COMPREHENSIVE PAIN CENTERS
A subsidiary of Lehigh Valley Pain Management, Inc.
Phone: (610) 366-9000 Toll Free: (800) 366-9078
A subsidiary of Lehigh Valley Pain Management, Inc.
Phone: (610) 366-9000 Toll Free: (800) 366-9078
Pain Management Procedures – both surgical and outpatient
CLICK HERE to download our Procedural GuidelinesBrachial Plexus Block - Axillary
This procedure is performed to decrease the pain sensation in your arm and hand. The brachial plexus is a nerve branch deep within the shoulders. It is located between the neck and the axillary area supplying the arms, hands, and nearby muscles with sensation. You will be lying on your back with the elbow of the involved arm flexed and your hand next to your head. Your physician will palpate the pulse in your armpit. Under sterile technique, the doctor will insert a small gauge needle through the anterior and posterior walls of the artery in order for the tip of the needle to lie close to the nerves. The doctor will inject a local anesthetic, like Novocain, over the nerves. This procedure is performed to decrease the discomfort in your area of pain. The amount and duration of pain relief varies with all individuals.
Celiac Plexus Block
This procedure is performed for pain control in patients with pancreatitis, pancreatic cancer, and stomach cancer. The patient is positioned prone on the X-Ray table. Under fluoroscopic guidance, a spinal needle is inserted through an anesthetic area of your skin next to your spine until it reaches the body of L1 vertebrae. The needle is then repositioned so its tip lies on the anterolateral aspect of the vertebral body. Dye is sometimes injected through the needle to confirm correct needle placement. A second needle is positioned in the same manner on the other side. After negative aspiration for blood and cerebrospinal fluid a local anesthetic, like Novocain, is injected over the celiac plexus.
The celiac plexus is a fusion of nerves near the celiac arterial trunk that supplies the upper portions of the digestive tract, the spleen, and the liver. Your physician has decided to inject this area with a local anesthetic and possibly a steroid to relieve your discomfort. The amount and duration of pain relief varies with all individuals. Pain relief is expected within 15 to 20 minutes.
This procedure is performed sitting in a chair with your forehead resting on the bed. If X-Ray is used then you will be lying on your stomach with a pillow under your chest. Sterile technique is maintained throughout the procedure. Your physician will use a very small needle to anesthetize the skin on the back of your neck. The doctor will then insert the epidural needle until it reaches the epidural space. The doctor will inject a solution of preservative-free normal saline, a steroid called Depo-Medrol, and/or local anesthetic. The epidural space is a potential space found above the space containing your spinal cord; it consists of fatty tissue, blood vessels, and nerve roots. The purpose of this injection is to reduce inflammation around the nerve roots to reduce pain sensation.
Cervical Facet Joint Injection
This procedure is performed with you lying on your back for the upper cervical facet joint injections and on your stomach for the lower levels. Under sterile conditions and with X-Ray guidance, your physician will insert a small gauge needle next to these joints. Once satisfied of the correct needle placement, he will inject a small amount of local anesthetic mixed with steroid to decrease inflammation in those joints. This procedure is performed for patients who complain of neck pain and headache due to irritation of the facet joints.
Cryoanalgesia
Cryoanalgesia refers to interrupting pain signals with the use of extremely cold temperatures. This procedure offers long term pain relief without the use of drugs. This technique is very acceptable for intractable pain of any origin, even if a mixed (motor/sensory) nerve is involved.
During the procedure, the patient remains conscious. Often the procedure is performed under fluoroscopy (a type of X-Ray). During stimulation the patient will feel a pulse or beat which is normally not painful. The nerve is being frozen which results in numbness in the area of pain. Within a few weeks the numbness disappears, but a majority of patients continue to feel pain relief for several months.
Discogram
A discogram is a diagnostic test performed to view and assess the internal structures of a disc and determine if it is a source of pain. The patient is given intravenous medication as a relaxant and pain reliever. A local anesthetic is injected into the patient’s skin 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. A saline solution and dye are injected into the disc, or discs if more than one disc is being examined. A CT Scan is usually performed on the painful disc after the dye is injected to obtain images of the dye distribution. This will display annular tears, scarring, disc bulges, and changes in the nucleus of the disc.
Disc Nucleoplasty
A contained herniated disc bulges outward and causes pain by decompressing a nerve root or the spinal cord against an adjacent bony structure of the spine.
