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Facet
joint injections are
used to localize and
treat low back pain that
is caused by problems of
the facet joints. These
joints are located on
each side of the
vertebrae; they join the
vertebrae together and
allow the spine to move
with flexibility. The
facet joint injections
form a pain block that
allows the doctor to
confirm that it is a
facet joint causing the
pain. The medication
used also decreases
inflammation of the
joint that occurs with
arthritis and joint
degeneration.
To
insure that an injection
is actually into the
facet joint,
"fluoroscopy" can be
used to confirm that the
needle is in the right
position before the
medication is injected.
A fluoroscope uses
X-rays to show a TV
image, so the doctor can
watch as the needle is
placed into the joint.
The fluoroscope can also
magnify the image,
increasing accuracy.
There
are two types of facet
joint injections:
Interarticular -
This is
injected directly into
the joint to block the
pain and reduce
inflammation.
Nerve Blocks -
These
help determine whether
the joint is indeed a
source of pain by
blocking the medial
branch or nerves that
connect with the joint.
Indications to use a
facet joint injection
A
facet joint injection is
perhaps the best way to
diagnose facet joint
syndrome. Joints that
may look abnormal on an
X-ray may in fact be
painless, and joints
that look fine may
indeed be the source of
the pain - only the
injection tells the true
story. These injections
may be used to treat low
back pain and determine
whether the facet joints
are the true culprits.
It is also a rather
simple procedure with
low risk.
Sacroiliac joint (SI
joint) pain is easily
confused with back pain
from the spine. The SI
joint is located between
the sacrum and the
hipbone. In some cases,
injecting the SI joint
with lidocaine may help
your doctor determine
whether it is the source
of your pain or not. If
the joint is injected
and your pain does not
go away, it is probably
coming from somewhere
else. If the pain goes
away immediately, your
doctor may also inject
cortisone into the joint
before removing the
needle. The cortisone is
added to treat the
inflammation from SI
joint arthritis that may
be causing your pain.
The injection usually
gives temporary relief
for several weeks or
months.
Indications to use a
sacroiliac joint
injection
SI joint injections can
be used to treat and to
prove that the SI joint
is the source of pain.
This injection usually
requires the use of
fluoroscopic (radiologic)
guidance or a CAT scan
in order to make sure
the needle is placed
correctly in the joint.
CAT scans are X-ray
tests that produce X-ray
"slices" taken of the
spine, so each section
can be examined
separately.
What it is:
A
discogram is an X-ray
examination of the
intervertebral discs.
The test is performed by
injecting dye into the
center of the injured
disc(s). The dye makes
the disc clearly visible
on X-ray film and a
fluoroscope screen.
What
the test shows:
This test is used to
determine which disc(s)
are damaged and if those
discs are causing pain.
This test will show if a
disc has begun to
rupture and will show if
the disc has tears in
the tough outer ring
called the "annulus". By
injecting fluid to
increase the pressure in
the disc, the doctor can
tell if the disc is
painful. This is
sometimes helpful in
determining exactly
which disc is causing
the pain.
What the test does not
show:
The
discogram is not a test
that is done frequently.
Usually the test is done
after an MRI if the MRI
fails to show a
herniated disc. The
discogram is normally
done when surgery is
being seriously
considered, because the
pain has not responded
to treatment, and there
is no evidence that the
disc is actually
herniated. The discogram
does not really show the
bones or the nerves that
well - only the inside
of the intervertebral
disc.
How
the test is done:
A discogram is done by
inserting a long needle
into the center of the
intervertebral disc
itself - into the
nucleus pulposus. The
needle is inserted from
the back. During a
discogram, you will
first be given
medication to help you
relax, and then a local
anesthetic in the skin
around the area of the
back where the needle
will be inserted. The
doctor watches on a
fluoroscope as he
inserts the needle to
make sure it goes into
the correct disc space.
The fluoroscope is a
special X-ray TV that
allows the doctor to see
your spine and the
needle as it moves. Once
the doctor is sure the
needle is in the disc
space, he will inject a
small amount of fluid to
cause pressure in the
disc space. If this
causes pain, it is a
good indication that the
disc is abnormal. Dye is
then inserted into the
disc that will show up
on X-rays. The X-rays
are taken, and
generally, a CAT scan is
done as well, to see the
disc in cross section.
The procedure usually
lasts about 40 minutes.
What risks the test has:
A
discogram requires a
needle to be inserted
into the disc. This test
has more risks
associated with it than
most other tests. This
is one of the reasons
that doctors prefer to
use the "non-invasive"
tests, such as the MRI
and CAT scan, first. The
risks associated with a
discogram include
infection of the disc
space, as well as an
allergic reaction to the
dye. Discograms are done
using X-rays. X-rays use
radiation, which in
large doses can increase
the risks of cancer. The
vast majority of
patients who get X-rays
will never get enough
radiation to worry about
cancer. Only patients
who must have multiple
X-rays (hundreds) over
many years need worry
about this risk.
What the test costs:
A
discogram of the spine
usually has two costs
associated with the
test. The first cost is
the fee for actually
doing the test. This is
called the "technical
fee". The second cost is
the fee of having a
specialist, such as a
radiologist or a spine
surgeon, read and
interpret the test. This
is called the
"professional fee". You
may get two bills for
this test: one from the
hospital or clinic where
you had the discogram
done, and one from the
specialist who read the
test.
What risks the test has:
A
discogram requires a
needle to be inserted
into the disc. This test
has more risks
associated with it than
most other tests. This
is one reason that
doctors prefer to use
the "non-invasive"
tests, such as the MRI
and CAT scan, first. The
risks associated with a
discogram include
infection of the disc
space and an allergic
reaction to the dye.
