Injection treatments & non-surgical therapies

CRMC’s non-surgical specialists diagnose neck pain, back pain, and common painful spinal conditions and offer specific treatment plans built on a conservative, nonsurgical approach. In many cases surgery is not indicated for a specific condition, and so we consider image guided injections in an effort to reduce your pain and improve function. 

Some of the goals of injection treatments and non-surgical therapies include:

  • Image guided injections may help improve function for a variety of common painful spine conditions.
  • They can help to relieve pain by reducing inflammation, irritation and swelling of nerves, joints, and discs of the spine.
  • In addition to reducing pain, image guided injections may be necessary for diagnosing specific causes of your pain. Identifying the exact source of your neck pain, back pain, or nerve pain is very important when considering all of a patients options.
  • By treating immediate pain, injections can also make it easier for you to participate in a physical or alternative therapy programs designed to strengthen muscles and resolve the underlying cause of the pain.

 

The type of injection you receive will be based on your symptoms and physical examination. Listed below are some of the specialized image guided injections we offer to patients:

EducatonalButton.jpg

Introduction

Epidural therapy is effective in the treatment of many painful conditions that originate from the spine.  These conditions include disc herniation and injury, acute herpes zoster, post-herpetic neuralgia, sciatica pain, radicular nerve pain, cancer pain, and post-surgical pain. Epidural steroid injections are used as a minimally invasive, non-surgical therapy to supplement other conservative medical therapies, such as physical therapy or rehabilitation programs.

There are several specific techniques or approaches to epidural steroid injections. The specific type of epidural steroid injection chosen by your doctor or provider will depend on the underlying condition and symptoms you are having. These are not limited to, but may include:

  • Interlaminar epidural steroid injections
  • Transforaminal epidural steroid injections
  • Caudal epidural steroid injections

There are also different types of steroid medications that may be administered.  These may include, but are not limited to:

  • Dexamethasone (Decadron)
  • Methylprednisolone (Depomedrol)
  • Triamcinolone (Kenalog)
  • Betamethasone (Celestone)

Goal of the procedure

Inflammation is the most common source of pain and irritation that involves the spine and nerves.  Nerve inflammation from various sources causes an increase in firing of the pain signal and has been shown to contribute to the perpetuation of many types of persistent pain states. Injection of steroid (cortisone or corticosteroid) into the epidural space around the nerves of the spine is a safe and effective treatment directed at reducing inflammatory pain and irritation.

The procedure

Epidural steroid injections are performed by your doctor in a sterile procedure suite utilizing X-ray guidance. This procedure is often done without sedation, as the skin over the area of interest is anesthetized with local anesthetic. In certain types of epidural injections, where the needle is placed in close proximity to a specific nerve, it is possible to have a very brief electric type pain “shoot” into an extremity. This is a common occurence and is typically mentioned during the procedure to reassure you that it is not abnormal or harmful.

Following the procedure, which often takes less than 10 minutes, you will be cared for by a nurse in the recovery area until you are ready to be discharged home.

After the procedure

Follow the specific instructions given to you by the nurses at the time of discharge from the recovery area:

  • Do not drive or operate heavy machinery for 24 hours after your procedure, if you received sedation
  • Resume “normal” daily activities as tolerated after your procedure. You may shower.
  • Do NOT soak in a bathtub or lake for 24 hours after your procedure
  • It may take 7-10 days for the procedure to be effective
  • You will receive a phone call from a clinic nurse, the following day to check in and see how you are recovering.

If your procedure includes sedation

  • You should have no solid foods for 8 hours before the procedure.
  • You may have clear liquids up to 2 hours before your procedure. Examples of these clear liquids are:  water, broth, clear juices with NO pulp, tea, coffee WITHOUT cream. Carbonated beverages are NOT allowed.
  • No gum chewing for 2 hours before your procedure.
  • No candy, throat lozenges, or mints.
  • A nurse will call you before your procedure to review your medications and make recommendations as to what medicines you should take before your procedure.

Failure to comply with these instructions may result in cancellation and rescheduling of your procedure.

Potential risks of the procedure

Epidural steroid procedures are considered safe, non-surgical, minimally invasive treatments for patients suffering from certain types of pain. As with all medical procedures, there are associated risks and possible side effects that may vary between each patient. These rare but potential risks are:

  • Pain at the injection site

  • Infection in the form of an epidural abscess or at the skin. In very rare instances minor infections can occur
  • Stroke
  • Dural puncture or cerebral spinal fluid leak.  This typically presents as a headache that is worse with upright position and completely alleviated when lying flat
  • Increased pain or worsening symptoms.
  • Bleeding in the form of an epidural hematoma or at the site. You may suffer bleeding from undergoing procedures, especially while on blood thinning medications. Please notify us if you are taking any of the following blood
  • thinning medications: 
    Plavix (Clopidogrel), Aspirin, XareltoWarfarin (Coumadin), 
  • (Rivaroxaban), Heparin, Lovenox  (Enoxaparin), Brilinta (Ticagrelor), or any others not listed.
  • Nerve or spinal cord damage. In extremely rare instances, a patient may suffer nerve or spinal cord damage from direct trauma from a needle. This could potentially result in permanent nerve damage or paralysis.
  • Allergic reactions to medications. The commonly used medications in this procedure include: Lidocaine, Bupivacaine, Ropivacaine, and IV contrast dye.
  • Other risks are not limited to, but include:  epidural fibrosis, aseptic meningitis, GI side effects, renal failure, seroma, and paralysis.
  • Inability to complete the injection due to technical or anatomic difficulty.

When should I expect results?

Epidural steroid injections reduce pain by decreasing inflammation of damaged or irritated structures.  The steroid (cortisone or corticosteroid) medication works on a cellular level, by decreasing inflammatory mediators.  This process is slow and often takes 7-10 days to produce results.  The immediate relief felt by the injection may be attributed more to the local anesthetic used by the doctor during the procedure.

Often times if one specific type of epidural steroid injection does not provide the relief that is expected, a different approach may be recommended by your doctor or provider. Typically, you will follow-up with the doctor 1 month after the procedure to evaluate results and come up with a plan if benefit was not obtained.

Insurance requirements

Insurance companies have a series of requirements that must be met, prior to their approval of epidural steroid injections. These may vary between insurance companies, however; they commonly include:

  • Physical Therapy – often a minimum of 4 weeksin duration
  • Appropriate imaging, which may include X-raysor MRI.
  • Documentation of failure to improve with otherconservative medical therapies

EducatonalButton.jpg

Introduction

A common source of neck, mid back, and low back pain, is arthritis of the facet joints. These are small synovial joints (like other joints in the body) that allow for movement of the neck and back. When arthritis becomes significant enough to involve these small joints, simple movements such as bending, twisting, standing, or walking can create significant pain. This pain is transmitted to the brain by way of a small nerve from each joint, called the medial branch nerve.

Facet joint injections are a safe, non-surgical, minimally invasive treatment for pain coming from arthritis or inflammation of the facet joints.

Goal of the injection

The goal of a facet joint injection is to place a small amount of steroid (cortisone or corticosteroid) and local anesthetic into one or more of the inflamed joint(s). The injection can be used to diagnose or treat. The injected steroid serves as an anti-inflammatory medication, decreasing pain and improving the patient’s movement and activity.

Sometimes facet injections are used specifically to help diagnose where the pain may be coming from, and can help determine if a patient would be a candidate for other treatments used to decrease painful conditions of the facet joints, such as radiofrequency ablation.

The procedure

The patient is brought into a sterile procedure suite, and asked to lie on the exam table. Using X-ray guidance, the skin is anesthetized and a small needle is directed to the joint(s) of interest. Once the needle is in proper location, a small amount of steroid medication is injected.

Following injection, the patient is cared for in the recovery area for a brief amount of time, and then discharged home.

After the procedure

Follow the specific instructions given to you by the nurses at the time of discharge from the recovery area:

  • Resume activity as tolerated
  • Patients may be encouraged to perform activities that typically cause an increase in their normal pain. This is used to “test” whether the diagnostic procedure is helpful in reducing your pain.
  • Do NOT soak in a bathtub or lake for 24 hours after the procedure. You may shower.
  • You will receive a phone call from a clinic nurse, asking about the relief of symptoms you experienced after your injection.

