Hospital Procedures

Hospital Procedures

CAUDAL STEROID INJECTION

  • Indication: Procedure is performed to relieve low back and radiating leg pain
  • Diagnosis: Spinal Stenosis, Radiculopathy, Sciatica, Herniated Discs, Post Laminectomy Syndrome
  • Procedure: The patient lies face down. A cushion is placed under the stomach area for comfort and to
    arch the back. The physician uses a fluoroscope to find the small opening at the base of the sacrum called the sacral hiatus. A local anesthetic numbs the skin and all the tissue down to the surface of the sacral hiatus. The physician then guides a needle through the anesthetized tract and into the epidural space. The needle is carefully inserted about one to two centimeters. Once inside the sacral hiatus space, a contrast or non-allergenic iodine based solution is injected. The solution helps the physician see the diseased and painful areas using a fluoroscope. A steroid is injected into the epidural space, bathing the painful area in medication.

EPIDURAL STEROID INJECTION (ESI)

  • Indication: Radiating pain.
  • Diagnosis: Radiculitis, Thoracic Pain, Neuritis, Lumbago
  • Procedure: A fluoroscope assists the physician in locating the appropriate vertebra and nerve root. A
    local anesthetic is used to numb the skin. All of the tissue down to the surface of the lamina portion of the vertebra bone is anesthetized. The physician slides a thicker needle through the anesthetized tract. Using the fluoroscope for guidance, the physician slides the needle toward the epidural space. A contrast solution is injected. The physician uses the fluoroscope to see the painful areas and to confirm the correct location of the needle tip. A steroid-anesthetics mix is injected into the foraminal epidural space bathing the painful nerve root with medication.
  • POSSIBLE RISKS/COMPLICATIONS OF ESI: Spinal headache, Bleeding (rare), Infection (rare), Bruising
  • WHEN TO CALL YOUR DOCTOR: Call right aware if you notice any of the following symptoms: Severe pain or headache, loss of bladder or bowel control, fever or chills, redness or swelling around the
    injection site.

INTRA-ARTICULAR HIP INJECTION

Medical Branch Block
  • Indication: Pain caused by arthritis/inflammation in the hip joint
  • Diagnosis: Osteoarthritis, Labral Tear
  • Procedure: The patient lies face up and a cushion is placed under the knee for comfort. The physician uses a fluoroscope to find the hip joint. A local anesthetic numbs the skin and all the tissue down to the surface of the sacroiliac joint. The physician advances a needle through the anesthetized tract and into the sacroiliac joint. A steroid-anesthetics mix is injected into the hip joint, bathing the painful area in medication. The needle is removed, and a small bandage is used to cover the tiny surface wound.

INTRA-ARTICULAR SHOULDER INJECTION

  • Indication: Performed to relieve pain caused by arthritis/inflammation in the shoulder joint
  • Diagnosis: Osteoarthritis, Labral Tear
  • Procedure: The patient lies face up and a cushion is placed under the knee for comfort. The physician uses a fluoroscope to find the shoulder joint. A local anesthetic numbs the skin and all the tissue down to the surface of the shoulder. The physician advances a needle through the anesthetized tract and into the shoulder. A steroid-anesthetics mix is injected into the shoulder joint, bathing the painful area in medication. The needle is removed, and a small bandage is used to cover the tiny surface wound.

LUMBAR TRANSFORAMINAL EPIDURAL STEROID INJECTION (TFESI)

  • Indication: Performed to relieve low back and radiating leg pain
  • Diagnosis: Spinal Stenosis, Radiculopathy, Sciatica and Herniated Discs.
  • Procedure: The patient lies face down. A cushion is placed under the stomach area which provides comfort and flexes the back. In this position, the spine opens and allows for easier access to the epidural space. A fluoroscope assists the physician in locating the appropriate lumbar vertebra and nerve root. A local anesthetic is used to numb the skin. All the tissue down to the surface of the vertebral transverse process is anesthetized. The physician slides a thin bent needle with a lightly curved point through the anesthetized tract. With the aid of the fluoroscope, the physician carefully guides the needle into the foraminal space near the nerve root. The physician injects a contrast solution and uses the fluoroscope to see the painful areas and confirm the correct location of the needle tip. A steroid-anesthetics mix is injected into the foraminal epidural space bathing the painful nerve root with soothing medication. The needle is removed and a small Band-Aid is used to cover the tiny needle surface wound. In some cases, it may be necessary to repeat the procedure as many as three times to provide the full benefit of the medication. However, many patients feel significant relief from only one or two injections.

MEDIAL BRANCH BLOCKS (MBB)

  • Indication: Back pain radiating across due to arthritis in the small joints in the spine.
  • Diagnosis: Degenerative Changes
  • Procedure: Each vertebra in the spine is connected to the vertebra above and below it by facet joints, which are located on both sides of the rear of the spine. Each facet joint has at least two medial branch nerves. They are part of the nerve pathway to and from each facet joint. A facet joint block can be both diagnostic and therapeutic for back and neck pain. A facet joint in your back or neck can become inflamed (swollen and irritated). Pain messages may then travel along the nerve pathway from the facet joint to your brain.

