Procedures
An intrathecal pump relieves chronic pain. It uses small amounts of medicine applied directly to the intrathecal space (the area surrounding the spinal cord) to prevent pain signals from being perceived by the brain. Pump candidates include people for whom conservative treatments have failed and surgery is not likely to help.
This injection procedure is performed to relieve low back and radiating leg pain. Steroid medication can reduce the swelling and inflammation caused by spinal conditions. Using a fluoroscope for guidance, the physician slides the needle toward the epidural space between the L-4 and L-5 vertebra. A contrast solution is injected. The physician uses the fluoroscope to confirm the correct location of the needle tip. A steroid-anesthetics mix is injected into the epidural space, bathing the painful nerve root with soothing medication.
During this minimally invasive procedure, the physician uses heat from radio waves to treat painful facet joints in your lower back. This procedure is also called radiofrequency rhizotomy. It can treat pain that doesn’t respond to medications or to physical therapy. The physician inserts an electrode through the cannula. A weak electric jolt is used to test its position. If the jolt recreates the pain but does not cause any other muscular effects, it is positioned correctly. Then the physician uses the electrode to heat the nerve. This disrupts its ability to transmit pain signals. Several nerves may be treated if necessary.
This outpatient procedure is an injection of a steroid-anesthetic medication. The medication can reduce swelling and inflammation of irritated spinal nerves. This procedure is performed to relieve pain in the lower back and pain that radiates from the back to the legs. When the area is numb, the physician carefully guides a needle into the foraminal space that surrounds the irritated nerve root. After the needle’s position has been confirmed, the physician injects a steroid-anesthetic medication. This medication bathes the irritated nerve roots. It will help alleviate the patient’s pain. The injection only takes a few minutes to complete.
This is an injection of numbing medicine. It bathes the medial branch nerves, which attach to the facet joints of your spine. These nerves hurt when facet joints are injured or diseased. The injection helps find the source of your pain. And it may relieve your pain for a brief time.
A cervical epidural steroid injection consists of an anesthetic and a steroid being injected into the epidural space in order to reduce inflammation and pain. When it is injected from the side it’s considered a transforaminal injection and it places the medication near the source of inflammation. The injection may begin with an IV to help you relax and a local anesthetic to numb your skin. The physician then inserts a thin needle into the epidural space. Fluoroscopy, a type of X-ray, is used to ensure proper needle placement and a dye may also be injected to make sure the needle is in the correct spot. Once the needle is correctly placed the physician injects the anesthetic and steroid.
A lumbar sympathetic block is an injection of a local anesthetic that can help relieve chronic leg and foot pain caused by conditions such as complex regional pain syndrome, reflex sympathetic dystrophy, vascular insufficiency, and shingles. Medications are delivered to the sympathetic nerves – a cluster of nerve cell bodies – along the front side of the spine. The goal is to reduce pain so that you can resume normal activities and physical therapy.
This injection procedure is performed to relieve pain caused by arthritis in the sacroiliac joint where the spine and hip bone meet. The steroid medication can reduce swelling and inflammation in the joint. A local anesthetic numbs the skin and all the tissue down to the surface of the sacroiliac joint.
Spinal cord stimulation (also called SCS) uses electrical impulses to relieve chronic pain of the back, arms and legs. It is believed that electrical pulses prevent pain signals from being received by the brain. SCS candidates include people who suffer from neuropathic pain and for whom conservative treatments have failed. The injection site is anesthetized. One or more insulated wire leads are inserted through an epidural needle or through a small incision into the space surrounding the spinal cord, called the epidural space. If the patient and the physician determine that the amount of pain relief is acceptable, the system may be permanently implanted. At the end of the trial implantation, the leads are removed. The permanent implantation may be performed while the patient is under sedation or general anesthesia. First, one or more permanent leads are inserted through an epidural needle or a small incision into the predetermined location in the epidural space. Next, a small incision is created, and the implantable pulse generator (IPG) battery is positioned beneath the skin. It is most often implanted in the buttocks or the abdomen. The leads are then connected to the IPG battery.
