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Services 
Services
Caudal Steroid Injection
Celiac Plexus Block
Cervical Steroid Injection
Dekompressor Discectomy
Discography
Facet Joint Injections
Fascia Iliaca Block
Intradiscal Electrothermal Therapy (IDET)
Intrathecal Pump Implant
Inter-Body Fusion (IBF)
Kyphoplasty
Lumbar Disc Microsurgery
Lumbar Epidural Steroid Injection
Lumbar Micro Endoscopic Discectomy
Lumbar Radiofrequency Neurotomy
Lumbar Sympathetic Block
Lumbar Transforaminal Epidural Steroid Injection
Medial Branch Block
Percutaneous Disc Nucleoplasty
RACZ Caudal Neurolysis
Sacroiliac Joint Steroid Injection
Spinal Cord Stimulator Implant
Stellate Ganglion Block
Vertebroplasty
Patient Education
Where Back Pain Begins
Spine Anatomy
About Cervical Radiculopathy
About Degenerative Disc Disease
About Facet Joint Syndrome (Arthritis)
About Hip Arthritis
About Herniated Discs
About Knee Arthritis
About Lumbar Radiculopathy (Sciatica)
About Metastatic Cancer
About Rotator Cuff Injuries
About Scoliosis
About Spinal Infection
About Spinal Stenosis
About Spondylolisthesis
Anterior Cervical Corpectomy
Cervical Micro Endoscopic Discectomy
Cervical Posterior Foraminotomy
Laminaplasty
Laminectomy
Lumbar Corpectomy
Spinal Fusion
Total Disc Replacement
YESS Discectomy
About Epidural Injections
About Nerve Blocks
About Facet Joint Injections
About Radiofrequency of Facet Joints
About Lysis of Adhesions
About Spinal Cord Stimulation
Epidural Injections
WHAT
IS IT?
An epidural is commonly known as a nerve block to decrease pain and
inflammation. Our clinic performs them under fluoroscopic guidance
to ensure accurate and safe localization. Steroids are a powerful
anti-inflammatory agent that may shrink swelling around nerve roots
from an inflamed, bulging or herniated disc. Because of the low risk
and incidence of significant complication, it is generally felt to
be a reasonable procedure to follow when disc or nerve root pain
which has failed to respond to more conservative measures. A large
percentage of patients will get complete resolution of symptoms.
HOW IS IT DONE?
Initially a local skin anesthetic is given before a spinal needle is
inserted into the epidural space of the lumbar or caudal spine.
After verifying proper location with contrast injection, local
anesthetic and steroids are delivered into the epidural space.
HOW OFTEN SHOULD I HAVE THIS PROCEDURE?
It is generally an accepted practice that this procedure can be
repeated up to three times within a few months, although in some
cases, additional injections may be administered. Injections may be
given as a single dose, or once every ten to fourteen days for a
series of three. Additional injections seem to have additive
effects.
WHAT ARE THE EXPECTED RESULTS?
Immediate, but temporary (few hours) pain relief may occur if the
local anesthetic reaches the source of pain. The steroid benefit
will typically not occur for several days to two weeks. If local
anesthetic is used, patients are advised to avoid driving for 12
hours. By the next day, previous activities can be resumed. Despite
the temporary improvement, patients are cautioned against strenuous
activity. It is generally advised to pursue a course of gradual
increase in activity, often coordinated with physical therapy or
other training once the injections have been completed.
WHAT ARE THE RISKS OR SIDE EFFECTS?
Side effects and adverse reactions are rare. Steroids have been
known to cause: fluid retention, weight gain, increased blood sugar
(mainly in diabetics,) elevated blood pressure, mood swings,
irritability, insomnia, and suppression of bodys own natural
production of cortisone. Fortunately, the serious side effects and
complications are uncommon. Additional risks associated with needle
placement include dural puncture which may result in a severe
"spinal headache". Bed rest and increasing fluids/caffeine intake
frequently alleviate symptoms. In rare cases it may be necessary to
perform a "blood patch" to seal the leaking dura. Other rare
potential risks include: worsening of pain symptoms, bleeding,
infection, backache, bowel or bladder dysfunction, hematoma, cord
compression, paralysis, neurologic damage or impairment, seizure or
death. In order to avoid these complications, the procedure is done
under strict sterile conditions, utilizing fluoroscopy to localize
the epidural space and guide the needle.