If your procedure includes sedation

  • You should have no solid foods for 8 hours before the procedure.
  • You may have clear liquids up to 2 hours before your procedure. Examples of these clear liquids are:  water, broth, clear juices with NO pulp, tea, coffee WITHOUT cream. Carbonated beverages are NOT allowed.
  • No gum chewing for 2 hours before your procedure.
  • No candy, throat lozenges, or mints.
  • A nurse will call you before your procedure to review your medications and make recommendations as to what medicines you should take before your procedure.

Failure to comply with these instructions may result in cancellation and rescheduling of your procedure.

Potential risk of the procedure

Facet joint injections are considered safe, non-surgical, minimally invasive treatments. As with all medical procedures, there associated risks and side-effects that may vary between each patient. These rare but potential risks are:

  • Pain at the injection site
  • In very rare instances (less than 1%), minor infections can occur
  • Increased pain or worsening symptoms.
  • Collapsed lung (Pneumothorax). This is a unique risk to thoracic facet joint injections because of the proximity of the lung in that region of the body.
  • Bleeding. The patient may suffer bleeding from undergoing procedures, especially while on blood thinning medications. Please notify us if you are taking any of the following blood thinning medications: Warfarin (Coumadin), Plavix (Clopidogrel), Aspirin, Xarelto (Rivaroxaban), Heparin, Lovenox (Enoxaparin), Brilinta (Ticagrelor), or any others not listed.
  • Nerve or spinal cord damage. In extremely rare instances, a patient may suffer nerve or spinal cord damage from direct trauma from a needle. This could potentially result in permanent nerve damage or paralysis.
  • Allergic reactions to medications. The commonly used medications in this procedure include: Lidocaine, Bupivacaine, Ropivacaine, IV contrast dye, and corticosteroid (cortisone).
  • Inability to complete the injection due to technical or anatomic difficulty.

Insurance requirements

Insurance companies have a series of requirements that must be met, prior to their approval of epidural steroid injections. These may vary between insurance companies, however; they commonly include:

  • Physical Therapy – often a minimum of 4 weeksin duration
  • Appropriate imaging, which may include X-raysor MRI.
  • Documentation of failure to improve with otherconservative medical therapies

EducatonalButton.jpg

Introduction

A common source of neck, shoulder, and headache pain is arthritis of the facet joints. These are small synovial joints (like other joints in the body) that allow for movement of the neck and head. When arthritis becomes significant enough to involve these small joints, simple movements can create significant pain in the neck and head. This pain is transmitted to the brain by a small nerve from each joint, called the medial branch nerve. Blocking this nerve with local anesthetic medication may temporarily alleviate pain coming from these joints.

This is a step in the process of identifying your pain, and identifying patients who may be eligible for radiofrequency ablation (neurolysis), which is a procedure that provides longer lasting relief, often 6-12 months duration.

Goal of the injection

In order to determine if pain in the neck, head, or shoulder region is coming from arthritis of the facet joints, we use a diagnostic procedure called medial branch diagnostic blocks. The goal of this procedure is to place a small amount of local anesthetic on the medial branch nerve, which sits over the joint. While the medial branch nerve is anesthetized, the pain transmitted from the neck should be significantly improved – helping us to localize the source of your neck pain.

The procedure

You will be accompanied into a sterile procedure suite and asked to lie on your side or face down on the exam table. Using X-ray guidance, the skin is anesthetized and a small needle is inserted over each area of interest. Once the needle is in the proper location over the medial branch nerve of each joint, a small amount of anesthetic is injected. Following the injection, you will be cared for in the recovery area for a brief amount of time, then discharged home.

After the procedure

Follow the specific instructions given to you by the nurses at the time of discharge from the recovery area:

  • Resume activity as tolerated.
  • You are encouraged to perform activities that typically cause an increase in your normal pain. This is used to “test” whether the diagnostic procedure is helpful in reducing your pain.
  • Do NOT soak in a bathtub or lake for 24 hours after the procedure. You may shower.
  • Keep a record of your pain and symptoms in the immediate hours after your injection.
  • You will receive a phone call from a clinic nurse, asking about the relief of symptoms you experienced after your injection. If you meet specific criteria designated by the insurance companies, you may be scheduled for a second diagnostic block – or you may  be scheduled for radiofrequency ablation as the next step

If your procedure includes sedation

  • You should have no solid foods for 8 hours before the procedure.
  • You may have clear liquids up to 2 hours before your procedure. Examples of these clear liquids are:  water, broth, clear juices with NO pulp, tea, coffee WITHOUT cream. Carbonated beverages are NOT allowed.
  • No gum chewing for 2 hours before your procedure.
  • No candy, throat lozenges, or mints.
  • A nurse will call you before your procedure to review your medications and make recommendations as to what medicines you should take before your procedure.

Failure to comply with these instructions may result in cancellation and rescheduling of your procedure.

Potential risks of the procedure

Radiofrequency ablation procedures are considered safe, non-surgical, minimally invasive treatments. As with all medical procedures, there associated risks and side-effects that may vary between each patient. These rare but potential risks are:

  • Pain at the injection site
  • Infection in the form of an epidural abscess or at the skin. In very rare instances minor infections can occur
  • Stroke
  • Dural puncture or cerebral spinal fluid leak.  This typically presents as a headache that is worse with upright position and completely alleviated when lying flat
  • Increased pain or worsening symptoms.
  • Bleeding in the form of an epidural hematoma or at the site. You may suffer bleeding from undergoing procedures, especially while on blood thinning medications. Please notify us if you are taking any of the following blood
  • thinning medications: 
  • Plavix (Clopidogrel), Aspirin, XareltoWarfarin (Coumadin), 
  • (Rivaroxaban), Heparin, Lovenox  (Enoxaparin), Brilinta (Ticagrelor), or any others not listed.
  • Nerve or spinal cord damage. In extremely rare instances, a patient may suffer nerve or spinal cord damage from direct trauma from a needle. This could potentially result in permanent nerve damage or paralysis.
  • Allergic reactions to medications. The commonly used medications in this procedure include: Lidocaine, Bupivacaine, Ropivacaine, and IV contrast dye.
  • Other risks are not limited to, but include:  epidural fibrosis, aseptic meningitis, GI side effects, renal failure, seroma, and paralysis.
  • Inability to complete the injection due to technical or anatomic difficulty.

Insurance requirements

Insurance companies have a series of requirements that must be met, prior to their approval of epidural steroid injections. These may vary between insurance companies, however; they commonly include:

  • Physical Therapy – often a minimum of 4 weeksin duration
  • Appropriate imaging, which may include X-raysor MRI.
  • Documentation of failure to improve with otherconservative medical therapies

EducatonalButton.jpg

Introduction

Radiofrequency ablation is a therapy that uses radio waves to create an electrical current through the body. This current delivers heat (80 degrees Celsius for 120 seconds) to targeted nerves and tissues. This non-surgical technique is used to target sources of pain in the back and neck.

Each spinal segment, or vertebrae, is connected to the other by a small joint, these are called facet joints. The cause of this inflammation or irritation is often arthritis. Radiofrequency ablation or neurotomy, is used to create a heat lesion on the medial branch nerve. This nerve is responsible for sending a pain signal to the spinal cord and brain from irritated or inflamed facet joints. The heat lesion prevents this nerve from sending a pain signal, and often significantly reduces a patient’s pain for an extended period of time.

Goal of the injection

The radiofrequency ablation procedure (RFA) is a non-surgical, minimally invasive technique that is performed in an outpatient setting. RFA is very similar to the medial branch block procedure, which is used to diagnose pain coming from the facet joints. The goal of the radiofrequency procedure is to provide at least 50% relief of chronic neck or back pain (national average result) for 6-12 months duration, often times even longer.

The procedure

You will likely receive IV sedation for this procedure. A nurse will typically start an IV in the pre-op area prior to the procedure. You are then accompanied into a sterile procedure suite, and asked to lie face down or on your side on the exam table. Using X-ray guidance, the doctor places a small needle on each facet joint, near the medial branch nerve. After the nerve is anesthetized with local anesthetic, an electrical current is used to create the ablation, or heat lesion. This nerve, once treated, will not be able to send as strong of a pain signal to the brain as it did before, giving yuy relief of your chronic neck or back pain.

