Treatments

Spinal Cord Stimulator Placement
Epidural Steroid Injection
Facet Interventions / Rhizotomy
Selective Nerve Block
Sacroiliac Injection
Sympathetic Ganglion block
Vertebroplasty

Epidural Steroid Injection

Procedure Details
Pre Procedure
Post Procedure
Epidural steroid injection has been known historically as the first-line, minimally invasive treatment for your pain of the neck or back. This technique is utilized in a large percentage of patients with unrelenting pain and has been successfully used since 1953. The physician uses an X-ray device called a fluoroscope to guide a needle down to the vertebrae that is causing the pain. The needle is carefully advanced under X-ray guidance into the epidural space, which is the area surrounding the spinal cord. After the physician injects a contrast solution to confirm the needle’s position, a steroid-anesthetic mix will then be injected into the epidural space. This mixture will help soothe the painful area and will aid in reducing inflammation.

The doctor who will perform the injection reviews your medical history and previous imaging studies to plan the best approach for the injections. Be prepared to ask any questions you may have at this appointment.

Patients who take blood-thinner medications (i.e. Coumadin, Heparin, Plavix, NSAIDs or high-dose aspirin) may need to stop taking them five days before the ESI. Discuss any medications with your doctors, including the one who prescribed them and the doctor who will perform the injection.

If you think you may be pregnant or are trying to get pregnant, please tell the doctor. Fluoroscopy X-rays used during the procedure may be harmful to the fetus.

Day of the procedure

  • Plan to arrive 15 minutes before your scheduled appointment time.
  • We recommended that you avoid eating two hours prior to the appointment.
  • Make arrangements to have someone drive you to and from the office or outpatient center the day of the injection.

As the needle is removed, a small bandage will be applied. The patient will be observed in our recovery room with food and drink before being discharged with post-treatment instructions. Although one injection may only be needed for some patients, others may require two to three injections in a series to gain significant functional relief.

Facet Interventions / Rhizotomy

Procedure Details
Pre Procedure
Post Procedure
As facet changes may be subtle and confounding, CT and MR imaging may not always be reliable. Careful patient history and physical exam may be crucial in the diagnosis of facet-related pain. The facet is served by a small nerve fiber called the medial branch, which is key to facet pain. In most cases, an initial test injection of anesthetic, called a block procedure, is used to evaluate the relevance of the facet to the patient’s pain. Often, two block procedures are required by insurance companies and have been shown to statistically improve the chance for successful rhizotomy if both block procedures show a substantial amount of relief. If there is good reduction of pain with block injection, a more permanent treatment may be used to deaden the nerve (neurolysis or rhizotomy) in an attempt to affect long-term relief.

View a Facet Joint Injection Procedure Video

For facet block:

Please do NOT take any pain medication, prescribed or over-the-counter, the day of your procedure and 12 hours after procedure.

Plan to arrive 15 minutes before your scheduled appointment time.

Make arrangements to have someone drive you to and from the office or outpatient center the day of the injection.

Patients who take blood-thinner medications (i.e. Coumadin, Heparin, Plavix, NSAIDs or high-dose aspirin) may need to stop taking them 5 days before the ESI. Discuss any medications with your doctors, including the one who prescribed them and the doctor who will perform the injection.

For Rhizotomy:

Do not eat any food four hours prior to your procedure. You may have clear liquids right up to procedure time.

If you are on ANY BLOOD THINNERS, please see the guidelines below (Check with your physician if you are unsure about stopping these medications):

Drug Name Please Discontinue
Argatroban 2 hours prior
Aspirin (Baby Aspirin) 5 days prior
Pletal (Cilostazol) 2 days prior
Plavix (Clopidogrel) 5 to 7 days prior
Pradaxa (Dabigatran) 2 days prior
Lovenox (Enoxaparin) 12 hours prior
Heparin 4 hours prior
Xarelto (Rivaroxaban) 3 days prior
Coumadin (Warfarin) 5 days prior

You will be placed in a recovery room after your intervention, where you may relax and will be given fluids. The doctor will then make a decision on your future pain management track and give you any other post operative instructions you may need. Also, plan to have a driver take you home after your procedure.