Stellate Ganglion Block
A stellate ganglion nerve block is an injection that numbs branches of nerves in your neck. This helps doctors find and treat several problems linked to the nerves. Treatment may require a series of injections. The physician inserts a needle and carefully guides it to the nerves of the stellate ganglion. The physician typically uses an x-ray device called a “fluoroscope.” This shows a video image of the needle’s position. Contrast dye may be injected to help confirm that the needle is placed correctly. Next, the physician injects medicine. It bathes the nerves. It can numb the nerves and reduce inflammation. If these nerves have been a source of pain, the medicine can relieve it. The injection may also provide other benefits, depending on your needs.
The physician uses an x-ray device called a fluoroscope to guide a needle down to the vertebra that is causing the pain. The needle is carefully pushed into the epidural space, which is the area surrounding the spinal cord. A contrast solution is injected to confirm the needle’s position. The physician injects a steroid-anesthetic mix into the epidural space, bathing the painful areas with soothing medication. The mixture will help reduce inflammation and reduce pain.
This outpatient procedure is designed to reduce or relieve the pain of trigger points. These small, tender knots can form in muscles or in the fascia (the soft, stretchy connective tissue that surrounds muscles and organs). The physician carefully inserts a needle through the skin and into the trigger point. The physician injects an anesthetic mixture into the trigger point. This causes the trigger point to relax. If the trigger point does not relax completely after the first injection, the physician may adjust the needle’s position and give additional injections. The trigger point injection procedure takes only a few minutes to complete.
A CRFA is a noninvasive procedure used to treat neck, back, and shoulder pain. The procedure may start with an IV to help you relax and a local anesthetic to numb your skin. The physician then inserts a very thin needle near the facet joint. Fluoroscopy, a type of X-ray, is used to ensure proper needle placement. The physician then checks to make sure it is at the correct nerve by stimulating it. This may cause muscle twitching. When the needle is in the proper place, the area is numbed. Radio frequency energy is then used to disrupt the medial branch nerve, which is often repeated at multiple levels of the spine.
Coccygeal injections are used to treat pain around the tail bone in the lower back. It involves an injection of a local anaesthetic and steroid around this area. Your procedure may be performed under X Ray guidance. You will be asked to sit or lie in a comfortable position. A small amount of local anaesthetic is injected to numb the skin overlying the injection site. The local anaesthetic/ steroid injection is then given. You may feel some discomfort during the injection, but this normally settles quickly.
EMDR (Eye Movement Desensitization and Reprocessing) is a psychotherapy that enables people to heal from the symptoms and emotional distress that are the result of disturbing life experiences. Repeated studies show that by using EMDR therapy people can experience the benefits of psychotherapy that once took years to make a difference. It is widely assumed that severe emotional pain requires a long time to heal. EMDR therapy shows that the mind can in fact heal from psychological trauma much as the body recovers from physical trauma. When you cut your hand, your body works to close the wound. If a foreign object or repeated injury irritates the wound, it festers and causes pain. Once the block is removed, healing resumes. EMDR therapy demonstrates that a similar sequence of events occurs with mental processes. The brain’s information processing system naturally moves toward mental health. If the system is blocked or imbalanced by the impact of a disturbing event, the emotional wound festers and can cause intense suffering. Once the block is removed, healing resumes. Using the detailed protocols and procedures learned in EMDR therapy training sessions, clinicians help clients activate their natural healing processes.ww
Myofascial release is a type of physical therapy often used to treat myofascial pain syndrome. Myofascial pain syndrome is a chronic pain disorder caused by sensitivity and tightness in your myofascial tissues. These tissues surround and support the muscles throughout your body. The pain usually originates from specific points within your myofascial tissues called “trigger points.”
Evaluation of back and neck pain requires a physician experienced in diagnosing spinal conditions. The work-up begins with a detailed history and physical examination. Your medical history helps the doctor understand your back and neck pain and the influence of your lifestyle on your pain.
During your physical exam, your physician will try to pinpoint the source of pain. Simple tests for flexibility and muscle strength may also be conducted. Diagnostic tests may be ordered to confirm the location and source of your pain.