HOW LONG DOES IT TAKE?
Thirty minutes plus approximately forty-five minutes of observed
recovery time.
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Nerve Block
WHAT IS IT?
An epidural is commonly known as a nerve block to decrease pain and
inflammation. Our clinic performs them under fluoroscopic guidance
to ensure accurate and safe localization. Steroids are a powerful
anti-inflammatory agent that may shrink swelling around nerve roots
from an inflamed, bulging or herniated disc. Because of the low risk
and incidence of significant complication, it is generally felt to
be a reasonable procedure to follow when disc or nerve root pain
which has failed to respond to more conservative measures. A large
percentage of patients will get complete resolution of symptoms.
HOW IS IT DONE?
Initially a local skin anesthetic is given before a spinal needle is
inserted into the epidural space of the lumbar or caudal spine.
After verifying proper location with contrast injection, local
anesthetic and steroids are delivered into the epidural space.
HOW OFTEN SHOULD I HAVE THIS PROCEDURE?
It is generally an accepted practice that this procedure can be
repeated up to three times within a few months, although in some
cases, additional injections may be administered. Injections may be
given as a single dose, or once every ten to fourteen days for a
series of three. Additional injections seem to have additive
effects.
WHAT ARE THE EXPECTED RESULTS?
Immediate, but temporary (few hours) pain relief may occur if the
local anesthetic reaches the source of pain. The steroid benefit
will typically not occur for several days to two weeks. If local
anesthetic is used, patients are advised to avoid driving for 12
hours. By the next day, previous activities can be resumed. Despite
the temporary improvement, patients are cautioned against strenuous
activity. It is generally advised to pursue a course of gradual
increase in activity, often coordinated with physical therapy or
other training once the injections have been completed.
WHAT ARE THE RISKS OR SIDE EFFECTS?
Side effects and adverse reactions are rare. Steroids have been
known to cause: fluid retention, weight gain, increased blood sugar
(mainly in diabetics,) elevated blood pressure, mood swings,
irritability, insomnia, and suppression of bodys own natural
production of cortisone. Fortunately, the serious side effects and
complications are uncommon. Additional risks associated with needle
placement include dural puncture which may result in a severe
"spinal headache". Bed rest and increasing fluids/caffeine intake
frequently alleviate symptoms. In rare cases it may be necessary to
perform a "blood patch" to seal the leaking dura. Other rare
potential risks include: worsening of pain symptoms, bleeding,
infection, backache, bowel or bladder dysfunction, hematoma, cord
compression, paralysis, neurologic damage or impairment, seizure or
death. In order to avoid these complications, the procedure is done
under strict sterile conditions, utilizing fluoroscopy to localize
the epidural space and guide the needle.
HOW LONG DOES IT TAKE?
Thirty minutes plus approximately forty-five minutes of observed
recovery time.
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Facet Joint Injections
WHAT IS IT?
An injection of local anesthetic and steroids into spinal joint(s)
to reduce inflammation and pain or to confirm that a suspicious
facet joint is the actual pain generator.
HOW IS IT DONE?
The patient is given a local skin anesthetic before a small spinal
needle is inserted under fluoroscopic guidance into the facet joint
or capsule. Local anesthetic and steroid are then injected.
WHAT SHOULD I EXPECT AFTER THE INJECTION?
Immediately after the injection, you may feel that your pain may be
gone or quite less. This will only last for a few hours due to the
local anesthetic used. Your pain may return and you may have a sore
back or neck for a day or two. You should start noticing pain relief
starting the 3rd to 5th day which may last days to months.
HOW LONG DOES IT TAKE?
Thirty minutes.
WILL THE INJECTION HURT?
This procedure is done under local anesthesia which makes the
procedure easy to tolerate.
WHAT SHOULD I DO AFTER THE PROCEDURE?
You may want to apply ice to the affected area. After the first day,
you can perform activity as tolerated.
CAN I GO TO WORK THE NEXT DAY?
Yes. Unless there are complications, you should be able to return to
your work the next day. The most common feeling is local soreness in
the neck or back.
HOW MANY INJECTIONS CAN I HAVE?