A Disc Nucleoplasty is an outpatient procedure to decompress herniated discs. During a Disc Nucleoplasty, a catheter is inserted into the disc under X-Ray guidance. The decompression device is introduced through the catheter.
Epidural Steroid Injection
Epidural Steroid Injections are of value to patients with both spinal stenosis and acute herniations. In cases of chronic stenosis, especially among the elderly, patients can remain functional despite a relatively high degree of pain, but they are often incapacitated by acute attacks. Pain management injections are very useful in fighting these acute episodes. The alternative to injection may be surgery or, in those for whom surgery is not an option, a life of pain. Patients need to understand that one injection is not a cure. Many patients will require a few injections per year. Epidural Steroid Injections can result in significant relief of pain.
Facet Joint Injection
The purpose of this procedure is to decrease pain and inflammation due to facet joint discomfort. The duration of pain relief varies with each patient. The injections are performed at multiple facet joints. The local anesthetic medication used will provide a temporary numbing effect, lasting from one or two hours to several hours. The steroid injection begins to take effect two or three days after the injection and continues to be effective for an extended period of time.
Greater & Lesser Occipital Nerve Blocks
These nerves are located on both sides in the back of your head. When irritated they can cause occipital headaches. The procedure consists of injecting a small amount of local anesthetic mixed with steroid through a small gauge needle around these nerves.
Intercostal Nerve Block
The intercostal area describes the spaces between your ribs that are supplying nearby muscles and structures such as the ribs with sensation. The purpose of this procedure is to decrease pain and inflammation in the area of your pain. The duration of pain relief varies with each patient. The local anesthetic medication used will provide a temporary numbing effect, lasting from one or two hours to several hours. The steroid injection begins to take effect two or three days after the injection and then continues to be effective for an extended period of time.
Intradiscal Block
Intradiscal describes the space between your discs that are supplying nearby discs with sensation. The purpose of this procedure is to decrease pain and inflammation in the area of your pain. The duration of pain relief varies with each patient. The local anesthetic medication used will provide a temporary numbing effect, lasting from one or two hours to several hours. The steroid injection begins to take effect two or three days after the injection and continues to be effective for an extended period of time.
Interscalene Brachial Plexus Block
This procedure is performed to numb the nerves of your shoulder, arm, and hand. You will be lying on your back. After adequate monitoring, your physician will locate a small groove in-between two muscles in your neck. The doctor will then insert a small gauge needle attached to a syringe in that groove until it touches the nerves. At that point, you will feel a transient small “electric” shock going down your arm. Your physician will withdraw the needle a few millimeters and inject a local anesthetic, like Novocain, over the nerves. The arm on the side of the procedure will be numb and possibly weak for a few hours.
Intrathecal Morphine Pump
This device is implanted inside your body and delivers a controlled amount of medication through a catheter into the subarachnoid space, which is the space that surrounds your spinal cord. The receptors where Morphine works are found predominantly at the level of the spinal cord. When taking Morphine orally, the medication is widely distributed throughout the body before a small amount reaches the spinal cord. The intrathecal pump delivers the medication where it is most effective. Therefore, the same or even better pain control can be achieved with less medication and less side effects. The system consists of two parts; a catheter and a pump with or without an access port.
The system is surgically implanted in the operating room with you lying on your side. Under X-Ray guidance, a special spinal needle is inserted into the subarachnoid space. The catheter is then inserted through the needle. Your surgeon will then make a pocket under your skin to hold your pump. Once the catheter and pump are in place, the surgeon will attach the catheter to the pump and close the pocket. You will be asked to come to your doctor’s office regularly for pump refill and follow-up visits.
Lumbar Sympathetic Nerve Block
The purpose of this procedure is to decrease pain and increase circulation in the area of your discomfort; it will improve blood flow to your legs as well as reduce burning pain with nerve diseases. This procedure is done under sterile technique with you lying on your stomach on the X-Ray table. The entry point of the needle next to your spine in the middle of your back is anesthetized. Under fluoroscopic guidance, a spinal needle is advanced until it touches the body of the L2 vertebrae. The doctor will then inject a local anesthetic medication, such as Novocain, in an area where a group of nerves (sympathetic nerves) that supply the legs come together in the back.
Increasing circulation provides more blood flow and oxygen in the area of your pain. The duration of pain relief varies with each patient. In addition to pain reduction, an increase in temperature will be expected in the involved leg at the conclusion of the procedure.