Following the injection, you will be cared for in the recovery area for a brief amount of time, and then discharged home.

After the procedure

Follow the specific instructions given to you by the nurses at the time of discharge from the recovery area:

  • Do not drive or operate heavy machinery for 24 hours after your procedure, if you received sedation
  • Resume activities as tolerated, understanding you may be sore for 7-10 days
  • It is not uncommon for the patient to not experience relief of their chronic back or neck pain for up to 7-10 days after the procedure
  • Do NOT soak in a bathtub or lake for 24 hours after the procedure. You may shower.
  • You will receive a phone call from a clinic nurse, the following day to check in and see how you are recovering.

If your procedure includes sedation

  • You should have no solid foods for 8 hours before the procedure.
  • You may have clear liquids up to 2 hours before your procedure. Examples of these clear liquids are:  water, broth, clear juices with NO pulp, tea, coffee WITHOUT cream. Carbonated beverages are NOT allowed.
  • No gum chewing for 2 hours before your procedure.
  • No candy, throat lozenges, or mints.
  • A nurse will call you before your procedure to review your medications and make recommendations as to what medicines you should take before your procedure.

Failure to comply with these instructions may result in cancellation and rescheduling of your procedure.

Potential risks of the procedure

Epidural steroid procedures are considered safe, non-surgical, minimally invasive treatments for patients suffering from certain types of pain. As with all medical procedures, there are associated risks and possible side effects that may vary between each patient. These rare but potential risks are:

  • Pain at the injection site
  • Infection in the form of an epidural abscess or at the skin. In very rare instances minor infections can occur
  • Stroke
  • Dural puncture or cerebral spinal fluid leak.  This typically presents as a headache that is worse with upright position and completely alleviated when lying flat
  • Increased pain or worsening symptoms.
  • Bleeding in the form of an epidural hematoma or at the site. You may suffer bleeding from undergoing procedures, especially while on blood thinning medications. Please notify us if you are taking any of the following blood
  • thinning medications: 
  • Plavix (Clopidogrel), Aspirin, XareltoWarfarin (Coumadin), 
  • (Rivaroxaban), Heparin, Lovenox  (Enoxaparin), Brilinta (Ticagrelor), or any others not listed.
  • Nerve or spinal cord damage. In extremely rare instances, a patient may suffer nerve or spinal cord damage from direct trauma from a needle. This could potentially result in permanent nerve damage or paralysis.
  • Allergic reactions to medications. The commonly used medications in this procedure include: Lidocaine, Bupivacaine, Ropivacaine, and IV contrast dye.
  • Other risks are not limited to, but include:  epidural fibrosis, aseptic meningitis, GI side effects, renal failure, seroma, and paralysis.
  • Inability to complete the injection due to technical or anatomic difficulty.

Insurance requirements

Insurance companies have a series of requirements that must be met, prior to their approval of epidural steroid injections. These may vary between insurance companies, however; they commonly include:

  • Physical Therapy – often a minimum of 4 weeksin duration
  • Appropriate imaging, which may include X-raysor MRI.
  • Documentation of failure to improve with otherconservative medical therapies

EducatonalButton.jpg

Introduction

Epidural therapy is effective in the treatment of many painful conditions that originate from the spine.  These conditions include disc herniation and injury, acute herpes zoster, post-herpetic neuralgia, sciatica pain, radicular nerve pain, cancer pain, and post-surgical pain. Epidural steroid injections are used as a minimally invasive, non-surgical therapy to supplement other conservative medical therapies, such as physical therapy or rehabilitation programs.

There are several specific techniques or approaches to epidural steroid injections. The specific type of epidural steroid injection chosen by your doctor or provider will depend on the underlying condition and symptoms you are having. These are not limited to, but may include:

  • Interlaminar epidural steroid injections
  • Transforaminal epidural steroid injections
  • Caudal epidural steroid injections

There are also different types of steroid medications that may be administered.  These may include, but are not limited to:

  • Dexamethasone (Decadron)
  • Methylprednisolone (Depomedrol)
  • Triamcinolone (Kenalog)
  • Betamethasone (Celestone)

Goal of the procedure

Inflammation is the most common source of pain and irritation that involves the spine and nerves.  Nerve inflammation from various sources causes an increase in firing of the pain signal and has been shown to contribute to the perpetuation of many types of persistent pain states. Injection of steroid (cortisone or corticosteroid) into the epidural space around the nerves of the spine is a safe and effective treatment directed at reducing inflammatory pain and irritation.

The procedure

Epidural steroid injections are performed by your doctor in a sterile procedure suite utilizing X-ray guidance. This procedure is often done without sedation, as the skin over the area of interest is anesthetized with local anesthetic. In certain types of epidural injections, where the needle is placed in close proximity to a specific nerve, it is possible to have a very brief electric type pain “shoot” into an extremity. This is a common occurence and is typically mentioned during the procedure to reassure you that it is not abnormal or harmful.

Following the procedure, which often takes less than 10 minutes, you will be cared for by a nurse in the recovery area until you are ready to be discharged home.

After the procedure

Follow the specific instructions given to you by the nurses at the time of discharge from the recovery area:

  • Do not drive or operate heavy machinery for 24 hours after your procedure, if you received sedation
  • Resume “normal” daily activities as tolerated after your procedure. You may shower.
  • Do NOT soak in a bathtub or lake for 24 hours after your procedure
  • It may take 7-10 days for the procedure to be effective
  • You will receive a phone call from a clinic nurse, the following day to check in and see how you are recovering.

If your procedure includes sedation

  • You should have no solid foods for 8 hours before the procedure.
  • You may have clear liquids up to 2 hours before your procedure. Examples of these clear liquids are:  water, broth, clear juices with NO pulp, tea, coffee WITHOUT cream. Carbonated beverages are NOT allowed.
  • No gum chewing for 2 hours before your procedure.
  • No candy, throat lozenges, or mints.
  • A nurse will call you before your procedure to review your medications and make recommendations as to what medicines you should take before your procedure.

Failure to comply with these instructions may result in cancellation and rescheduling of your procedure.

Potential risks of the procedure

Epidural steroid procedures are considered safe, non-surgical, minimally invasive treatments for patients suffering from certain types of pain. As with all medical procedures, there are associated risks and possible side effects that may vary between each patient. These rare but potential risks are:

  • Pain at the injection site

  • Infection in the form of an epidural abscess or at the skin. In very rare instances minor infections can occur
  • Stroke
  • Dural puncture or cerebral spinal fluid leak.  This typically presents as a headache that is worse with upright position and completely alleviated when lying flat
  • Increased pain or worsening symptoms.
  • Bleeding in the form of an epidural hematoma or at the site. You may suffer bleeding from undergoing procedures, especially while on blood thinning medications. Please notify us if you are taking any of the following blood
  • thinning medications: 
    Plavix (Clopidogrel), Aspirin, XareltoWarfarin (Coumadin), 
  • (Rivaroxaban), Heparin, Lovenox  (Enoxaparin), Brilinta (Ticagrelor), or any others not listed.
  • Nerve or spinal cord damage. In extremely rare instances, a patient may suffer nerve or spinal cord damage from direct trauma from a needle. This could potentially result in permanent nerve damage or paralysis.
  • Allergic reactions to medications. The commonly used medications in this procedure include: Lidocaine, Bupivacaine, Ropivacaine, and IV contrast dye.
  • Other risks are not limited to, but include:  epidural fibrosis, aseptic meningitis, GI side effects, renal failure, seroma, and paralysis.
  • Inability to complete the injection due to technical or anatomic difficulty.

When should I expect results?

Epidural steroid injections reduce pain by decreasing inflammation of damaged or irritated structures.  The steroid (cortisone or corticosteroid) medication works on a cellular level, by decreasing inflammatory mediators.  This process is slow and often takes 7-10 days to produce results.  The immediate relief felt by the injection may be attributed more to the local anesthetic used by the doctor during the procedure.

Often times if one specific type of epidural steroid injection does not provide the relief that is expected, a different approach may be recommended by your doctor or provider. Typically, you will follow-up with the doctor 1 month after the procedure to evaluate results and come up with a plan if benefit was not obtained.

