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Cervical Procedures

Cervical Medial Branch Radio Frequency Ablation

Outpatient procedure for treating Neck, Shoulder, and Upper back pain. Sometimes this pain may feel like muscle tension, and other times it may be more severe. Cervical Facet Joints are found on both sides of the spine. They tell the brain when the facet joint has been injured. Medial branch nerves tell the brain when the facet joint has been injured. Cervical facet joint pain can occur in an area from your head down to your shoulder blade. If you have been experiencing pain in one or more of these areas, and has lasted longer than two months you may be experiencing Cervical Facet Pain. RFA (Radiofrequency Ablation) uses energy to disrupt nerve function. When this is done to a cervical medial branch nerve, it stops the nerve from transmitting pain signals from the injured joint. Nerves can regenerate after this procedure is completed, but the return of pain is not definite. If pain does return, another RFA treatment cycles can be done.
 

Discograms

A discogram is an enhanced X-Ray of the Intervertebral discs. A dye is injected into the center of the disc. The dye allows the disc to be clearly visible on the film/screen. This procedure is usually done to see which disc has structural damage and if it is causing pain. Normal discs and even ones with degenerative changes do not usually cause pain. This procedure is done prior to surgery to give the Doctor a better idea of the problem and the location that it is affecting. This procedure is relied on when disc surgery is being seriously considered, and usually lasts about 40 minutes.
 

Epidural Steroid Injections

This procedure is an injection of corticosteroids into the space outside the covering of the spinal cord in the lower back. This procedure has multiple indications for treatment, neck pain, headaches, herniated discs, degenerative disc disease, radiculopathy, and spinal stenosis. The spinal cord runs from the brain to the waist, about every inch along the entire length of the spinal cord it gives off branches(spinal nerves) that carry sensations and pain signals from the body back to the brain. The steroid will be injected directly into the epidural space using fluoroscopy to guide the needle. During the injection the patient will feel increases in pressure. The patients vitals will be recorded over the next 15 to 20 minutes, once the patients vitals are stable, you will be allowed to go home. It generally takes 24 to 72 hours for the effects o the steroid medication to take effect and may be about a week before the maximum benefits are achieved, usually 2-3 injections over a 6 week period to achieve maximum results.
 

Facet/Medial Nerve Block

Medial branch nerves are small nerves that feed from the facet joints in the spine, and carry pain signals to the brain from the given joint. This procedure temporarily blocks the pain signal being carried by the medial branch nerves that supply any given joint. Like many other spinal injections, this procedure is best when performed under fluoroscopy. Patients are generally advised not to drive themselves to this procedure, avoid any strenuous, activity and get plenty of rest the night before. The injection itself generally only takes a few minutes but the entitre procedure usually lasts between 15-30 min, and once the procedure is finished the patient generally rests between 15-30 minutes and then is asked to move the affected area to provoke the pain. Relief has been known to start immediately but on occasion has taken hours before the patient feels relief.
 

Nerve Root Blocks

The procedure is performed for pain that is caused by an irritated nerve root. The idea behind this procedure is to reduce the inflation of the root and block the pain from traveling up the nerve to the brain. Nerve root blocks will bring partial or complete relief of pain, but that relief is only temporary. This block can also be used to determine the severity of the injury. Some slight discomfort has been associated with this procedure but will cease very soon after, and is usually done as an outpatient procedure.
 

Stellate Ganglion/sympathetic Blocks

This procedure is an injection of a local anesthetic in the “sympathetic nerve tissue” located on either side of the voice box in the neck. This injection may reduce pain, swelling, color, and sweating changes in the upper extremity and improve mobility. The local anesthetic generally consists of Lidocaine, bupivacaine or another local anesthetic.Epinephrine may be added to the injection to prolong the effects. After the procedure patients are advised to take it easy for atleast a day and only take part in activities that are tolerable. If the patient responds to the first injection they will be recommended for repeat injections. Since every persons body is different there is no set number of injections that any patient should receive, but they should continue until relief is maintained.
 

Thoracic Procedures 

Diagnostic Medical Branch Nerve Injections

This procedure is used to diagnose lower back pain that stays above the knee. Medial Branch nerves are very small branches of nerves that control sensation to the facet joint, or where each bone of the spine connect with the next. Once this injection is administered, there are three things that can generally happen. First if the pain does not go away it generally means that the patient is experiencing pain from somewhere other than the facet joints. If the pain goes away for a few hours but returns again and does not get better then the facet joints most likely are the source of the pain. If the pain goes away, returns in a few hours, but then gets better over the next few days the medication had a long lasting effect on the pain and the problem should subside for some time.
 