A Medial Branch Block can confirm whether the facet joints are indeed the source of pain and can help relieve the pain and inflammation.
A small area of skin is numbed with a local anesthetic injection. Guided by fluoroscopic x-ray, a
needle is placed into the facet joint. The correct placement of the needle is confirmed by injecting
contrast dye into the joint. A combination of numbing anesthetic and an anti-inflammatory steroid
medication is delivered to the joint through a thin-needle. Depending on the location of pain, one or more injections may be administered. If the pain subsides after the injection, this suggests that the facet joint (or joints) injected were the cause of the pain. Back or neck pain may disappear immediately after a successful block. However, once the numbing effect of the anesthetic wears off, pain may return.

**80% or greater relief and improvement on functional status after the first diagnostic Medial
Branch Block with pain returns after 4-6 hours will then qualify for a second diagnostic block. If
improvement is 80% or greater with the second block is obtained along with improvement in
functional status, but pain reoccurs after 4-6 hours, Radiofrequency Ablation is indicated**

RADIOFREQUENCY NEUROTOMY/ABLATION

  • Indication: Back pain that occurs on one or both sides of your lower back, extends into the buttock
    region and thighs but not usually past the knee, worsens if you twist or lift something, improves when
    you are lying down.
  • Diagnosis: Degenerative Changes
  • Procedure: Radiofrequency Neurotomy is a procedure to reduce back pain. Heat generated by radio waves is used to target specific nerves and temporarily interfere with their ability to transmit pain signals. The radio waves are delivered to the targeted nerves via needles inserted through the skin above your spine. Imaging scans are used during radiofrequency neurotomy to help the doctor position the needles precisely. The goal is to temporarily reduce chronic pain in the back or neck that has not been adequately relieved by other means, such as medications or physical therapy.

SACROILIAC JOINT INJECTION

  • Indication: Performed to relieve pain caused by arthritis/inflammation in the sacroiliac joint where the
    spine and hip bone meet.
  • Diagnosis: Sacroiliits
  • Procedure: The patient lies face down and a cushion is placed under the stomach for comfort and to arch the back. The physician uses a fluoroscope to find the sacroiliac joint. A local anesthetic numbs the skin and all the tissue down to the surface of the sacroiliac joint. The physician advances a needle through the anesthetized tract and into the sacroiliac joint. The needle is removed, and a small bandage is used to cover the tiny surface wound.

If patient obtains a 75% or greater relief and improvement in
functional status after the first diagnostic block but pain returns after 4-6 hours, we will then
perform a second diagnostic block. If improvement is 75% or greater with this second block and
again there is improvement in functional status but pain reoccurs after 4-6 hours, we will proceed with therapeutic SI joint injection which is meant to provide longer lasting relief.

LUMBAR SYMPATHETIC BLOCK

sympathetic block
  • Indication: Performed to relieve leg pain caused by complex regional pain syndromes, which may
    develop after an injury to a joint or limb
  • Diagnosis: Complex Regional Pain Syndrome (CRPS)/ Rejection sensitive dysphoria (RSD)
  • Procedure: Usually a series of injections are needed to treat the problem. The patient lies on the stomach on a table equipped with a special x-ray (fluoroscopic) unit. An IV is started to administer medication to relax the patient. A local anesthetic numbs the skin and tissue down to the sympathetic nerves. The physician slides a needle through the anesthetized tract. A contrast solution is injected. The
    physician uses a fluoroscope to identify the painful areas and to confirm the correct location of the needle tip. A mixture of anesthetic, saline and anti-inflammatory medicine is injected around the sympathetic nerves to block pain signals and from reaching the brain. The legs may feel weak or numb for a few hours after the procedure. Then, the pain from the legs should improve. More blocks may be repeated about once a week until the pain subsides.

COOLED RADIOFREQUENCY ABLATION FOR KNEE PAIN

Do you have Degenerative Joint Disease (Osteoarthritis/OA) of the knee? Chronic knee pain? Have you
had a Partial Knee Replacement/Total Knee Replacement? Are you unable/don’t want to have a knee replacement?
Genicular Neurotomy (aka ablation or RFA) may be the answer for you!

RFA is an innovative treatment option for treating knee pain without surgery. This highly advanced procedure which selectively applies a sophisticated type of radio wave to the nerves surrounding the
knee (the genicular nerves). Cooled radiofrequency ablation of the knees is a minimally invasive, safe,
effective means of controlling knee pain. For those who are not candidates for knee surgery, cooled
radiofrequency ablation is an important option.
Knee pain is a very frustrating and common problem.

The first step of osteoarthritis is physical therapy and over the counter medications followed by injections (corticosteroids of hyaluronic acid injections). While surgery is an accepted treatment option for patients it is not always the best or most convenient
of options. In these cases, RFA is a safe and successful alternative to joint replacement. Some have pain that persists after surgery. Traditionally in these unfortunate cases, patients had few options if any that did not involve additional surgery that was rarely successful. With RFA, patients can look forward to pain
relief without any further surgeries.