Insurance requirements

Insurance companies have a series of requirements that must be met, prior to their approval of epidural steroid injections. These may vary between insurance companies, however; they commonly include:

  • Physical Therapy – often a minimum of 4 weeksin duration
  • Appropriate imaging, which may include X-raysor MRI.
  • Documentation of failure to improve with otherconservative medical therapies

EducatonalButton.jpg

Introduction

A common source of neck, mid back, and low back pain, is arthritis of the facet joints. These are small synovial joints (like other joints in the body) that allow for movement of the neck and back. When arthritis becomes significant enough to involve these small joints, simple movements such as bending, twisting, standing, or walking can create significant pain. This pain is transmitted to the brain by way of a small nerve from each joint, called the medial branch nerve.

Facet joint injections are a safe, non-surgical, minimally invasive treatment for pain coming from arthritis or inflammation of the facet joints.

Goal of the injection

The goal of a facet joint injection is to place a small amount of steroid (cortisone or corticosteroid) and local anesthetic into one or more of the inflamed joint(s). The injection can be used to diagnose or treat. The injected steroid serves as an anti-inflammatory medication, decreasing pain and improving the patient’s movement and activity.

Sometimes facet injections are used specifically to help diagnose where the pain may be coming from, and can help determine if a patient would be a candidate for other treatments used to decrease painful conditions of the facet joints, such as radiofrequency ablation.

The procedure

The patient is brought into a sterile procedure suite, and asked to lie on the exam table. Using X-ray guidance, the skin is anesthetized and a small needle is directed to the joint(s) of interest. Once the needle is in proper location, a small amount of steroid medication is injected.

Following injection, the patient is cared for in the recovery area for a brief amount of time, and then discharged home.

After the procedure

Follow the specific instructions given to you by the nurses at the time of discharge from the recovery area:

  • Resume activity as tolerated
  • Patients may be encouraged to perform activities that typically cause an increase in their normal pain. This is used to “test” whether the diagnostic procedure is helpful in reducing your pain.
  • Do NOT soak in a bathtub or lake for 24 hours after the procedure. You may shower.
  • You will receive a phone call from a clinic nurse, asking about the relief of symptoms you experienced after your injection.

If your procedure includes sedation

  • You should have no solid foods for 8 hours before the procedure.
  • You may have clear liquids up to 2 hours before your procedure. Examples of these clear liquids are:  water, broth, clear juices with NO pulp, tea, coffee WITHOUT cream. Carbonated beverages are NOT allowed.
  • No gum chewing for 2 hours before your procedure.
  • No candy, throat lozenges, or mints.
  • A nurse will call you before your procedure to review your medications and make recommendations as to what medicines you should take before your procedure.

Failure to comply with these instructions may result in cancellation and rescheduling of your procedure.

Potential risk of the procedure

Facet joint injections are considered safe, non-surgical, minimally invasive treatments. As with all medical procedures, there associated risks and side-effects that may vary between each patient. These rare but potential risks are:

  • Pain at the injection site
  • In very rare instances (less than 1%), minor infections can occur
  • Increased pain or worsening symptoms.
  • Collapsed lung (Pneumothorax). This is a unique risk to thoracic facet joint injections because of the proximity of the lung in that region of the body.
  • Bleeding. The patient may suffer bleeding from undergoing procedures, especially while on blood thinning medications. Please notify us if you are taking any of the following blood thinning medications: Warfarin (Coumadin), Plavix (Clopidogrel), Aspirin, Xarelto (Rivaroxaban), Heparin, Lovenox (Enoxaparin), Brilinta (Ticagrelor), or any others not listed.
  • Nerve or spinal cord damage. In extremely rare instances, a patient may suffer nerve or spinal cord damage from direct trauma from a needle. This could potentially result in permanent nerve damage or paralysis.
  • Allergic reactions to medications. The commonly used medications in this procedure include: Lidocaine, Bupivacaine, Ropivacaine, IV contrast dye, and corticosteroid (cortisone).
  • Inability to complete the injection due to technical or anatomic difficulty.

Insurance requirements

Insurance companies have a series of requirements that must be met, prior to their approval of epidural steroid injections. These may vary between insurance companies, however; they commonly include:

  • Physical Therapy – often a minimum of 4 weeksin duration
  • Appropriate imaging, which may include X-raysor MRI.
  • Documentation of failure to improve with otherconservative medical therapies

EducatonalButton.jpg

Introduction

A common source of upper back pain, is arthritis of the facet joints. These are small synovial joints (like other joints in the body) that allow for movement of the back. When arthritis becomes significant enough to involve these small joints, simple movements such as bending, twisting, standing, or walking can create significant pain in the upper back. This pain is transmitted to the brain by way of a small nerve from each joint, called the medial branch nerve.

This procedure is a step in the process of identifying your pain, and identifying patients who may be eligible for radiofrequency ablation (neurolysis), which is a procedure that provides longer lasting relief, often 6-12 months duration.

Goal of the injection

In order to determine if pain in the upper back is coming from arthritis of the facet joints, a diagnostic procedure called medial branch blocks is performed. This procedure is done by placing a small amount of local anesthetic on the medial branch nerve, which sits over the joint. While the medial branch nerve is anesthetized, the pain transmitted from the upper back should be significantly improved – helping to localize the source of your upper back pain.

The procedure

You will be accompanied into a sterile procedure suite, and asked to lie face down on the exam table. Using X-ray guidance, the skin is anesthetized and a small needle is inserted over each area of interest. Once the needle is in proper location over the medial branch nerve of each joint, a small amount of anesthetic is injected. Following the injection, the patient is cared for in the recovery area for a brief amount of time, and then discharged home.

After the procedure

Follow the specific instructions given to you by the nurses at the time of discharge from the recovery area:

  • Resume activity as tolerated
  • You are encouraged to perform activities that typically cause an increase in their normal pain. This is used to “test” whether the diagnostic procedure is helpful in reducing your pain.
  • Do NOT soak in a bathtub or lake for 24 hours after the procedure. You may shower.
  • Keep a record of your pain and symptoms in the immediate hours after your injection
  • You will receive a phone call from a clinic nurse asking about the relief of symptoms you experienced after your injection. If you meet specific criteria designated by the insurance companies, you may be scheduled for a second diagnostic block – or you may be scheduled for radiofrequency ablation as the next step.

If your procedure includes sedation

  • You should have no solid foods for 8 hours before the procedure.
  • You may have clear liquids up to 2 hours before your procedure. Examples of these clear liquids are:  water, broth, clear juices with NO pulp, tea, coffee WITHOUT cream. Carbonated beverages are NOT allowed.
  • No gum chewing for 2 hours before your procedure.
  • No candy, throat lozenges, or mints.
  • A nurse will call you before your procedure to review your medications and make recommendations as to what medicines you should take before your procedure.

Failure to comply with these instructions may result in cancellation and rescheduling of your procedure.

Potential risks of the procedure

Radiofrequency ablation procedures are considered safe, non-surgical, minimally invasive treatments. As with all medical procedures, there are associated risks and side-effects that may vary between each patient. These rare but potential risks are:

  • Pain at the injection site
  • Infection. In very rare instances (less than 1%) minor infections can occur
  • Increased pain or worsening symptoms.
  • Collapsed lung (Pneumothorax). This is a unique risk to thoracic medial branch blocks because of the proximity of the lung in that region of the body.
  • Bleeding. You may suffer bleeding from undergoing procedures, especially while on blood thinning medications. Please notify us if you are taking any of the following blood thinning medications: Warfarin (Coumadin), Plavix (Clopidogrel), Aspirin, Xarelto (Rivaroxaban), Heparin, Lovenox (Enoxaparin), Brilinta (Ticagrelor), or any others not listed.
  • Nerve or spinal cord damage. In extremely rare instances, a patient may suffer nerve or spinal cord damage from direct trauma from a needle. This could potentially result in permanent nerve damage or paralysis.
  • Allergic reactions to medications. The commonly used medications in this procedure include: Lidocaine, Bupivacaine, Ropivacaine, IV contrast dye, and corticosteroid (cortisone).
  • Inability to complete the injection due to technical or anatomic difficulty.

Insurance requirements

Insurance companies may require up to two medial branch diagnostic block procedures, demonstrating measurable relief of symptoms for a specific amount of time, prior to approving the radiofrequency ablation procedure.