Selective Nerve Block

Procedure Details
Pre Procedure
Post Procedure

A minimally-invasive technique that can be performed in a matter of minutes, typically without need for any sedation, utilizing CT or X-ray guidance. Selective nerve blocks are similar to epidural steroid injections in many ways. Instead of targeting a large area of the spinal column and its nerve tissue, injecting a diluted solution, selective nerve blocks use a concentrated mixture of both anti-inflammatory steroid and/or anesthetic agent. The concentrated solution only makes slight contact directly with one or two specific nerve fibers or bundles, and the patient may obtain significant pain relief in a matter of a few minutes. A block without steroid is often used for diagnostic purposes at the request of an ordering neurosurgeon to identify or confirm a specific problematic nerve that is causing pain or weakness, before offering surgical or non-surgical intervention to treat the problem.

The doctor who will perform the injection reviews your medical history and previous imaging studies to plan the best approach for the injections. Be prepared to ask any questions you may have at this appointment.

Patients who take blood-thinner medications (i.e. Coumadin, Heparin, Plavix, aspirin, and other NSAIDS) may need to stop five days before the selective nerve block. Discuss any medications with your doctors, including the one who prescribed them and the doctor who will perform the injection.

If you think you may be pregnant or are trying to get pregnant, please tell the doctor. Fluoroscopy X-rays used during the procedure may be harmful to the fetus.

Day of the procedure

  • Plan to arrive 15 minutes before your scheduled appointment time.
  • We recommend that you avoid eating two hours prior to the appointment.
  • Make arrangements to have someone drive you to and from the office or outpatient center on the day of the injection.

As the needle is removed, a small bandage will be applied. The patient will be observed in a recovery room with food and drink before being discharged with post treatment instructions. Although one injection may only be needed for some patients, others may need two to three injections for significant relief if the injection is performed for therapeutic purposes.

Sacroiliac Injection

Procedure Details
Pre Procedure
Post Procedure

When sacroiliac pain is suspected, injection of the joint space may serve as a dual purpose. A small amount of local anesthetic mixed with steroid solution, typically performed under CT guidance, allows early onset of pain relief along with the more extended anti-inflammatory pain relief of the steroid. The rapid onset anesthetic also helps to confirm or deny the injected joint as the source of the patient’s pain and may help direct additional treatment, such as physical therapy.

The doctor who will perform the injection reviews your medical history and previous imaging studies to plan the best approach for the injections. Be prepared to ask any questions you may have at this appointment.

Patients who take blood-thinner medications (i.e. Coumadin, Heparin, Plavix, aspirin, or other NSAIDS) may need to stop five days before the injection. Discuss any medications with your doctors, including the one who prescribed them and the doctor who will perform the injection.

If you think you may be pregnant or are trying to get pregnant, please tell the doctor. Fluoroscopy X-rays used during the procedure may be harmful to the fetus.

Day of the procedure

  • Plan to arrive 15 minutes before your scheduled appointment time.
  • You may have something light to eat on the day of the appointment.
  • Make arrangements to have someone drive you to and from the office or outpatient center the day of the injection.

As the needle is removed, a small bandage will be applied. The patient will be observed in a recovery room for a period of time before being discharged with post treatment instructions. Although one injection may only be needed for some patients, the injection can be repeated after a period of time if pain recurs, oftentimes in combination with other treatment modalities, such as physical therapy.

Vertebroplasty

Procedure Details
Pre Procedure
Post Procedure

Vertebroplasty is one of our procedures that is used to help pain related to collapse of a vertebral body in the spine, possibly due to osteoporosis, trauma, or cancer. Under X-ray guidance, bone cement is placed into the weakened vertebral body through a small needle to improve strength of the porous and weakened bone, preventing further collapse, diminishing pain, and allowing improved function. The procedure has a high rate of success in appropriately selected patients, and multiple fractured vertebral bodies may be treated in a single treatment session.

The doctor who will perform the procedure reviews your medical history and previous imaging studies to plan the best approach to the vertebra to be treated. Be prepared to ask any questions you may have.

Patients who take blood-thinner medications (i.e. Coumadin, Heparin, Plavix, aspirin, and other NSAIDS) may need to stop 5 days before the selective nerve block. Discuss any medications with your doctors, including the one who prescribed them and the doctor who will perform the procedure.

If you think you may be pregnant or are trying to get pregnant, please tell the doctor. Fluoroscopy X-rays used during the procedure may be harmful to the fetus.

Day of the procedure

  • Plan to arrive 15 minutes before your scheduled appointment time.
  • We recommended that you refrain from eating four hours prior to the appointment.
  • Make arrangements to have someone drive you to and from the office or outpatient center the day of the injection.

After the needle is removed, a small bandage will be applied. The patient will be observed in a recovery room for typically one to two hours before being discharged with post treatment instructions, usually with limited activity through the first hour as the vertebral cement quickly stabilizes and procedural sedation wears off. The procedure may be repeated if future compressions should occur. Potential lifestyle changes may also be discussed to avoid as much of the continuing trauma to the vertebrae and spinal column as possible.