Epidural Steroid Injections

This procedure is an injection of corticosteroids into the space outside the covering of the spinal cord in the lower back. This procedure has multiple indications for treatment, neck pain, headaches, herniated discs, degenerative disc disease, radiculopathy, and spinal stenosis. The spinal cord runs from the brain to the waist, about every inch along the entire length of the spinal cord it gives off branches(spinal nerves) that carry sensations and pain signals from the body back to the brain. The steroid will be injected directly into the epidural space using fluoroscopy to guide the needle. During the injection the patient will feel increases in pressure. The patients vitals will be recorded over the next 15 to 20 minutes, once the patients vitals are stable, you will be allowed to go home. It generally takes 24 to 72 hours for the effects o the steroid medication to take effect and may be about a week before the maximum benefits are achieved, usually 2-3 injections over a 6 week period to achieve maximum results.
 

Intercostal Nerve Block

An intercostal nerve block is an injection of a steroid or other medication around the intercostal nerves that are located under each rib. This injection reduces the inflammation and/or swelling of tissue around the intercostal nerves, in between the ribs or in the chest wall. The objective behind this procedure is to reduce pain, and other symptoms caused by inflammation or irritation of the intercostal nerve and surrounding structures. This injection is comprised of a local anesthetic and a steroid medication. The medication can take 3-5 days to start working and can last several days to a few months depending on the patient.
 

Radiofrequency Rhizotomy

This is a therapeutic procedure that decreases/eliminates pain symptoms that arise from degenerative facet joints in the spine. During this procedure the nerves that innervate the facet are destroyed using highly localized heat generated from RF. After the procedure is over and the nerve block wears off, the pain may return or be worse than originally until the procedure has time to take effect. Greatest improvement can be seen 2-3 weeks after the procedure but has been known to take even longer in some cases. Physical therapy can also be done to speed up recovery time.
 

Kyphoplasty

This is a procedure designed to reduce back pain caused by compression fractures of the thoracic and lumbar spine that have failed to heal normally. Usually patients are admitted to the hospital for this procedure. A local anesthetic and heavy sedation is given to the patient to help make them more comfortable during the procedure. Using fluoroscopy the doctor inserts a special needle into the damaged vertebra on each side. Through the needle channels are drilled into the bone, Kyphx balloons are then placed into each channel. The balloons are slowly inflated, moving the broken vertebra to try and restore the bone to its original location. Once the desired result is achieved the balloons are deflated and the bone is held in place with bone cement to hold them in place. Patients usually see improvement in pain within 24-48 hours.
 

Lumbar Procedures 

Diagnostic Medial Nerve Injection

This procedure is used to diagnose lower back pain that stays above the knee. Medial Branch nerves are very small branches of nerves that control sensation to the facet joint, or where each bone of the spine connect with the next. Once this injection is administered, there are three things that can generally happen. First if the pain does not go away it generally means that the patient is experiencing pain from somewhere other than the facet joints. If the pain goes away for a few hours but returns again and does not get better then the facet joints most likely are the source of the pain. If the pain goes away, returns in a few hours, but then gets better over the next few days the medication had a long lasting effect on the pain and the problem should subside for some time.
 

Discograms

A discogram is an enhanced X-Ray of the Intervertebral discs. A dye is injected into the center of the disc. The dye allows the disc to be clearly visible on the film/screen. This procedure is usually done to see which disc has structural damage and if it is causing pain. Normal discs and even ones with degenerative changes do not usually cause pain. This procedure is done prior to surgery to give the Doctor a better idea of the problem and the location that it is affecting. This procedure is relied on when disc surgery is being seriously considered, and usually lasts about 40 minutes.
 

Epidural Steroid Injections

This procedure is an injection of corticosteroids into the space outside the covering of the spinal cord in the lower back. This procedure has multiple indications for treatment, neck pain, headaches, herniated discs, degenerative disc disease, radiculopathy, and spinal stenosis. The spinal cord runs from the brain to the waist, about every inch along the entire length of the spinal cord it gives off branches(spinal nerves) that carry sensations and pain signals from the body back to the brain. The steroid will be injected directly into the epidural space using fluoroscopy to guide the needle. During the injection the patient will feel increases in pressure. The patients vitals will be recorded over the next 15 to 20 minutes, once the patients vitals are stable, you will be allowed to go home. It generally takes 24 to 72 hours for the effects o the steroid medication to take effect and may be about a week before the maximum benefits are achieved, usually 2-3 injections over a 6 week period to achieve maximum results.
 

Facet/Medial Nerve Block 

Medial branch nerves are small nerves that feed from the facet joints in the spine, and carry pain signals to the brain from the given joint. This procedure temporarily blocks the pain signal being carried by the medial branch nerves that supply any given joint. Like many other spinal injections, this procedure is best when performed under fluoroscopy. Patients are generally advised not to drive themselves to this procedure, avoid any strenuous, activity and get plenty of rest the night before. The injection itself generally only takes a few minutes but the entitre procedure usually lasts between 15-30 min, and once the procedure is finished the patient generally rests between 15-30 minutes and then is asked to move the affected area to provoke the pain. Relief has been known to start immediately but on occasion has taken hours before the patient feels relief.
 