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Introduction

Radiofrequency ablation is a therapy that uses radio waves to create an electrical current through the body. This current delivers heat (80 degrees Celsius for 120 seconds) to targeted nerves and tissues. This non-surgical technique is used to target sources of pain in the back and neck.

Each spinal segment, or vertebrae, is connected to the other by a small joint, these are called facet joints. The cause of this inflammation or irritation is often arthritis. Radiofrequency ablation or neurotomy, is used to create a heat lesion on the medial branch nerve. This nerve is responsible for sending a pain signal to the spinal cord and brain from irritated or inflamed facet joints. The heat lesion prevents this nerve from sending a pain signal, and often significantly reduces a patient’s pain for an extended period of time.

Goal of the injection

The radiofrequency ablation procedure (RFA) is a non-surgical, minimally invasive technique that is performed in an outpatient setting. RFA is very similar to the medial branch block procedure, which is used to diagnose pain coming from the facet joints. The goal of the radiofrequency procedure is to provide at least 50% relief of chronic upper back pain (national average result) for 6-12 months duration, often times even longer.

The procedure

You will likely receive IV sedation for this procedure. A nurse will typically start an IV in the pre-op area prior to the procedure. You are then accompanied into a sterile procedure suite, and asked to lie face down on the exam table. Using X-ray guidance, the doctor places a small needle on each facet joint, near the medial branch nerve. After the nerve is anesthetized with local anesthetic, an electrical current is used to create the ablation, or heat lesion. This nerve, once treated, will not be able to send as strong of a pain signal to the brain as it did before, giving you relief of your chronic upper back pain.

Following the injection, you will be cared for in the recovery area for a brief amount of time and then discharged home.

After the procedure

Follow the specific instructions given to you by the nurses at the time of discharge from the recovery area:

  • Do not drive or operate heavy machinery for 24 hours after your procedure, if you received sedation
  • Resume activities as tolerated, understanding you may be sore for 7-10 days
  • It is not uncommon for the patient to not experience relief of their chronic upper pain for up to 7-10 days after the procedure
  • Do NOT soak in a bathtub or lake for 24 hours after the procedure. You may shower.
  • You will receive a phone call from a clinic nurse, the following day to check in and see how you are recovering.

If your procedure includes sedation

  • You should have no solid foods for 8 hours before the procedure.
  • You may have clear liquids up to 2 hours before your procedure. Examples of these clear liquids are:  water, broth, clear juices with NO pulp, tea, coffee WITHOUT cream. Carbonated beverages are NOT allowed.
  • No gum chewing for 2 hours before your procedure.
  • No candy, throat lozenges, or mints.
  • A nurse will call you before your procedure to review your medications and make recommendations as to what medicines you should take before your procedure.

Failure to comply with these instructions may result in cancellation and rescheduling of your procedure.

Potential risk of the procedure

Radiofrequency ablation procedures are considered safe, non-surgical, minimally invasive treatments. As with all medical procedures, there are associated risks and side-effects that may vary between each patient. These rare but potential risks are:

  • Pain at the injection site
  • Infection. In very rare instances (less than 1%), minor infections can occur
  • Increased pain or worsening symptoms.
  • Collapsed lung (pneumothorax). This is specific to thoracic RFA due to the close proximity of the lung in this area.
  • Post-ablation neuritis, which is an irritation of the nerves being targeted.
  • Stroke
  • Bleeding. You may suffer bleeding from undergoing procedures, especially while on blood thinning medications. Please notify us if you are taking any of the following blood thinning medications: Warfarin (Coumadin), Plavix (Clopidogrel), Aspirin, Xarelto (Rivaroxaban), Heparin, Lovenox (Enoxaparin), Brilinta (Ticagrelor), or any others not listed.
  • Nerve or spinal cord damage. In extremely rare instances, a patient may suffer nerve or spinal cord damage from direct trauma from a needle. This could potentially result in permanent nerve damage or paralysis.
  • Allergic reactions to medications. The commonly used medications in this procedure include: Lidocaine, Bupivacaine, Ropivacaine, IV contrast dye, and corticosteroid (cortisone).
  • Inability to complete the injection due to technical or anatomic difficulty.

Insurance requirements

Insurance companies have a series of requirements that must be met, prior to their approval of the radiofrequency ablation procedure. These may vary between insurance companies, however; they commonly include:

  • Physical Therapy – often a minimum of 4 weeks in duration
  • Completion of medial branch nerve diagnostic block procedure with adequate relief for a minimum of 3 hours duration. Most insurance companies require two diagnostic block procedures.
  • Due to the proximity of vital structures in the neck, such as nerves and blood vessels, the radiofrequency procedure may be performed on one side of the body at a time. This is for safety reasons, and minimizes potential adverse outcomes and complications.

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Introduction

Epidural therapy is effective in the treatment of many painful conditions that originate from the spine.  These conditions include disc herniation and injury, acute herpes zoster, post-herpetic neuralgia, sciatica pain, radicular nerve pain, cancer pain, and post-surgical pain. Epidural steroid injections are used as a minimally invasive, non-surgical therapy to supplement other conservative medical therapies, such as physical therapy or rehabilitation programs.

There are several specific techniques or approaches to epidural steroid injections. The specific type of epidural steroid injection chosen by your doctor or provider will depend on the underlying condition and symptoms you are having. These are not limited to, but may include:

  • Interlaminar epidural steroid injections
  • Transforaminal epidural steroid injections
  • Caudal epidural steroid injections

There are also different types of steroid medications that may be administered.  These may include, but are not limited to:

  • Dexamethasone (Decadron)
  • Methylprednisolone (Depomedrol)
  • Triamcinolone (Kenalog)
  • Betamethasone (Celestone)

Goal of the procedure

Inflammation is the most common source of pain and irritation that involves the spine and nerves.  Nerve inflammation from various sources causes an increase in firing of the pain signal and has been shown to contribute to the perpetuation of many types of persistent pain states. Injection of steroid (cortisone or corticosteroid) into the epidural space around the nerves of the spine is a safe and effective treatment directed at reducing inflammatory pain and irritation.

The procedure

Epidural steroid injections are performed by your doctor in a sterile procedure suite utilizing X-ray guidance. This procedure is often done without sedation, as the skin over the area of interest is anesthetized with local anesthetic. In certain types of epidural injections, where the needle is placed in close proximity to a specific nerve, it is possible to have a very brief electric type pain “shoot” into an extremity. This is a common occurence and is typically mentioned during the procedure to reassure you that it is not abnormal or harmful.

Following the procedure, which often takes less than 10 minutes, you will be cared for by a nurse in the recovery area until you are ready to be discharged home.

After the procedure

Follow the specific instructions given to you by the nurses at the time of discharge from the recovery area:

  • Do not drive or operate heavy machinery for 24 hours after your procedure, if you received sedation
  • Resume “normal” daily activities as tolerated after your procedure. You may shower.
  • Do NOT soak in a bathtub or lake for 24 hours after your procedure
  • It may take 7-10 days for the procedure to be effective
  • You will receive a phone call from a clinic nurse, the following day to check in and see how you are recovering.

If your procedure includes sedation

  • You should have no solid foods for 8 hours before the procedure.
  • You may have clear liquids up to 2 hours before your procedure. Examples of these clear liquids are:  water, broth, clear juices with NO pulp, tea, coffee WITHOUT cream. Carbonated beverages are NOT allowed.
  • No gum chewing for 2 hours before your procedure.
  • No candy, throat lozenges, or mints.
  • A nurse will call you before your procedure to review your medications and make recommendations as to what medicines you should take before your procedure.

Failure to comply with these instructions may result in cancellation and rescheduling of your procedure.

