Treatments

Epidural Steroid Injection
Selective Nerve Block
Facet Interventions
Vertebroplasty
Trigger Point Injection
Spinal Cord Stimulator Placement
Sacroiliac Joint Injection

Epidural Steroid Injection

Pre Procedure
Procedure Details
Post Procedure

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 take blood thinner medications (ie. Coumadin, Heparin, Plavix, Ticlid, Fragmin, Orgaran, Lovenox, Innohep, high-dose aspirin) may need to stop taking it 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.

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 have something light to eat prior to the appointment.
  • Make arrangements to have someone drive you to and from the office or outpatient center the day of the injection.

Historically known 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 pushed into the epidural space, which is the area surrounding the spinal cord. After the physician injects a contrast solution to confirm the needles position, a steroid-anesthetic mix will then be injected into the epidural space. This mixture will help sooth the painful area and will aid in reducing inflammation.

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As the needle is removed, a small bandage will be applied. The patient will be placed 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 are required to have two to three injections upon significant relief.

Selective Nerve Block

Pre Procedure
Procedure Details
Post Procedure

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 take blood thinner medications (ie. Coumadin, Heparin, Plavix, Ticlid, Fragmin, Orgaran, Lovenox, Innohep, high-dose aspirin) may need to stop taking it 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 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 have something light to eat prior to the appointment.
  • Make arrangements to have someone drive you to and from the office or outpatient center the day of the injection.

A minimally invasive technique that can be performed in a matter of minutes, often without the 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 spinal 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.

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As the needle is removed, a small bandage will be applied. The patient will be placed 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 are required to have two to three injections upon significant relief.

Facet Interventions

Pre Procedure
Procedure Details
Post Procedure

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

Anticipate procedure and recovery time to be approximately 1 hour.

Do not EAT any food 4 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

 

 

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 many cases, a test injection of anesthetic is used to evaluate the relevance of the facet to the patients’ pain. If there is good reduction of pain, a more permanent treatment may be used to deaden the nerve (neurolysis or rhizotomy) in an attempt to affect term relief.

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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.

Vertebroplasty

Pre Procedure
Procedure Details
Post Procedure

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

Patients who take take blood thinner medications (ie. Coumadin, Heparin, Plavix, Ticlid, Fragmin, Orgaran, Lovenox, Innohep, high-dose aspirin) may need to stop taking it 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 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 have something light to eat prior to the appointment.
  • Make arrangements to have someone drive you to and from the office or outpatient center the day of the injection.

Vertebroplasty is one of our procedures that is used to help cancer pain and osteoperosis. Bone cement is placed into the weakened vertebral body to improve strength of the porous 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.

Once the area of bone is cemented and filled, the tube will be removed with an “internal cast” in place. The cast stabilizes the vertebral body resulting in rapid pain relief. A small bandage will be applied and the patient will be placed in a recovery room for several hours with food and drink before being discharged with post treatment instructions.

Trigger Point Injection

Pre Procedure
Procedure Details
Post Procedure

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 take blood thinner medications (ie. Coumadin, Heparin, Plavix, Ticlid, Fragmin, Orgaran, Lovenox, Innohep, high-dose aspirin) may need to stop taking it 5 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.
  • We recommended that you have something light to eat prior to the appointment.
  • Make arrangements to have someone drive you to and from the office or outpatient center the day of the injection.

Trigger point is the term used to describe hypersensitivity in a taut, knot-like muscle. It is thought that the hypersensitivity develops in response to repetitive pain or trauma to a muscle blunder, leading to localized pain.  A trigger point injection is placed directly within the trigger joint area and may provide almost immediate relief of pain.

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As the needle is removed, a small bandage will be applied. The patient will be placed 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, most trigger point injection patients will have a series of three injections, generally one week apart.

Spinal Cord Stimulator Placement

Pre Procedure
Procedure Details
Post Procedure

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

Patients who take take blood thinner medications (ie. Coumadin, Heparin, Plavix, Ticlid, Fragmin, Orgaran, Lovenox, Innohep, high-dose aspirin) may need to stop taking it 5 days before the surgery. Discuss any medications with your doctors, including the one who prescribed them and the doctor who will perform the placement.

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 have something light to eat prior to the appointment.
  • Make arrangements to have someone drive you to and from the office or outpatient center the day of the injection.

A spinal cord stimulator is a small device implantd under the skin surface, connected to a small set of 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, and there by 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.

After the procedure the patient will be placed in a recovery room for several hours with food and drink before the doctor goes over your post treatment instructions. The implants electrical pulses are programmed with an external control unit. The doctor will show the patient how to turn the unit on and off as well as how to adjust the stimulation power and switch between different programs.

Sacroiliac Joint Injection

Pre Procedure
Procedure Details
Post Procedure

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 take blood thinner medications (ie. Coumadin, Heparin, Plavix, Ticlid, Fragmin, Orgaran, Lovenox, Innohep, high-dose aspirin) may need to stop taking it 5 days before the joint 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.
  • We recommended that you have something light to eat prior to the appointment.
  • Make arrangements to have someone drive you to and from the office or outpatient center the day of the injection.

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 allows early onset of pain 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.

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.

We Look Forward To Working With You.