts 10-20 minutes.

 

What patients are candidates?

Patients in members with epidural adhesions, adhesive arachnoiditis, or failed back syndrome from multiple previous surgeries for herniated lumbar disc are candidates.

 

Results

Most patients report pain relief and increased mobility for a few months or longer.

Discography

A procedure utilized to identify if the source of pain is from the disc or in the case of multiple level herniations, which levels are the source of the discomfort.

 

How it’s performed

Using x-ray guidance, a needle is placed in the discs of the spine at the level of interest. A pressure gauge is used to measure the pressure of the discs. Then, using contrast media, the shape of the disc is identified as the dye is injected. The procedure usually lasts 20 to 30 minutes.

 

What patients are candidates?

Persistent spinal (cervical, thoracic, lumbar) pain, suspected disc abnormality, non-invasive tests have not provided an explanation or source of pain, and if pain correlation is desired.

 

Post procedure

After the procedure, the patient may be required to have a CT scan of the back to further visualize the discs. If there are no complications, the patient is discharged 40 to 60 minutes after the procedure.

Trigger Point Injection 

Trigger point injection is used to treat extremely painful areas of muscle. Normal muscle contracts and relaxes when it is active. A trigger point is a knot or tight, ropy band of muscle that form when muscle fails to relax. The knot often can be felt under the skin.

 

What patients are candidates?

Patients with myofascial pain syndrome (chronic pain involving muscle and the tissue that surrounds muscle) that does not respond to other conservative treatments. Many muscle groups, especially those in the arms, legs, lower back, and neck are treated by this method.

 

How it’s performed

Injections are given in the physician’s office and takes approximately 10 minutes. A small needle is inserted into the trigger point and a local anesthetic (i.e. lidocaine, marcaine) with or without a corticosteroid is injected. Injection medication inactivates the trigger point and thus alleviates pain.

 

Results

Sustained relief is usually achieved with brief course of treatment. The injection may cause a twitch or pain that lasts a few seconds to a few minutes.

Spinal Cord Stimulator

When oral medications and/or nerve blocks do not sufficiently control chronic pain, implantable systems may be more effective. These systems are designed to interrupt transmission of pain signals from the spinal cord to the brain. By blocking this signal to the brain, the patient will not feel the pain.

 

How it’s performed

Spinal cord stimulation (SCS) for pain control passes low levels of electricity to the back portion of the spinal cord by inserting a thin catheter lined with electrical wires called electrode. This blocks the sensation of pain. The device is implanted during a surgical procedure and may include a system with an external power source or a fully implanted system similar to heart pacemakers.

 

What patients are candidates?

Spinal cord stimulators may be used to manage pain from failed back surgery syndrome or radiculopathy (sciatica or leg pain), chronic neuropathic pain (i.e. complex regional pain syndrome / RSD, nerve injury).

 

Results

About 50 to 60 percent of patients will get a 50 percent or better pain relief with this procedure. A trial is first performed to see if it is effective and how the patient reacts before the surgery is performed. The procedure is reversible and the implantable system can be removed.

Radiofrequency Ablation

Radiofrequency ablation (or RFA) is a procedure used to reduce pain. An electrical current produced by a radio wave is used to heat up a small area of nerve tissue, thereby decreasing pain signals from that specific area.

 

What Patients are candidates?

Radiofrequency ablation is most commonly offered to patients with neck or back pain from facet joint problems like arthritis or injury. For these patients, radiofrequency ablation is used to interrupt nerves that go directly to the individual facet joints. Radiofrequency ablation is also used in patients with RSD involving arms or legs to interrupt the sympathetic nerve supply to the involved arm or leg.

 

How it's performed

The physician uses x-ray guidance (fluoroscopy) to direct a special (radiofrequency) needle alongside the medial or lateral branch nerves. A small amount of electrical current is often carefully passed through the needle to assure it is next to the target nerve and a safe distance from other nerves. This current should briefly recreate the usual pain and cause a muscle twitch in the neck or back. The targeted nerves will then be numbed to minimize pain while the lesion is being created.

 

Results

Initially there will be muscle soreness for up to a week afterward. Ice packs will usually control this discomfort. After the first several days, your pain may be gone or quite less.