Procedures

Epidural Block

Epidural steroid block An epidural block is performed under fluoroscopy to confirm a specific diagnosis and/or decrease pain and inflammation. This can be given in the cervical (neck), thoracic (upper back), and lumbar (lower back) area. The epidural space is a fairly tight bony canal containing fat that cushions the spinal cord and the nerve roots within the spinal canal. Lower back pain, leg pain, and arm pain are usually caused by inflammation and irritation of nerve roots. This may be due to arthritis, ruptured or bulging disc and continued post-operative scarred or swollen tissues, all likely contributing to interference in the blood supply sources and contributing to chronic ischemia (oxygen and nutrients deprivation). By injecting a steroid into the epidural space that surrounds the nerve roots, the inflammation and swelling are decreased, and shrinking the boggy , angry tissues we can allow at least a temporary improvement in that toxic environment.

Frequently Asked Questions about Epidural Block

Facet (Medial Branch) Block

A Medial Branch Block (MBB) is a refined procedure used to identify arthritis, frequently not recognized by any other tests, including MRI or CT scans. It works by causing a temporary interruption of the nerve supply to a facet joint with a small amount of local anesthetic, placed through a precisely x-ray guided thin needle around the nerve branches that provide the supply to each facet joint. These nerves are called the medial branches.

Once the source of your pain is identified with MMB, Radiofrequency Ablation of those nerves will provide an extended period of pain relief, facilitating a rehabilitative protocol.

Frequently Asked Questions about Facet (Medial Branch) Block

Medial Branch

Medial Branch Radiofrequency (RF) ablation follows a successful diagnostic Medial Branch Block (MBB) that identifies the source of pain. Radiofrequency Rhizotomy will provide an extended period of pain relief, enabling a rehabilitation and a reparative process to be adopted with more ease.

It is a procedure which causes an interruption of the nerve supply to a facet joint. This interruption, known as a denervation, is accomplished by a radio-frequency probe that heats the small nerve branches to each facet joint and disrupts them for a prolonged time (4-12 months).

Frequently Asked Questions about Medial Branch Block

Provocative Discogram

A discogram is a diagnostic test performed to view and assess the internal structure of a disc and determine if it is a source of pain.

This procedure will diagnose a disc injury which may be the cause of your ongoing pain. It also will help determine if you are a suitable candidate for disc surgery. A small amount of intravenous medication will be administered as a relaxant and pain reliever and a local anesthetic is injected in the area that is being examined. A needle is inserted through a previously placed needle in the skin and into the disc under fluoroscopy.

Frequently Asked Questions about Provocative Discogram

Selective Nerve Root Block

A selective nerve root block is intended to target and determine if and which particular specific spinal nerve root is your source of pain. It will reduce inflammation around the nerve root thus decreasing or relieving the pain. This can be given in the cervical (neck), thoracic (upper back), and lumbar (lower back area).

The pain you are experiencing in the upper or lower extremities is usually caused by inflammation and irritation of a nerve root. Another possible explanation is ischemia caused by swelling that squashes the tiny blood vessels supplying vital nutrients to the nerve root tissue. The combination of numbing medication and steroids will offer pain relief as well as decrease of the edema, providing much needed respite to the suffering nerve.

Frequently Asked Questions about Selective Nerve Root Block

Spinal Cord Stimulation

A spinal cord stimulator is a device used to exert pulsed electrical signals to the spinal cord to control chronic pain. Further applications are in motor disorders. The lumbar spinal cord is a preferred target for the control of spinal spasticity or augmentation of standing and stepping capabilities.

Spinal cord stimulation (SCS), in the simplest form, consists of stimulating electrodes, implanted in the epidural space, an electrical pulse generator, implanted in the lower abdominal area or gluteal region, conducting wires connecting the electrodes to the generator, and the generator remote control. SCS has notable analgesic properties and, at the present, is used mostly in the treatment of failed back surgery syndrome, complex regional pain syndrome and refractory pain due to ischemia.

Frequently Asked Questions about Spinal Cord Stimulation

Stellate Ganglion Block

A stellate ganglion block is an injection of local anesthetic to block the sympathetic ganglions (sometimes described as relay stations in the pain transmission channels) located on either side of the neck. Blocking these areas may reduce symptoms such as pain, swelling, color, and sweating changes in the upper extremities and may also improve mobility. It works by delaying and interfering with the pain sensation processing and transmission mechanisms. It's useful for pain located in the head, neck, chest, or arm caused by sympathetically maintained pain (reflex sympathetic dystrophy), causalgia (nerve injury), herpes zoster (shingles), or intractable angina (pain related to decreased blood flow to the heart). Stellate ganglion blocks are also used to see if blood flow can be improved in those patients with circulation problems related to vascular disease.

Stellate ganglion blocks may be therapeutic (to relieve pain) and/or diagnostic (to determine the source of your pain). In many cases, they may be an essential component to a long term program of keeping your pain within tolerable limits, especially for cases where even the strongest medications have little benefit, and significant as well as dangerous side effects