In a six-month period, we generally do not perform more than three
injections. Giving more than three injections will increase the
likelihood of side effects from cortisone. Also, if three injections
with fluoroscopic guidance have not helped you much, it is very
unlikely that you will get any further benefit from additional
injections.
WHAT ARE THE RISKS AND SIDE EFFECTS?
This procedure is safe when performed in a controlled setting.
However, with any procedure there are risks, side effects, and
possibility of complications. The most common side effect is
temporary discomfort. The other risks involve, infection, bleeding,
worsening of symptoms.
WHO SHOULD NOT HAVE THIS INJECTION?
As with other types of injections, you should not have the procedure
if you are currently taking blood-thinning medicine (i.e. Coumadin.)
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Radiofrequency of Facet Joints
WHAT IS IT?
Facet RF or neurotomy is a procedure which results in interruption
of the nerve supply to a facet joint. Denervation is accomplished by
a radiofrequency probe that heats the small nerve branches to each
facet joint.
HOW MANY FACETS ARE TREATED?
Based on your symptoms and your diagnostic block, your doctor will
determine which facet(s) may be causing your pain.
WILL I KNOW RIGHT AWAY IF THE PROCEDURE WORKED?
No, it may take several weeks before the results are known, but most
patients notice improvement in 2 weeks.
DOES THE PROCEDURE HURT?
Most patients feel mild discomfort only during the placement of the
need. After that, local anesthetic is used to prevent pain.
HOW LONG DOES IT TAKE?
The neurotomy takes 10 to 45 minutes, depending on the number of
levels to be done.
DO I NEED TO BE PUT ASLEEP FOR THE PROCEDURE?
No. The procedure is done under local anesthesia because you need to
be able to tell your doctor what you are feeling to improve results.
WHAT SHOULD I EXPECT AFTER THE PROCEDURE?
We advise patients to take it easy the day of the procedure. You may
need to apply ice to the affected area for 20-30 minutes at a time
for the next 48 hours. Your doctor will provide specific activity
restrictions as indicated.
ARE THERE ANY POTENTIAL RISKS TO THE PROCEDURE?
Generally speaking the procedure is safe, however with any procedure
there are associated risks, side effects, and complications. The
most common side effect is temporary discomfort following the
procedure. Increased localized back pain and/or leg pain can be
expected from several days to several weeks and rarely several
months. Destabilization of the facet joint is a risk and post
injection training to strengthen the extensor muscles can reduce
this possibility. Fortunately, because the procedure is performed
with x-ray guidance in a controlled environment, serious side
effects and complications are rare.
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Lysis of Adhesions
WHAT ARE ADHESIONS?
Adhesions are a common cause of chronic pain when excessive scarring
occurs in the epidural space. This is usually following spinal
surgery, but can also occur with chronic inflammation around a
nerve. The epidural space forms a protective layer around the spinal
cord. Scar tissue may restrict the natural movement of nerves
causing inflammation therefore creating pain.
HOW DO I KNOW IF I HAVE SCAR TISSUE?
Scar tissue that irritates nerves commonly occurs after spine
surgery. When suspected by clinical history, scar tissue can be
confirmed with contrast enhanced MRI and diagnostic epidurography
(epidurogram) or injected contrast into the epidural space.
Obstructions of normal dye pattern flow in the epidural space
surrounding irritated nerves can be identified.
HOW DOES IT WORK?
After local anesthetic, your physician can insert a spring guided
catheter into the epidural space through the caudal canal. This
space is easily visualized under fluoroscopic guidance as the sacral
hiatus is a natural opening in the spine near the end of the
tailbone. Aided by real-time fluoroscopic imaging, the catheter can
be guided directed to the affected nerve roots.
Spinal catheters have a soft, non-abrasive tip to glide off
sensitive areas, and a strong body to steer through the epidural
space. Once the tip of the cather is in place, medication can be
delivered to relieve pain at the source.
WHAT SHOULD I EXPECT DURING THE PROCEDURE?
After the medical staff has prepared you for your procedure, you
will be positioned on a table that is compatible for fluoroscopy.
