Procedures

Spine

Epidural Steroid Injections

An epidural injection is the administration of medications into the epidural space. It is used to treat swelling, pain, and inflammation of the nerve roots associated with herniated discs and radiculopathy (nerve irritation or injury). The medications used are steroids, which are anti-inflammatory, and numbing medications (local anesthetics).


Spine

Medial Branch Injections

Medial branch injections place numbing medications on the medial nerves to temporarily block the pain involved in facet arthritis. If this treatment is successful, a radiofrequency procedure can be performed to 'burn off' the nerves to provide long-term pain relief.


Spine

Facet Joint Injections

Facet joints are small paired joints in the spine that become arthritic when the discs are degenerated. This is a common cause of back pain. Two types of procedures are performed for the facet joints. One is a direct injection into the joint, using steroid and numbing medications. The other uses numbing medications to block a nerve that innervates the joint, called the medial branch.


Prolotherapy

Prolotherapy

Joint pain or arthritic pain frequently has a component of ligament laxity. A ligament connects bones to hold them together, and can be damaged by trauma, degeneration with age, or day-to-day wear and tear. Ligaments do not heal well due to lack of blood supply. A lax ligament will allow the joint to be hypermobile, or move too much, which causes pain with activities.

Prolotherapy is performed by injecting an irritating solution into the ligament to stimulate scar formation. The scar tissues will strengthen the ligament and stabilize the joint. One of the commonly used solutions is high concentration dextrose, which is a harmless sugar once it is absorbed by the body. Typical sites of injections are the neck (cervical spine), upper back (thoracic spine), low back (lumbar spine), and the tailbone which are preformed at this clinic. The injections take several sessions, about four to six, one month apart. Prolotherapy is a noninvasive procedure with minimal risk and the potential to provide good pain relief and sometimes to cure various forms of joint pain.


What is a minimally-invasive procedure?:

It is not surgery! It is an injection procedure performed with needles. It is an outpatient procedure that returns patients to their normal activities of daily living quickly. Various minimally-invasive procedures and techniques have been used over the years to treat pain related to degeneration of the spine.

Benefits of minimally-invasive procedures include:

  • No surgical incision, just needle insertions
  • Decreased operative time
  • General anesthesia not required, just intravenous sedation
  • No scarring
  • Outpatient setting- patient goes home on same day as surgery
  • A more rapid healing time
  • Faster return to work than with invasive surgery

All cases are performed on an outpatient basis as opposed to an inpatient stay of up to two to three days for traditional open incision surgery. Most patients return to work after a few days and experience significantly less pain than with traditional surgery. The incidence of complications is much lower than with traditional surgery.

Spine

Intradiscal Electrothermal Annuloplasty (IDET)

A physician inserts a needle into the disc and directs a wire (SpineCATH) into the disc while shooting x—rays for visualization and correct placement. The wire is heated for about 15 minutes to destroy the nerves in the disc that causes pain and denature the protein to make the herniated disc shrink. The overall success rate in reducing pain is 60-75%


Spine

Electrothermal Decompression (EDD)

Similar to the IDET, this procedure uses a more stiff wire for more aggressive decompression of the disc. IDET is better for back pain, and EDD is better for leg plus back pain. A heating element is used to modify the protein wall of the disc and reduce the amount of disc material that causes nerve irritation. The procedure involves a special wire (decompression heating element) which is guided into your disc through a spinal needle. An x—ray is used to confirm the catheter placement in the disc. The disc is heated for a short period of time determined by the physician. The catheter and needle are removed, and you will be discharged home with specific instructions.


Spine

Percutaneous Discectomy (NUCLEOPLASTY)

During the procedure, a needle is inserted into the disc and a wire (the Spine Wand) is placed into the center of the disc where a series of channels are created to remove tissue from the nucleus. Removing tissue from the disc decompresses the disc and relieves the pressure extended by the disc on the nearby nerve root. As pressure is relieved, pain is reduced, consistent with the clinical results of earlier percutaneous discectomy procedures.


Vertebroplasty

Vertebroplasty

Fracture of the vertebral body of the spine can cause severe back pain, making it difficult to get around. Frequently this occurs in an individual with osteoporosis (bones lacking calcium) who falls. Vertebroplasty is performed by injecting bone cement into the vertebral body using a needle. There is no surgery involved. The cement stabilizes and strengthens the bone.

Vertebroplasty is performed as an outpatient procedure under IV sedation. The procedure results in significant pain relief within a few hours. It is a low risk procedure with good outcome. It enables one to return to normal daily activities within a few days.


Kyphoplasty

Kyphoplasty

This procedure is just like vertebroplasty except that prior to bone cement being injected, a balloon is inflated to raise the fractured vertebral body. This reduces the pressure inside the bone during cement injection and lessens the chance of the cement leaking to undesirable sites. By raising the collapsed vertebral body, this procedure attempts to preserve the height of the vertebral body, thereby staying as close to normal anatomy as possible. As with vertebroplasty, pain relief is immediate and the bone is less likely to break in the future. The main drawback of kyphoplasty is its cost — it is much more expensive than vertebroplasty.