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Procedures
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 steroid, which is anti-inflammatory,
and numbing medications (local anesthetics).
Medial Branch Blocks
Medial branch blocks are injections where numbing medications are placed on
the medial nerves to temporarily block the pain involved in facet arthritis.
If this is successful, a radiofrequency procedure could be performed to
'burn off' the nerves to provide long-term pain relief.
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 is using numbing
medications to block a nerve that innervates the joint, called the medial
branch.
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.
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No surgical incision, just needle insertions
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Decreased operative time
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General anesthesia not required, just intravenous sedation
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No scarring
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Outpatient setting- goes home on same day as surgery
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A more rapid healing time
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Faster returning to work than 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
traditional surgery.
At the Pain Treatment Center, our priority is providing the best care for
our patients. For this reason, we offer a variety of minimally- invasive
techniques that uses state-of-the-art instruments. The Pain Treatment Center
can help you determine whether any of the options are the correct course of
action for your specific medical condition. The minimally invasive spine
surgery techniques that the Pain Treatment Center offers include:
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%.
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 reduces 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.
Percutaneous Discectomy (NUCLEOPLASTY)
The most advanced form of percutaneous discectomy developed to date is
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. With tissue
removed from the disc, it 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
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 strengthen the bone.
It 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.
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 solution 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), shoulders, knees, hips,
sacroiliac joints, and the tailbone. The injections take several sessions,
about four to six, one month apart. Prolotherapy is a noninvasive procedure
with minimal risk, potential to provide good pain relief, and sometimes
cure, for various forms of joint pain.
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