The physician will inject local anesthetic in the skin where the
needle will be introduced. This may cause a very short pinching
sensation. Mild sedation can be given during the procedure to reduce
potential discomfort. Following anesthesia of the area, an epidural
needle is inserted through which a catheter is advanced to the
injection site. During the procedure, you may be asked how a certain
stimulus may feel. The movement of the catheter is continuously
monitored under X-ray guidance to assure safe and effective
positioning. The makeup of the epidural space is as unique as your
fingerprints, so relative ease of placement varies. Your physician
will inject contrast material to see an outline of the epidural
space on the monitor. The contrast material is simply a fluid that
shows up on x-ray, and has no adverse effect on the human body in
this procedure. Other fluids will also be injected to relieve pain,
dissipate scar tissue, and reduce inflammation. Common injectates
may include steroids, local anesthetics, and preservative free
normal saline.
WHAT HAPPENS NEXT?
Following the procedure, you will be observed in our recovery area
for an appropriate amount of time. The procedure and the results
will be discussed with you. The injectates help to break up the
scarring around the nerve root and reduce swelling. The anesthetic
agent can work the day of the procedure to temporarily relieve the
pain. The steroid however, will take effect over the next several
days. It may take several visits to break up all of the adhesions
associated with your pain. Physical therapy is an excellent adjunct
to the procedure in relieving the spinal nerves from inflammation.
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Spinal Cord Stimulation
WHAT IS SPINAL CORD STIMULATION (SCS)?
Spinal cord stimulation is an advanced treatment for chronic pain
using low-level electrical impulses to stimulate targeted nerves
along the spine. The stimulation interferes with the transmission of
pain signals to the brain. When successful, painful sensations are
replaced with what some patients describe as a more pleasing
sensation, called paresthesia.
WHAT DOES SPINAL CORD STIMULATION THERAPY INVOLVE? Spinal cord
stimulation requires a minor surgical procedure to implant the
system components. During the procedure, one or more leads are
placed in the epidural space. The leads contain electrodes that
produce the electrical signals that result in stimulation. The leads
are then connected to a small electronic device placed just under
the skin.
IS SPINAL CORD STIMULATION SAFE?
Spinal cord stimulation has been used successfully in thousands of
people worldwide over the last two decades. SCS has been approved by
the FDA for the treatment of certain types of chronic pain,
including pain of the arms, legs and/or trunk.
WHAT DOES SPINAL CORD STIMULATION FEEL LIKE? The sensation - called
paresthesia - can differ from patient to patient. Some people
describe it as a pleasant tingling. Ideally, the stimulation should
be located in areas where chronic pain is usually felt, replacing
the pain with a more pleasing, non-painful sensation.
WILL I BE TOTALLY PAIN-FREE WITH SPINAL CORD STIMULATION?
Spinal cord stimulation is not a cure, so it is unlikely that it
will eliminate all of your pain. The degree of pain relief attained
varies from person to person. The goal of SCS is to decrease severe
chronic pain to a more manageable level.
WILL SPINAL CORD STIMULATION ALLOW ME TO BE FREE OF PAIN MEDICINES?
Spinal cord stimulation is part of an overall treatment plan to
manage chronic pain. Many people are able to decrease or even
discontinue pain medications. However, there may be times when your
pain increases, and you will need pain medication in addition to
spinal cord stimulation.
IS SPINAL CORD STIMULATION SIMILAR TO TENS?
Both TENS and SCS use electrical impulses, but they are very
different in how they work and the types of pain they can treat
effectively. A TENS unit is an external device. It delivers
electrical impulses through pads placed directly on the skin over
the painful area. TENS stimulation is weaker and more localized than
SCS. TENS is generally not effective for severe chronic pain. Past
success or failure with TENS therapy is not an indication of how you
will respond to spinal cord stimulation therapy.
DOES SPINAL CORD STIMULATION REQUIRE MAJOR SURGERY?
No. The trial procedure requires sterile conditions. The permanent
unit if pain relief is adequate will be performed at a hospital or
day surgery center and typically does not require a lengthy hospital
stay.
ARE THERE POSSIBLE COMPLICATIONS WITH THE SURGERY?
As with any procedure, there is a risk of infection and bleeding.
There is also a possibility of injury to the spinal cord, equipment
failure, or lack of benefit from the therapy. Although the risk of
complication is low, you should ask your doctor about them.
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