- X-rays are usually the first step in diagnostic testing methods. X-rays show bones and the spaces between the bones.
- MRI (magnetic resonance imaging) uses a magnetic field and radio waves to generate highly detailed pictures of the inside of your body. Because X-rays only show bones, MRIs are needed to see soft tissues like discs in the spine. These images help your doctor provide a more accurate diagnosis. This type of imaging is very safe and usually pain free.
- CT scan/myelogram – A CT scan is like an MRI in that it provides more diagnostic information about the internal structures of the spine. A myelogram is used to diagnose a bulging disc, tumor or changes in the bones surrounding the spinal cord or nerves. A local anesthetic is injected into your low back to numb the area. A lumbar puncture (spinal tap) is then performed. A dye is injected into the spinal canal to reveal where problems lie.
- Electrodiagnostic – Electrical testing of the nerves and spinal cord may be performed as part of our diagnostic workups. These tests, called Electromyography (EMG) or Somato Sensory Evoked Potentials (SSEP), assist your neurosurgeon in understanding how your nerves or spinal cord are affected by your condition.
- Bone Scan – Bone imaging is used to detect infection, malignancy, fractures and arthritis in any part of the skeleton. Bone scans are also used for finding lesions for biopsy or excision.
- Discography – Discography is used to determine the internal structure of your disc. It is performed by using a local anesthetic and injecting a dye into your disc under X-ray guidance. An X-ray and CT scan are performed to view the appearance of the disc composition to determine if its structure is normal or abnormal. In addition to your disc appearance, your doctor will note if you have pain with this injection. The benefit of a discogram is that it enables the spine surgeon to confirm which disc level is really causing your pain. This ensures that surgery will be more successful and reduces the risk of operating on the wrong disc.
- Injections – Pain-relieving injections can relieve back pain and give the physician important information about the problem, as well as provide a bridge therapy.
Orthopedic surgery corrects problems that arise in the skeleton and its attachments, the ligaments and tendons. It may also deal with some problems of the nervous system, such as those that arise from injury of the spine. These problems can occur at birth, through injury, or as the result of aging. They may be acute, as in injury, or chronic, as in many aging-related problems.
With the development of anesthesia and an understanding of the importance of aseptic technique in surgery, orthopedic surgeons extended their role to include surgery involving the bones and related nerves and connective tissue.
The terms orthopedic surgeon and orthopedist are used interchangeably today to indicate a medical doctor with special certification in orthopedics.
Many orthopedic surgeons maintain a general practice, while some specialize in one aspect of orthopedics, such as hand surgery, joint replacements, or disorders of the spine. Orthopedics treats both acute and chronic disorders. Some orthopedists specialize in trauma medicine and can be found in emergency rooms and trauma centers treating injuries. Others find their work overlapping with plastic surgeons, geriatric specialists, pediatricians, or podiatrists. A rapidly growing area of orthopedics is sports medicine, and many sports medicine doctors are board certified orthopedists.
Caudal epidural injections are steroid injections that are given in the coccyx (tailbone or caudal) region to treat chronic lower back pain and chronic pain in the legs. The pain specialist cleans and then numbs the area of the lower back located just above the buttocks with a topical anesthetic before inserting a needle and injecting contrast dye into the caudal area. The contrast dye is visible in the x-ray images and allows the pain specialist to see exactly where the dye is being delivered. Finally, the medication is injected into the caudal space.
Facet joint injections are injections, which we perform using X-ray guidance, that help us diagnose and treat pain that comes from the small joints of the spine (facet joints). Disease in these joints, including arthritis, can cause pain in the head, neck, upper and lower back, and buttocks. These procedures take about five minutes and we can use either local anesthesia or comfortable sedation.
Botox injections are a minimally invasive treatment option for patients suffering from migraine headaches, spasticity, myofascial pain, back pain, neck pain, or neuropathy. While this injection procedure is most commonly known for its effect on wrinkles, it is also a highly effective pain therapy that can provide three to four months of pain relief. These injections typically contain a mixture of botulinum toxin and saline solution or local anesthetic. Between five and 10 injections in multiple areas may be needed to successfully relax tense muscles.