Potential risks of the procedure

Epidural steroid procedures are considered safe, non-surgical, minimally invasive treatments for patients suffering from certain types of pain. As with all medical procedures, there are associated risks and possible side effects that may vary between each patient. These rare but potential risks are:

  • Pain at the injection site

  • Infection in the form of an epidural abscess or at the skin. In very rare instances minor infections can occur
  • Stroke
  • Dural puncture or cerebral spinal fluid leak.  This typically presents as a headache that is worse with upright position and completely alleviated when lying flat
  • Increased pain or worsening symptoms.
  • Bleeding in the form of an epidural hematoma or at the site. You may suffer bleeding from undergoing procedures, especially while on blood thinning medications. Please notify us if you are taking any of the following blood
  • thinning medications: 
    Plavix (Clopidogrel), Aspirin, XareltoWarfarin (Coumadin), 
  • (Rivaroxaban), Heparin, Lovenox  (Enoxaparin), Brilinta (Ticagrelor), or any others not listed.
  • Nerve or spinal cord damage. In extremely rare instances, a patient may suffer nerve or spinal cord damage from direct trauma from a needle. This could potentially result in permanent nerve damage or paralysis.
  • Allergic reactions to medications. The commonly used medications in this procedure include: Lidocaine, Bupivacaine, Ropivacaine, and IV contrast dye.
  • Other risks are not limited to, but include:  epidural fibrosis, aseptic meningitis, GI side effects, renal failure, seroma, and paralysis.
  • Inability to complete the injection due to technical or anatomic difficulty.

When should I expect results?

Epidural steroid injections reduce pain by decreasing inflammation of damaged or irritated structures.  The steroid (cortisone or corticosteroid) medication works on a cellular level, by decreasing inflammatory mediators.  This process is slow and often takes 7-10 days to produce results.  The immediate relief felt by the injection may be attributed more to the local anesthetic used by the doctor during the procedure.

Often times if one specific type of epidural steroid injection does not provide the relief that is expected, a different approach may be recommended by your doctor or provider. Typically, you will follow-up with the doctor 1 month after the procedure to evaluate results and come up with a plan if benefit was not obtained.

Insurance requirements

Insurance companies have a series of requirements that must be met, prior to their approval of epidural steroid injections. These may vary between insurance companies, however; they commonly include:

  • Physical Therapy – often a minimum of 4 weeksin duration
  • Appropriate imaging, which may include X-raysor MRI.
  • Documentation of failure to improve with otherconservative medical therapies

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Introduction

A common source of neck, mid back, and low back pain, is arthritis of the facet joints. These are small synovial joints (like other joints in the body) that allow for movement of the neck and back. When arthritis becomes significant enough to involve these small joints, simple movements such as bending, twisting, standing, or walking can create significant pain. This pain is transmitted to the brain by way of a small nerve from each joint, called the medial branch nerve.

Facet joint injections are a safe, non-surgical, minimally invasive treatment for pain coming from arthritis or inflammation of the facet joints.

Goal of the injection

The goal of a facet joint injection is to place a small amount of steroid (cortisone or corticosteroid) and local anesthetic into one or more of the inflamed joint(s). The injection can be used to diagnose or treat. The injected steroid serves as an anti-inflammatory medication, decreasing pain and improving the patient’s movement and activity.

Sometimes facet injections are used specifically to help diagnose where the pain may be coming from, and can help determine if a patient would be a candidate for other treatments used to decrease painful conditions of the facet joints, such as radiofrequency ablation.

The procedure

The patient is brought into a sterile procedure suite, and asked to lie on the exam table. Using X-ray guidance, the skin is anesthetized and a small needle is directed to the joint(s) of interest. Once the needle is in proper location, a small amount of steroid medication is injected.

Following injection, the patient is cared for in the recovery area for a brief amount of time, and then discharged home.

After the procedure

Follow the specific instructions given to you by the nurses at the time of discharge from the recovery area:

  • Resume activity as tolerated
  • Patients may be encouraged to perform activities that typically cause an increase in their normal pain. This is used to “test” whether the diagnostic procedure is helpful in reducing your pain.
  • Do NOT soak in a bathtub or lake for 24 hours after the procedure. You may shower.
  • You will receive a phone call from a clinic nurse, asking about the relief of symptoms you experienced after your injection.

If your procedure includes sedation

  • You should have no solid foods for 8 hours before the procedure.
  • You may have clear liquids up to 2 hours before your procedure. Examples of these clear liquids are:  water, broth, clear juices with NO pulp, tea, coffee WITHOUT cream. Carbonated beverages are NOT allowed.
  • No gum chewing for 2 hours before your procedure.
  • No candy, throat lozenges, or mints.
  • A nurse will call you before your procedure to review your medications and make recommendations as to what medicines you should take before your procedure.

Failure to comply with these instructions may result in cancellation and rescheduling of your procedure.

Potential risk of the procedure

Facet joint injections are considered safe, non-surgical, minimally invasive treatments. As with all medical procedures, there associated risks and side-effects that may vary between each patient. These rare but potential risks are:

  • Pain at the injection site
  • In very rare instances (less than 1%), minor infections can occur
  • Increased pain or worsening symptoms.
  • Collapsed lung (Pneumothorax). This is a unique risk to thoracic facet joint injections because of the proximity of the lung in that region of the body.
  • Bleeding. The patient may suffer bleeding from undergoing procedures, especially while on blood thinning medications. Please notify us if you are taking any of the following blood thinning medications: Warfarin (Coumadin), Plavix (Clopidogrel), Aspirin, Xarelto (Rivaroxaban), Heparin, Lovenox (Enoxaparin), Brilinta (Ticagrelor), or any others not listed.
  • Nerve or spinal cord damage. In extremely rare instances, a patient may suffer nerve or spinal cord damage from direct trauma from a needle. This could potentially result in permanent nerve damage or paralysis.
  • Allergic reactions to medications. The commonly used medications in this procedure include: Lidocaine, Bupivacaine, Ropivacaine, IV contrast dye, and corticosteroid (cortisone).
  • Inability to complete the injection due to technical or anatomic difficulty.

Insurance requirements

Insurance companies have a series of requirements that must be met, prior to their approval of epidural steroid injections. These may vary between insurance companies, however; they commonly include:

  • Physical Therapy – often a minimum of 4 weeksin duration
  • Appropriate imaging, which may include X-raysor MRI.
  • Documentation of failure to improve with otherconservative medical therapies

EducatonalButton.jpg

Introduction

A common source of low back pain, is arthritis of the facet joints. These are small synovial joints (like other joints in the body) that allow for movement of the low back. When arthritis becomes significant enough to involve these small joints, simple movements such as bending, twisting, standing, or walking can create significant pain in the low back. This pain is transmitted to the brain by a small nerve from each joint, called the Medial Branch Nerve. Blocking this nerve with local anesthetic medication may temporarily aleviate pain coming from these joints. This is a step in the process of identifying your pain, and identifying patients who may be eligible for radiofrequency ablation (neurolysis), which is a procedure that provide longer lasting relief, often 9-12 months duration.

Goal of the injection

In order to determine if pain in the low back is coming from arthritis of the facet joints, we use a diagnostic procedure called Medial Branch Diagnostic Blocks. The goal of this procedure is to place a small amount of local anesthetic on the Medial Branch Nerve, which sits over the joint. While the medial branch nerve is anesthetized, the pain transmitted from the low back should be significantly improved – helping us to localize the source of your low back pain.

The procedure

The patient is brought into a sterile procedure suite, and asked to lay face down on the exam table. Using X-ray guidance, the skin is anesthetized and a small needle is inserted over each area of interest. Once the needle is in proper location, over the medial branch nerve of each location, a small amount of anesthetic is injected. Following injection, the patient is cared for in the recovery area for a brief amount of time, and then discharged home.

After the procedure

Follow the specific instructions given to you by the nurses at the time of discharge from the recovery area:

  • Resume activity as tolerated
  • You are encouraged to perform activities that typically cause an increase in your normal pain. This is used to “test” whether the diagnosstic procedure is helpful in reducing your pain
  • Do NOT soak in a bathtub or lake for 24 hours after the procedure. You may shower.
  • Keep a record of your pain and symptoms in the immediate hours after your injection
  • You will receive a phone call from a clinic  nurse, asking about the relief of symptoms  you experienced after your injection. If  you meet specific criteria designated by the  insurance companies, you may be scheduled  for a second diagnostic block – or you may  be scheduled for radiofrequency ablation as  the next step.

If your procedure includes sedation

  • You should have no solid foods for 8 hours before the procedure.
  • You may have clear liquids up to 2 hours before your procedure. Examples of these clear liquids are:  water, broth, clear juices with NO pulp, tea, coffee WITHOUT cream. Carbonated beverages are NOT allowed.
  • No gum chewing for 2 hours before your procedure.
  • No candy, throat lozenges, or mints.
  • A nurse will call you before your procedure to review your medications and make recommendations as to what medicines you should take before your procedure.