If your pain is relieved by this procedure then a series of blocks may be desired to help break the pain cycle.
Nerve Block
Many different types of nerve blocks can be performed depending on the area where you feel your pain. The purpose of this procedure is to decrease pain and inflammation in the area of your pain. The duration of pain relief varies with each patient. The local anesthetic medication used will provide a temporary numbing effect, lasting from one or two hours to several hours. The steroid injection begins to take effect two or three days after the injection and continues to be effective for an extended period of time.
Minimally Invasive Lumbar Decompression (MILD)
More than 1.5 million Americans suffer from chronic pain and immobility caused by lumbar spinal stenosis (LSS), a degenerative, age-related narrowing of the lower spinal canal that causes pressure on the nerves. Approximately, 700,000 of them are in some form of treatment for LSS every year. Many address their LSS symptoms with either pain medications or steroid injections, but these treatments either eventually stop working or just wear off. For years, the next line of treatment for LSS has been lumbar spine decompression surgery involving the insertion of artificial implants (interspinous spacers), removal of portions of the vertebrae and attached ligaments (laminectomy), and/or fusion of the spine.
MILD is a safe and effective alternative that is the least invasive surgical procedure for LSS. MILD, or Minimally Invasive Lumbar Decompression, is FDA approved for decompression of the lumbar spine. It is an image-guided, percutaneous (skin puncture) procedure that is most often performed on an outpatient basis. The physician removes the bone or tissue causing the pressure on the nerve through a puncture the diameter of a pencil. This procedure provides immediate and lasting relief for patients by addressing a primary cause of lumbar spinal stenosis.
Myofascial Trigger Point Injection
A myofascial trigger point is a hyper-irritable spot located in a muscle or its associated tendon and ligament. A trigger point is active when it causes pain. Trigger points are found in the skeletal muscles because, being the larger organ of the body, they are subject to all the stresses of routine daily activities. When the involved muscle is stretched, pain is experienced in the local area. When the point of maximum tenderness is identified, compressed pain is referred to adjacent areas.
The goal of therapy is to reduce pain and improve function. This can be accomplished by the stretch and spray technique to relax the muscle, trigger point injections with local anesthetic into the point of maximal tenderness, and a graded exercise program.
Phenol (Chemical) Sympathectomy
Phenol (Chemical) Sympathectomy is often performed to prevent or reduce constriction in the small blood vessels in your legs and feet. The aim is to improve the circulation in the leg or foot but is occasionally done to reduce pain from other conditions, where disease of blood vessels is not the primary problem. Excessive sweating is also a reason to have phenol (chemical) sympathectomy.
RACZ Catheter - also known as Lysis of Adhesions
This procedure is performed to remove excessive scarring in the epidural space, otherwise inaccessible by normal epidural. The epidural space is a thin area between the inside of the spine and the protective layer around the spinal cord. Scar tissue may restrict the natural movement of nerves causing inflammation, therefore creating pain.
Step 1: A local anesthetic numbs the skin and tissue.
Step 2: The physician inserts the catheter into the epidural space under X-Ray guidance at the nearest convenient region, usually the caudal canal, via the sacral hiatus. The sacral hiatus is a natural opening in the spine near the end of the tailbone. The catheter can be seen and directed to the affected nerve root.
Step 3: A contrast solution is injected so the physician can use the fluoroscope to locate and confirm the correct location of the catheter.
Step 4: A steroid-anesthetic solution is injected to relieve pain, dissipate scar tissue and reduce inflammation.
You will be observed in the patient recovery area. It is important to remember that this procedure is only part of your treatment. The steroid anesthetic solution will help to break up scarring around the nerve root and reduce swelling. This procedure may need to be repeated if scar tissue returns.
Indications: Post-Laminectomy Syndrome, Epidural Adhesions, Vertebral Body Compression Fracture, Disc Disruption, Radiculopathy and history of lumbar surgeries.
Rhizotomy (Radiofrequency)
A rhizotomy, or RFTC, is a procedure in which the roots of the spinal nerves within the spinal canal are interrupted with high temperatures. This procedure is performed to decrease your discomfort in the area of your pain sensation. The duration of pain relief varies with each patient. During the procedure your physician will ask you where and when you feel the pain sensation.
