ESI's ( Epidural Steroid Injections)
Epidural Steroid Injections (ESIs) are an integral part of a non-surgical management of low back, sciatica and neck pain. The goal of the injection is to relieve pain often temporarily and sometimes completely. The steroid injection works by reducing pain and inflammation of the spinal nerve. Although most physicians agree that the pain relief provided by the injection tend be temporary, providing one week or up to one year of pain relief is very beneficial for a patient during an acute episode of back or neck pain. A successful injection can provide enough relief for the patient to enter rehabilitation, physical therapy and begin to stretch and strengthen their body and possibly eliminate the back or neck pain entirely.
RFA's (Radio Frequency Ablation)
Often referred as a radiofrequency ablation or neurotomy is an interventional procedure that reduces or eliminates back or neck pain and spasms caused by damaged or degenerative facet or sacroiliac joints. The procedure introduces a needle under X-Ray to damaged facet and targets the medial branch nerve that carries the pain signal. Once the needle is positioned, a radiofrequency probe is inserted and heated to ablate the nerve.
The advantages of the radiofrequency ablation are relief of back or neck pain and spasm for up to 18 months. Most patients receive pain relief on average between 6 to 12 months. The procedure is done with only a needle stick and with the patient awake and local skin anesthetic. Patients have very little post-procedure pain and can return to work or their lifestyle immediately.
Facet Joint injection
The facet joints are found on both sides of the spine. These joints can become very painfully irritated and inflamed. A facet joint injection can pinpoint the root cause and diagnosis for patients suffering from back pain. This injection can also relieve pain and inflammation temporarily. The injection itself contains a soothing anesthetic and anti-inflammatory steroid.
MBB ( Medial Branch Block)
Patients suffering from chronic back pain often have painful facet joints. There pain is better when leaning forward but when they lean back they get sharp pain or spasm. The medial branch nerve is an extension from the exiting nerve of the spinal cord that innervates the facet joint and the primary muscles that support your back. These small nerves communicate pain from your back to your brain. The physician uses a medial branch block for two reasons: first, diagnostically to pinpoint the root cause of your back pain and secondly, therapeutically to block the nerves with anesthetic and sometimes anti-inflammatory steroid providing the patients with relief. If the patient receives at least 50% pain relief then when the anesthetic wears off the patient may benefit from a rhizotomy.
Spinal Cord Stimulator
Spinal cord stimulation is an electrical current used to treat chronic pain. There are two types of stimulator devices: Peripheral Nerve Stimulation (PNS) and Spinal Cord Stimulation (SCS). Both of the devices use a small pulse generator that sends electrical pulses to the nerve. These pulses interfere with nerve impulses that allow you to feel pain.
Patients that are candidates for nerve or spinal cord stimulator would go through two steps. First, the physician will insert a temporary electrode percutaneous through the skin for a treatment trial run. The electrode is connected to a stimulator that the patient can control. If the trial is successful, the physician will implant the permanent stimulator under your skin. This procedure can be done with local anesthetic and a sedative to make sure the patient is alert but comfortable. After the procedure is done you and your physician will determine what is the best pulse strength for you.
Intrarticular Joint Injections
An intra-articular injection is a procedure where medication is injected into the joint space for the purpose of relieving joint pain. An intra-articular injection is typically given when a joint with localized pain (acute or chronic) has not responded to or stops responding to oral pain medication, oral anti-inflammatory medication, or other conservative treat options.
Trigger Point injection
Trigger point injections (TPI) are injections of anesthetic and steroid directly into the “knots” in your muscle. The knots are known as “trigger points.” They occur when your muscle involuntarily contracts or spasms, which causes the area to become tender and to radiate pain elsewhere in your body.
A disc decompression is performed on patients who are experiencing “radicular” pain, which is defined as pain that radiates along the distribution of a spinal nerve root. An example would be a patient with a herniated disc in the lumbar spine who has low back pain that radiates down the leg to the foot. This procedure is most commonly performed on painful discs in the lumbar spine (lower back), although it is being offered for cervical (neck) and thoracic (mid back) discs as well. Patients have generally failed to improve with conservative treatments, including medication, physical therapy, and spinal injections like Epidural Steroid Injection. Patients with a relatively small or contained disc herniation are better candidates than those with large herniations. The presence of a free disc fragment or significant disc space narrowing on MRI is a contraindication to Disc Decompression. Furthermore, a patient’s candidacy for Disc Decompression is often determined by a Discogram to confirm that the target disc(s) is/are indeed the cause of a patient’s pain. The discogram is especially important if a patient’s MRI reveals more than one abnormal disc in the painful area of the spine, since a patient’s pain can originate from two or more discs.
SI Joint Fusion
Sacroiliac joint fusion is a surgical procedure which fuses the iliac bone (pelvis) to the spine
(sacrum) for stabilization. It may be performed for a variety of conditions including pain, trauma,
infection, cancer, and spinal instability. The intial treatment for sacroiliac joint syndrome is
usually non-surgical, however, surgical options may be explored when the patient is refractory to
or unable to tolerate more conservative interventions.
M.I.L.D (Minimally Invasive Lumbar Decompression)
The MILD procedure is an outpatient minimally invasive procedure. It does not require general anesthesia or strong pain medicine with side effects such as opioid medications. It is done without any implants in the spine. The incision is very small, estimated to be the size of a baby aspirin (5.1 mm) and requires no stitches for closure. The MILD procedure can help reduce your pain and increase your time standing and walking. As this is a minimally invasive procedure, there is very little time needed for recovery. In fact, most patients usually resume their normal activity within 24 hours without any restrictions.
Kyphoplasty is a minimally invasive surgery used to treat a spinal compression fracture.
Spinal compression fractures occur primarily in spinal vertebrae that have been weakened by osteoporosis. Compression fractures typically occur in the thoracic region of the spine, which includes the T1 through T12 vertebrae, but may also occur in the lumbar spine, or L1 through L5.
The goals of kyphoplasty are to reduce pain from the fracture, stabilize the vertebra, and restore the vertebra back to its normal height.
Basivertebral Nerve Ablation
The Intracept procedure is a minimally invasive, outpatient procedure targeted to ablate or destroy the Basivertebral Nerve in the vertebral body to significantly improve chronic, axial low back pain. The procedure maintains the normal spine architecture and does not use an implant. Level 1, randomized, double-blind, sham-controlled clinical trials demonstrate the safety and effectiveness of the Intracept procedure with the procedure leading to statistically significant pain relief and functional improvement.