Discograms include
X-rays. X-rays use
radiation. In large
doses, radiation can
increase the risk of
cancer. The vast
majority of patients who
get X-rays will never
get enough radiation to
worry about cancer. Only
patients who must have
multiple X-rays
(hundreds) over many
years need worry about
this risk.
What the test costs:
A
discogram of the spine
usually has two costs
associated with it. The
first cost is the fee
for actually doing the
test. This is called the
"technical fee". The
second cost is the fee
of having a specialist,
such as a radiologist or
a spine surgeon, read
and interpret the
results. This is called
the "professional fee".
You may get two bills
for this test: one from
the hospital or clinic
where you had the
discogram, and one from
the specialist who read
the test.
This
diagnostic and
therapeutic injection of
the sheath surrounding a
nerve root is done to
decrease pain
temporarily and to
define it more
precisely. The exam uses
therapeutic steroid and
local anesthetic to
decrease pain and
inflammation. Pain
relief from the
procedure varies from
minimal to long-term,
depending on the
specific symptoms.
Symptoms
must be present for this
procedure to be
effective. If the
patient is not
experiencing symptoms
prior to the procedure,
he/she should cancel the
appointment and
reschedule the exam once
the symptoms have
returned.
The
patient will be awake
throughout the
procedure. A radiologist
will advance a needle
under fluoroscopic
guidance, positioning
the needle adjacent to
the nerve sheath.
Contrast material will
then be injected to
confirm needle position.
Next the medications are
injected, which may
create a pressure
sensation.
Preparation:
Stop blood thinners 48
hours in advance; stop
pain medication 8 hours
in advance
Liquids and/or a light
snack before the
injection
Patient should bring
previous films
Patient will need a
driver - due to the
effects of certain
medications, the
patient’s driving
reflexes may be impaired.
What is spinal cord
stimulation?
Spinal cord stimulation
is a pain treatment that
delivers low voltage
electrical stimulation
to the spinal cord to
block the sensation of
pain. These currents
cause a biological
change and interrupt
pain signals to the
brain.
A generator that
delivers electrical
impulses to the spinal
cord is implanted under
the skin in the abdomen
or back. A cable with
electrodes, which are
implanted near the
spinal cord, is extended
from the generator. The
patient uses a
programmer, a portable
device outside the body,
to control the settings
for pain relief. The
device runs on a lithium
battery that lasts about
3 to 5 years.
Spinal cord stimulation
was developed in the
late 1960s and widely
used in the 1970s. The
first completely
implantable system came
into use in 1982 after
being developed by
Medtronic, Inc.
IDET
therapy is a minimally
invasive treatment in
which the physician
applies precisely
controlled heat to a
broad section of the
affected disc wall. Heat
contracts and thickens
the disc material,
resulting in contraction
or closure of the disc
wall fissures and a
reduction in the bulge
of the inner disk
material.
IDET
therapy is a
minimally invasive
treatment in which
the physician
applies precisely
controlled heat to a
broad section of the
affected disc wall.
Heat contracts and
thickens the disc
material, resulting
in contraction or
closure of the disc
wall fissures and a
reduction in the
bulge of the inner
disk material.
Patients with severe
or chronic low back
pain, caused by this
type of disc
problems, now have a
new, advanced,
non-surgical
treatment option
that bridges the gap
between traditional
pain management
therapy and spinal
surgery.
Disc decompression has
been shown to treat
symptomatic patients
with contained herniated
discs.
Percutaneous disc
decompression has been
used in the treatment of
herniated discs for over
30 years and in over
500,000 patients. A
variety of techniques
have been used to
decompress discs,
including chemical,
mechanical, and
thermal/heat
(radiofrequency and
laser) methods.
Whilst the basic
mechanism of
percutaneous disc
decompression has been
well understood, each of
the previous methods has
suffered from
limitations. No method
has adequately addressed
all of the issues
inherent in disc
decompression – until
now.
DISC Nucleoplasty is a
significant and
clinically demonstrated
innovation in
percutaneous disc
decompression. It
combines tissue removal
with thermal treatment,
enabling simple and
efficient disc
decompression to be
performed with minimal
invasion and trauma.
Since it’s first
application in July
2000, the DISC
Nucleoplasty procedure
has been used to treat
over 20,000 patients in
the USA and around the
world. During this time
a variety of peer
reviewed and published
studies have
demonstrated both the
safety and effectiveness
of the procedure. It has
quickly become a leading
treatment for
symptomatic patients
with contained herniated
discs.
Radiofrequency lesioning
of nerves is a procedure
that may be used to
reduce chronic pain by
preventing transmission
of pain signals. It is a
safe procedure in which
a section of nerve
tissue is heated to
cause a long-lasting
interruption in pain
signals and reduce pain
in that area.
Your health professional
will first identify the
nerve or nerves that are
sending pain signals to
your brain. The location
of the nerves will be
identified by X-rays
taken of the position of
your bones. After you
receive a local
anesthetic, an
instrument is placed
under your skin through
which electrical
stimulation is given to
heat the surrounding
tissue. This may cause
you to feel a buzzing or
tingling sensation. The
heat "numbs" your
nerves, blocking them
from sending pain
signals to your brain.
However, the nerve often
tries to grow back and
therefore the results
are only temporary and
usually last for around
6 to 9 months.
This procedure is done
in an operating room and
takes between 20 minutes
to an hour or longer
depending on how many
nerves are being
blocked. If the nerve
blocked is not the nerve
causing the pain, your
pain will not be
reduced.
Radiofrequency lesioning
is not effective for
everyone. If you have
not responded well to
other treatment, such as
diagnostic local
anesthesia nerve blocks,
radiofrequency lesioning
will probably not work
for you.
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