Failure to comply with these instructions may result in cancellation and rescheduling of your procedure.

Potential risks of the procedure

Facet joint injections are considered safe, non-surgical, minimally invasive treatments. As with all medical procedures, there associated risks and side-effects that may vary between each patient. These rare but potential risks are:

  • Pain at the injection site
  • Infection in the form of an epidural abscess or at the skin. In very rare instances minor infections can occur
  • Stroke
  • Dural puncture or cerebral spinal fluid leak.  This typically presents as a headache that is worse with upright position and completely alleviated when lying flat
  • Increased pain or worsening symptoms.
  • Bleeding in the form of an epidural hematoma or at the site. You may suffer bleeding from undergoing procedures, especially while on blood thinning medications. Please notify us if you are taking any of the following blood
  • thinning medications: 
  • Plavix (Clopidogrel), Aspirin, XareltoWarfarin (Coumadin), 
  • (Rivaroxaban), Heparin, Lovenox  (Enoxaparin), Brilinta (Ticagrelor), or any others not listed.
  • Nerve or spinal cord damage. In extremely rare instances, a patient may suffer nerve or spinal cord damage from direct trauma from a needle. This could potentially result in permanent nerve damage or paralysis.
  • Allergic reactions to medications. The commonly used medications in this procedure include: Lidocaine, Bupivacaine, Ropivacaine, and IV contrast dye.
  • Other risks are not limited to, but include:  epidural fibrosis, aseptic meningitis, GI side effects, renal failure, seroma, and paralysis.
  • Inability to complete the injection due to technical or anatomic difficulty.

Insurance requirements

Insurance companies have a series of requirements that must be met, prior to their approval of epidural steroid injections. These may vary between insurance companies, however; they commonly include:

  • Physical Therapy – often a minimum of 4 weeksin duration
  • Appropriate imaging, which may include X-raysor MRI.
  • Documentation of failure to improve with otherconservative medical therapies

EducatonalButton.jpg

Introduction

Radiofrequency ablation is a therapy that uses radio waves to create an electrical current through the body. This current delivers heat (80 degrees Celsius for 120 seconds) to targeted nerves and tissues. This non-surgical technique is used to target sources of pain in the back and neck.

Each spinal segment, or vertebrae, is connected to the other by a small joint, these are called facet joints. The cause of this inflammation or irritation is often arthritis. Radiofrequency ablation or neurotomy, is used to create a heat lesion on the medial branch nerve. This nerve is responsible for sending a pain signal to the spinal cord and brain from irritated or inflamed facet joints. The heat lesion prevents this nerve from sending a pain signal, and often significantly reduces a patient’s pain for an extended period of time.

Goal of the injection

The radiofrequency ablation procedure (RFA) is a non-surgical, minimally invasive technique that is performed in an outpatient setting. RFA is very similar to the medial branch block procedure, which is used to diagnose pain coming from the facet joints. The goal of the radiofrequency procedure is to provide at least 50% relief of chronic neck or back pain (national average result) for 6-12 months duration, often times even longer.

The procedure

You will likely receive IV sedation for this procedure. A nurse will typically start an IV in the pre-op area prior to the procedure. You are then accompanied into a sterile procedure suite, and asked to lie face down on the exam table. Using X-ray guidance, the doctor places a small needle on each facet joint, near the medial branch nerve. After the nerve is anesthetized with local anesthetic, an electrical current is used to create the ablation, or heat lesion. This nerve, once treated, will not be able to send as strong of a pain signal to the brain as it did before, giving tyou relief of your chronic neck or back pain.

Following the injection, you will be cared for in the recovery area for a brief amount of time, and then discharged home.

After the procedure

Follow the specific instructions given to you by the nurses at the time of discharge from the recovery area:

  • Do not drive or operate heavy machinery for 24 hours after your procedure, if your eceived sedation
  • Resume activities as tolerated, understanding you may be sore for 7-10 days
  • It is not uncommon for the patient to not experience relief of their chronic back or neck pain for up to 7-10 days after the procedure
  • Do NOT soak in a bathtub or lake for 24 hours after the procedure. You may shower.
  • You will receive a phone call from a clinic nurse the following day to check in and see how you are recovering.

If your procedure includes sedation

  • You should have no solid foods for 8 hours before the procedure.
  • You may have clear liquids up to 2 hours before your procedure. Examples of these clear liquids are:  water, broth, clear juices with NO pulp, tea, coffee WITHOUT cream. Carbonated beverages are NOT allowed.
  • No gum chewing for 2 hours before your procedure.
  • No candy, throat lozenges, or mints.
  • A nurse will call you before your procedure to review your medications and make recommendations as to what medicines you should take before your procedure.

Failure to comply with these instructions may result in cancellation and rescheduling of your procedure.

Potential risks of the procedure

Radiofrequency ablation procedures are considered safe, non-surgical, minimally invasive treatments. As with all medical procedures, there are associated risks and side-effects that may vary between each patient. These rare but potential risks are:

  • Pain at the injection site
  • Infection in the form of an epidural abscess or at the skin. In very rare instances minor infections can occur
  • Stroke
  • Dural puncture or cerebral spinal fluid leak.  This typically presents as a headache that is worse with upright position and completely alleviated when lying flat
  • Increased pain or worsening symptoms.
  • Bleeding in the form of an epidural hematoma or at the site. You may suffer bleeding from undergoing procedures, especially while on blood thinning medications. Please notify us if you are taking any of the following blood
  • thinning medications: 
  • Plavix (Clopidogrel), Aspirin, XareltoWarfarin (Coumadin), 
  • (Rivaroxaban), Heparin, Lovenox  (Enoxaparin), Brilinta (Ticagrelor), or any others not listed.
  • Nerve or spinal cord damage. In extremely rare instances, a patient may suffer nerve or spinal cord damage from direct trauma from a needle. This could potentially result in permanent nerve damage or paralysis.
  • Allergic reactions to medications. The commonly used medications in this procedure include: Lidocaine, Bupivacaine, Ropivacaine, and IV contrast dye.
  • Other risks are not limited to, but include:  epidural fibrosis, aseptic meningitis, GI side effects, renal failure, seroma, and paralysis.
  • Inability to complete the injection due to technical or anatomic difficulty.

Insurance requirements

Insurance companies have a series of requirements that must be met, prior to their approval of epidural steroid injections. These may vary between insurance companies, however; they commonly include:

  • Physical Therapy – often a minimum of 4 weeksin duration
  • Appropriate imaging, which may include X-raysor MRI.
  • Documentation of failure to improve with otherconservative medical therapies

Selective Nerve Root Block (SNRB) in the Lumbar Spine

This injection targets a painful nerve in your lumbar spine. It helps your doctor find which nerve is hurt by a herniated disc, spinal stenosis or some other problem. It may give you pain relief.

Selective Nerve Root Block (SNRB) in the Cervical Spine

This injection targets a painful nerve in your cervical spine. It helps your doctor find which nerve is pressed on by a herniated disc, spinal stenosis or some other problem. It may give you pain relief.

 

This minimally-invasive procedure repairs a vertebral compression fracture. It helps restore the spine's natural shape. Some patients experience rapid pain relief after the procedure.

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Introduction

Knee pain is traditionally treated with physical therapy, steroid injections, viscous supplementation injections (rooster comb), joint replacement, and medications. When these methods are ineffective at treating knee pain, a procedure to block the pain signal coming from the knee itself can be used. This procedure is called a genicular nerve block.

Knee pain is transmitted to the brain by several nerve pathways. The genicular nerves are small branches of larger nerves that are located close to the knee joint itself. Blocking these small genicular nerves can help to temporarily alleviate a significant portion of the pain coming from the knee.

This is a step in the process of identifying your pain, and identifying patients who may be eligible for radiofrequency ablation (neurolysis), which is a procedure that provides longer lasting relief, often 6-12 months duration.

Goal of the injection

In order to determine if pain in the knee can be reduced, we use a diagnostic procedure called genicular nerve block. The goal of this procedure is to place a small amount of local anesthetic on three to four small genicular nerve branches, which are located near the knee joint. While the genicular nerves are anesthetized, the pain transmitted from the knee should be significantly improved – helping us to localize the source of your knee pain.

