EPIDURAL STEROID INJECTIONS
 What are Epidural Steroid Injections?
The placement of anti-inflammatory steroid solution near the inflamed spinal nerves that are responsible for your pain. The site of the nerve irritation is most often within the bony spinal column just outside the spinal cord, in the portion of the bony spinal canal known as the epidural space.
Who may benefit from them?
People with neck, arm, back or leg pain (sciatica) due to irritation of the spinal nerves. Causes of the nerve inflammation are mechanical (direct pressure) or chemical (irritating substance) and result from either herniated or damaged spinal discs, a tight spinal canal (spinal stenosis) or severe arthritis of the spine.
How are they done?
Epidural steroid injections are safely performed on an outpatient basis. All of our procedures are done under continuous x-ray (fluoroscopy) to ensure exact placement of the medication. The skin is always numbed with local anesthetic before careful placement of specially designed small gauge needles. First, contrast (dye) is injected to better visualize the anatomy and confirm proper location. The therapeutic steroid mixture is then injected and the needle is removed. The procedure typically lasts less than 15 minutes followed by 20-minute recovery.
FACET INJECTIONS
What are facet injections?
Injections of local anesthetic to numb the small joints of the bony spine in the neck or back. Often, facet injections are performed for diagnostic purposes to determine whether or not these joints are causing neck or back pain. If the facet joints are causing your pain, treatment (radiofrequency) is then directed to these specific sites.
Who is a candidate for facet injections?
Anyone with persistent neck or back pain, who has not responded to epidural steroid injections or conservative therapies (i.e. chiropractor, anti-inflammatory medications, physical therapy).
How is the injection performed?
Facet injections are safely performed on an outpatient basis. After sterilizing the area, a small amount of local anesthetic is used to numb the skin. Needles are then placed through the numb area to the desired locations using real-time x-ray (fluoroscopy) to ensure precise placement. A small amount of local anesthetic is injected and the needle is withdrawn. The procedure itself typically takes 15 minutes followed by a short observation period.
RADIOFREQUENCY
What is radiofrequency?
Radiofrequency is a safe and effective technique used in pain management to desensitize specific nerves and reduce pain impulses using radiowaves. It is used to treat certain neck, arm, back or leg pain problems after the cause of the pain has been identified.
Who is a candidate for radiofrequency?
People with persistent neck, arm, back or leg pain, with specific nerves or joints that have been identified as causing their pain. Diagnostic blocks, with local anesthetic, have been performed prior to the use of radiofrequency to ensure that the correct origin of the pain is located.
How is radiofrequency performed?
Radiofrequency is performed on an outpatient basis with the availability of monitoring and sedation. After sterilizing the area, a small amount of local anesthetic is used to numb the skin. Small needles are then placed through the numb area to the desired locations using special realtime x-ray (fluoroscopy) to ensure precise placement. A probe, attached to a radiofrequency generator, is passed through the needle and produces radiowaves that desensitize the desired nerves. The procedure itself takes less than 30 minutes, followed by a short observation period.
PERCUTANEOUS DISC DECOMPRESSION
Percutaneous Disc Decompression?
Percutaneous Disc Decompression procedure is indicated in patients who are suffering from pain, numbness or disability resulting from a bulging or herniated lumbar disk. Most often, these patients are presenting with pain in the lower back, which may be radiating into either leg and foot, or both, and is often associated with numbness. It is indicated in certain patients with low back pain only, after further diagnostic testing. Similarly, it may be appropriate in patients with leg pain only, resulting from an abnormal lumbar disk.
The appropriate diagnostic evaluation prior to this procedure will nearly always involve a cervical or lumbosacral spine MRI as well as complete history and physical examination. If the pain is limited to the lower back without obvious radiation into the legs, discography or injection of contrast dye into the disk to further elucidate the pain mechanism may be required. The extent of disk bulge or herniation must be modest, as large herniated disks may not respond well to this treatment. On the other hand, it should be noted that patients with small bulging or herniated disks may benefit more from this non-invasive treatment than from a surgical approach to treating their disk abnormality.
Nucleoplasty uses a coblation technology, which utilizes radiofrequency energy to ablate tissue inside the disk resulting in decompression of the disk and thermal alteration of the tissue. This effectively reduces the extent of disk protrusion, as well as desensitizing the disk itself. The resultant pain relief should be obvious within several days after the procedure and the pain associated with the procedure itself is quite minimal.
The procedure is done through a needle that is placed into the herniated disc after numbing the skin. Real time X-ray guidance is used to properly locate the needle tip inside the abnormal disk and contrast dye may be injected to confirm optimal placement. A wand is placed through the needle, to generate radio waves that dissolve excess disk tissue, reducing the size of the disk. This relieves the pressure in the disk and on adjacent nerves.
This procedure is done on an outpatient basis with minimal recovery necessary and with very low incidence of complications. The result is disk decompression and pain relief, accomplished without surgical intervention and with far less opportunity for complication or need for rehabilitation.
DeKompressor technology reduces the herniated disc by removing tissue using a rotary action through a needle. This achieves similar results to Nucleoplasty, effectively creating a space or vacuum effect within the disc, pulling the herniation or bulge backward.
Hydrocision uses a probe placed through a needle which generates a high pressure water stream; effectively eating the internal disc material which is then removed through a separate port in the probe. The herniated disc is then decompressed. |