Spinal Cord Stimulator Placement

Procedure Details
Pre Procedure
Post Procedure
A spinal cord stimulator is a small device implanted under the skin’s surface, connected to a small set of wires and electrodes that extend to the spinal canal. The device uses a low-level electrical stimulation of the spinal nerves to block pain impulses from passing through the spinal cord to the brain, thereby impeding the pain sensation. By blocking these pain signals, the overall sense of pain may be markedly reduced and quality of life may be significantly improved.

Prior to implantation of the device, a test stimulation procedure is performed with one or two small wire leads placed into the spinal canal through a small needle and attached to a belt pack. If successful, with improvement in both pain level and functional abilities, consideration and discussion will then be given to movement to permanent implantation.

After both the trial and implantation procedures, we will be in frequent contact and may make changes to the programming of the stimulator device to optimize the level of pain relief.

The doctor who will perform the procedure, reviews your medical history and previous imaging studies to plan the best approach for the device placement. Be prepared to ask any questions you may have.

Patients who take blood-thinner medications (i.e. Coumadin, Heparin, Plavix, aspirin, and other NSAIDS) may need to stop five days before the procedure. Discuss any medications with your doctors, including the one who prescribed them and the doctor who will perform the procedure.

Day of the procedure

  • Plan to arrive 15 minutes before your scheduled appointment time.
  • We ask that you have nothing to eat four hours prior to the appointment.
  • Make arrangements to have someone drive you to and from the office or outpatient center the day of the procedure.

After procedure, bandages will be applied. The patient will be observed in a recovery room for typically one to two hours before being discharged with post treatment instructions. Initial programming of the generator computer control will usually be performed prior to discharge. Following a trial procedure, the leads will usually be removed under X-ray in five days in the clinic. If the permanent implantation is performed, the small incision to place the battery/generator and wire leads will be closed with sutures or skin staples, and these will be removed one week after the procedure during the scheduled office post procedure follow-up examination.

Sympathetic Ganglion Block

Procedure Details
Pre Procedure
Post Procedure

Sympathetic ganglia are clusters of specialized nerve cells that are present in the neck and chest, as well as the abdomen and pelvis and play a role in the transmission and perception of pain impulses as they travel to the spinal cord and brain. It is well-known, but not completely understood, that these clusters of nerve cells play a role in the develop of chronic pain syndromes, such as Chronic Regional Pain Syndrome (CRPS) and coccydynia, often occurring after what may be mild trauma, and possibly related to abnormal function and firing of the nerve fibers. Sympathetic ganglion block may also be useful in the treatment of pain related to cancer or inflammatory disease, such as pancreatitis.

During a block, a small needle is guided to the group of fibers, utilizing X-ray, CT scan, or ultrasound guidance. A mixture of anesthetic and, often, some steroid is injected along the nerves, and the needle removed. It is suspected that the mixture resets and calms the firing of the nerve fibers and decreases the level of perceived pain. The steroid may also reduce some associated inflammation. The most commonly utilized sympathetic blocks are the stellate ganglion block, lumbar sympathetic block, celiac plexus block, superior hypogastric block, and impar ganglion block. Sympathetic blocks may be used in combination with other treatment options, such as medications and in pain situations that occur after trauma or injury. Often, they are combined with intense physical therapy to improve strength and flexibility and potentially retrain the nerve fibers.

The doctor who will perform the injection will review your medical history and previous imaging studies to plan the best approach to injection. Be prepared to ask any questions you may have pre procedure.

Patients who take blood-thinner medications (i.e. Coumadin, Heparin, Plavix, aspirin, or other NSAIDS) may need to stop five days before the sympathetic block. Discuss any medications with your doctors, including the one who prescribed them and the doctor who will perform the injection.

If you think you may be pregnant or are trying to get pregnant, please tell the doctor. Fluoroscopy X-rays used during the procedure may be harmful to the fetus.

Day of the procedure

  • Plan to arrive 15 minutes before your scheduled appointment time.
  • We recommended that you avoid food intake four hours prior to the appointment.
  • Make arrangements to have someone drive you to and from the office or outpatient center the day of the injection.

After the needle is removed, a small bandage will be applied. The patient will be observed in a recovery room for typically one hour post procedure to allow sedation to wear off, if utilized. Post procedure follow-up and associated therapies will be discussed.

We Look Forward To Working With You.