The procedure

You will be brought into a sterile procedure suite, and asked to lie on the exam table. Using X-ray guidance, the skin is anesthetized and a small needle is inserted over each genicular nerve location. Once the needle is in proper position, a small amount of anesthetic is injected.

Following injection, the patient is cared for in the recovery area for a brief amount of time, and then discharged home.

After the procedure

Follow the specific instructions given to you by the nurses at the time of discharge from the recovery area:

  • Resume activity as tolerated
  • Patients are encouraged to perform activities that typically cause an increase in their normal pain. This is used to “test” whether the diagnostic procedure is helpful in reducing your pain.
  • Keep a record of your pain and symptoms in the immediate hours after your injection
  • Do NOT soak in a bathtub or lake for 24 hours after the procedure. You may shower.
  • You will receive a phone call from a clinic  nurse, asking about the relief of symptoms you experienced after your injection. If you meet specific criteria designated by the insurance companies, you may be scheduled for a second diagnostic block – or you may be scheduled for radiofrequency ablation as the next step.

If your procedure includes sedation

  • You should have no solid foods for 8 hours before the procedure.
  • You may have clear liquids up to 2 hours before your procedure. Examples of these clear liquids are:  water, broth, clear juices with NO pulp, tea, coffee WITHOUT cream. Carbonated beverages are NOT allowed.
  • No gum chewing for 2 hours before your procedure.
  • No candy, throat lozenges, or mints.
  • A nurse will call you before your procedure to review your medications and make recommendations as to what medicines you should take before your procedure.

Failure to comply with these instructions may result in cancellation and rescheduling of your procedure.

Potential risks of the procedure

Genicular nerve block procedures are considered safe, non-surgical, minimally invasive treatments. As with all medical procedures, there associated risks and side-effects that may vary between each patient. These rare but potential risks are:

  • Pain at the injection site
  • In very rare instances (less than 1%), minor infections can occur
  • Increased pain or worsening symptoms.
  • Bleeding. Youmay suffer bleeding from undergoing procedures, especially while on blood thinning medications. Please notify us if you are taking any of the following blood thinning medications: Warfarin (Coumadin), Plavix (Clopidogrel), Aspirin, Xarelto (Rivaroxaban), Heparin, Lovenox (Enoxaparin), Brilinta (Ticagrelor), or any others not listed.
  • Allergic reactions to medications. The commonly used medications in this procedure include: Lidocaine, Bupivacaine, Ropivacaine, IV contrast dye, and corticosteroid (cortisone).
  • Inability to complete the injection due to technical or anatomic difficulty.

Insurance requirements

Insurance companies may require two genicular nerve diagnostic block procedures, demonstrating relief of symptoms for a specific amount of time, prior to approving the radiofrequency ablation procedure.

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Introduction

Radiofrequency ablation is a therapy that uses radio waves to create an electrical current through the body. This current delivers heat (80 degrees Celsius for 120 seconds) to targeted nerves and tissues. This non-surgical technique is used to target sources of pain coming from the knee, that has not been alleviated by traditional treatments for knee pain.

Radiofrequency ablation or neurotomy, is used to create a heat lesion around the genicular nerves of the knee. These nerves are responsible for sending a pain signal to the spinal cord and brain from the knee joint.

Goal of the injection

The radiofrequency ablation procedure (RFA) is a non-surgical, minimally invasive technique that is performed in an outpatient setting. RFA is very similar to the genicular nerve block procedure, which is used to diagnose pain coming from the knee joint. The goal of the radiofrequency procedure is to provide at least 50% relief of chronic knee pain (national average result) for 6-12 months duration, often times even longer.

The procedure

You will likely receive IV sedation for this procedure. A nurse will typically start an IV in the pre-op area prior to the procedure. You will then be accompanied into a sterile procedure suite, and asked to lie on the exam table. Using X-ray guidance, the doctor places a small needle near each genicular nerve. After the nerve is anesthetized with local anesthetic, an electrical current is used to create the ablation, or heat lesion. This nerve, once treated, will not be able to send as much of a pain signal to the brain as it did before, giving you relief of your chronic knee pain.

Following the injection, you will be cared for in the recovery area for a brief amount of time, and then discharged home.

After the procedure

Follow the specific instructions given to you by the nurses at the time of discharge from the recovery area:

  • Do not drive or operate heavy machinery for 24 hours after your procedure, if you received sedation
  • Resume activities as tolerated, understanding you may be sore for 7-10 days
  • It is not uncommon for the patient to not experience relief of their chronic knee pain for up to 7-10 days after the procedure
  • Do NOT soak in a bathtub or lake for 24 hours after the procedure. You may shower.
  • You will receive a phone call from a clinic nurse, the following day to check in and see how you are recovering.

If your procedure includes sedation

  • You should have no solid foods for 8 hours before the procedure.
  • You may have clear liquids up to 2 hours before your procedure. Examples of these clear liquids are:  water, broth, clear juices with NO pulp, tea, coffee WITHOUT cream. Carbonated beverages are NOT allowed.
  • No gum chewing for 2 hours before your procedure.
  • No candy, throat lozenges, or mints.
  • A nurse will call you before your procedure to review your medications and make recommendations as to what medicines you should take before your procedure.

Failure to comply with these instructions may result in cancellation and rescheduling of your procedure.

Potential risks of the procedure

Radiofrequency ablation procedures are considered safe, non-surgical, minimally invasive treatments. As with all medical procedures, there are associated risks and side-effects that may vary between each patient. These rare but potential risks are:

  • Pain at the injection site
  • In very rare instances (less than 1%), minor infections can occur
  • Increased pain or worsening symptoms.
  • Post-ablation neuritis, which is an irritation of the nerves being targeted.
  • Bleeding. Youmay suffer bleeding from undergoing procedures, especially while on blood thinning medications. Please notify us if you are taking any of the following blood thinning medications: Warfarin (Coumadin), Plavix (Clopidogrel), Aspirin, Xarelto (Rivaroxaban), Heparin, Lovenox (Enoxaparin), Brilinta (Ticagrelor), or any  others not listed.
  • Allergic reactions to medications. The commonly used medications in this procedure include: Lidocaine, Bupivacaine, Ropivacaine, IV contrast dye, and corticosteroid (cortisone).
  • Inability to complete the injection due to technical or anatomic difficulty.

Insurance requirements

Insurance companies have a series of requirements that must be met, prior to their approval of the the radiofrequency ablation procedure. These may vary between insurance companies, however; they commonly include:

  • Physical Therapy – often a minimum of 4 weeks in duration
  • Completion of the genicular nerve block procedures with adequate relief for a minimum of 3 hours duration. Some insurance companies may require two diagnostic block procedures.

Spinal cord stimulation (also called SCS) uses electrical impulses to relieve chronic pain of the back, arms and legs. It is believed that electrical pulses prevent pain signals from being received by the brain. SCS candidates include people who suffer from neuropathic pain and for whom conservative treatments have failed.

What the Intracept Procedure Involves

The Intracept Procedure is a same-day procedure performed in an outpatient surgery center. Unlike some major surgeries, the Intracept Procedure is implant-free and preserves the overall structure of the spine.

The Intracept Procedure involves heating the basivertebral nerve with a radiofrequency probe to stop it from sending pain signals to the brain. Patients are under anesthesia, and the procedure generally lasts an hour.

Different from other nerves in the body that regenerate, the BVN has not shown an ability to grow back as a pain-transmitting nerve following the Intracept Procedure.

Step One: Access the Pedicle

Under fluoroscopic guidance, the Intracept® Introducer Cannula Assembly is advanced through the pedicle.

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Step Two: Create the Channel

The Intracept® Curved Cannula Assembly is used to create a channel to the trunk of the basivertebral nerve.

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Step Three: Place the RF Probe

The Intracept® RF Probe is inserted into the curved path and placed at the trunk of the basivertebral nerve.

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Step Four: Ablate the BVN

The Intracept® RF Generator is used to deliver radiofrequency energy that ablates the basivertebral nerve.

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What to Expect After the Procedure

Following the procedure, the doctor may recommend some precautions to take – and after a brief recovery period, most people resume normal activities.

Learn More

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Schedule your consultation today to discover your options.

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