Lumbar Sympathetic Block

This is an injection of local anesthetic into or around the sympathetic nerves. These nerves are located on either side of the spine in the lower back. This procedure is performed to block the sympathetic nerves that go to the leg on the same side as the injection. This may result in lower pain score, swelling, color, sweating and other changes in the lower extremity. The injection can take anywhere from 10-30 min. If the patient responds to the first injection then they will be recommended for repeat injections. Some may need 2-5 and others can require more than 10 depending on the given patient. Usually the duration of relief increases with each additional injection.
 

Nerve Root Blocks

The procedure is performed for pain that is caused by an irritated nerve root. The idea behind this procedure is to reduce the inflation of the root and block the pain from traveling up the nerve to the brain. Nerve root blocks will bring partial or complete relief of pain, but that relief is only temporary. This block can also be used to determine the severity of the injury. Some slight discomfort has been associated with this procedure but will cease very soon after, and is usually done as an outpatient procedure.
 

Percutaneous Disectomy

This is the removal of herniated disc material through a small incision in the skin rather than invasive surgery. If you are suffering from low back and radicular pain caused by a contained herniated disc then you are a likely candidate for this procedure. This is an out patient procedure and the patients will be allowed to go home shortly after the surgery. You can expect the injection site to be sore for a few days after the procedure. It is very important to limit your activity for the first week after surgery to allow time for rest and healing. You can start stretching/physical therapy at your doctors instruction.
 

Radiofrequency Rhizotomy

This is a therapeutic procedure that decreases/eliminates pain symptoms that arise from degenerative facet joints in the spine. During this procedure the nerves that innervate the facet are destroyed using highly localized heat generated from RF. After the procedure is over and the nerve block wears off, the pain may return or be worse than originally until the procedure has time to take effect. Greatest improvement can be seen 2-3 weeks after the procedure but has been known to take even longer in some cases. Physical therapy can also be done to speed up recovery time.
 

Sacroiliac Joint Injection

This injection serves several purposes, by injecting the numbing medicine into the joint the patient will be able to determine almost instantly if this is the site/cause of their pain. If your pain stops completely with the injection of the numbing medicine it means that this joint is more than likely not your pain source. Cortisone is also injected into the joint to help relieve any inflammation, which may lead to long term pain relief. 20-30 minutes after the procedure the patient will move and try to aggravate the joint. The patient will also monitor their pain score over the next week to see how the injection is affecting them.
 

Transforminal Injections

This is an injection of long acting steroid into the opening on the side of the spine where nerve roots exist, also known as the Foramen. The steroid that is injected during this procedure reduces inflammation and swelling of the spinal nerve roots and other tissue surrounding the area. This injection can also be used to identify a specific spinal nerve root level or levels that are the source of pain. The injection consists of a mix of saline, local anesthetic, and the long acting steroid medication. The patient may feel pressure associated with the injection but no pain to speak of. The injection takes 3-5 days to start working and can last for several days to months. If your pain persists in the first two weeks after the injection you may be recommended for another injection.
 

Racz Procedure

This type of procedure is used to dissolve some of the scar tissue around the entrapped nerves in the epidural space of the spine so that medications such as cortisone can reach the effected areas. This procedure requires a series of three injections. First a catheter is inserted in the epidural space, and the first injection is done through this catheter. The second injection is done the following day and on the third day the final injection is administered and then the catheter is removed. The actual injection consists of a local anesthetic and the steroid mediacation, and x-ray dye to help with visualization. This is all done under local anesthetic so the patient is awake the entire time. The medication will start to work after 5-7 days and can last for months to follow.
 

Baclofen and Morphine Intrathecal Infusion pumps

This is a special device that delivers concentrated amounts of medication into the spinal chord area through a catheter allowing the patient to decrease or illiminate the need for oral medicines. This pump delivers medication 24/7 so it eliminates pain breakthroughs and other symptoms. This procedure is done in two stages, the first stage a single injection is done to asses the effectiveness of the medication and screening for unwanted side effects. If this injection is successful then a permanent device is placed under the skin. If the procedure is successful your pain should be controlled or lessened greatly. The medication rate is controlled by remote to make sure the proper medication dosages are being used. This pump will last 1-3 months depending on the concentration and amount of medication infused.
 

Spinal Cord Stimulators

This is a special device that stimulates nerves by using tiny electrical impulses via small electrical wires placed on the spinal cord itself. This device interrupts nerve conduction to the brain. Each procedure can take up to three hours, and the wires are placed under x-ray guidance. This procedure will be done in the operating room to maintain sterility. Depending on how much the device is used, the batteries in the generator may last several years. These batteries are permanent in this device so they cannot be replaced or recharged. After this procedure patients usually have a 50-70% reduction in their pain. After the procedure the patient should rest for a few days and only do activities as tolerated by your body.
 
 
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Copyright 2012 Dr. Hedayatnia