Sacroiliac Nerve Block
The sacroiliac joint is a weight bearing joint formed by the surfaces of the Ilium and Sacrum, commonly known as the tail bone. The purpose of a sacroiliac nerve block is to decrease pain and inflammation in the area of your pain. The duration of pain relief varies with each patient. The local anesthetic medication used will provide a temporary numbing effect, lasting from one or two hours to several hours. The steroid injection begins to take effect two or three days after the injection and continues to be effective for an extended period of time.
Spinal Cord Stimulator (SCS)
SCS is an implantable medical device that delivers small electrical pulses to your spinal cord which block the sensations of pain. You will experience paresthesia (a tingling sensation) that alters the perception of pain - in the area where you would normally feel pain. This procedure is offered to patients who have chronic intractable nerve pain, particularly in their extremities after oral medications, nerve blocks, and surgeries fail to adequately control their pain.
This device has three components: A power source and a lead or wire with four electrodes at the end. This sterile procedure is performed in the operating room with you lying on your stomach under monitored anesthesia care. The entry point of the needle in your skin near your spine is numbed with local anesthetic. A special epidural needle is inserted into your epidural space under fluoroscopic guidance. The lead is inserted through the epidural needle and threaded upward until the electrodes lie over the area where you experience pain. An extension wire connected to a power source is attached to the lead. The power source is turned on and parameters (amplitude, frequency, rate) are maneuvered until you experience comfortable tingling sensation in your pain area. Your cooperation is requested during the testing period. Once satisfied, the extension is taped to your back and you are sent home with a temporary power source, called a screener. You will be taught how to use it. If you and your doctor are satisfied with the trial screening period, then a second surgery will be performed during which the lead and power source (pulse generator or receiver depending on the type of SCS selected) will be implanted.
Stellate Ganglion Block (Sympathetic Block)
The stellate is a group of nerves in the neck area. The purpose of this procedure is to decrease pain and increase circulation in the area of your discomfort. A stellate ganglion block is an injection of a local anesthetic (pain relieving medication) around this group of nerves to relieve pain. The pain relief will affect one side of the head and neck, the upper arm and upper part of the chest on the same side of the body. A stellate ganglion block may be performed to decrease pain and increase the circulation and blood supply to the affected arm. Increasing circulation provides more blood flow and oxygen to the area of your pain. The duration of pain relief varies with each patient. If your pain is relieved by this procedure then a series of blocks may be desired to help break the pain cycle.
Trigger Point Injection
A trigger point can be defined as a tender point in your muscles usually associated with a strain that persists beyond the normal healing period of a strain, usually three to six months. Trigger points feel like firm nodules or bands and upon compression can refer pain away from the initial site. The purpose of this procedure is to decrease pain and inflammation in the area of your muscle. The local anesthetic medication used provides a temporary numbing effect, lasting from one or two hours to several hours. The steroid injection begins to take effect two or three days after the injection and continues to be effective for an extended period of time.
TruFUSE Facet Fusion®
Lumbar Facet Fusion is a common diagnosis for patients who suffer from back pain. TruFUSE® Facet Fusion represents a surgical option for back pain sufferers. TruFUSE® can be used as a standalone procedure for degenerative facet joint disease and other indications for facet fusion or in conjunction with a lumbar laminectomy decompression to provide stability to the affected spine segments.
TruFUSE® Facet Fusion “is a minimally invasive procedure that has been designed to address facet degenerative disease and long-term back pain issues. The TruFUSE® procedure eliminates the ‘cause’ of the pain without drugs, screws, rods or major surgery.”
Vertebroplasty
Vertebroplasty is a procedure used for vertebral compression fractures, usually in patients with Osteoporosis. Vertebroplasty stabilizes the collapsed vertebra using a specially formulated acrylic bone cement. This is typically an outpatient procedure (no hospitalization, no surgery) and requires only a local anesthetic. Once the area of the spine is numb, the physician inserts one or two needles through a small incision. The surgeon will inject a bone cement into the affected vertebra. Most patients experience pain reduction within hours.
This procedure is performed to decrease the pain sensation in your arm and hand. The brachial plexus is a nerve branch deep within the shoulders. It is located between the neck and the axillary area supplying the arms, hands, and nearby muscles with sensation. You will be lying on your back with the elbow of the involved arm flexed and your hand next to your head. Your physician will palpate the pulse in your armpit. Under sterile technique, the doctor will insert a small gauge needle through the anterior and posterior walls of the artery in order for the tip of the needle to lie close to the nerves. The doctor will inject a local anesthetic, like Novocain, over the nerves. This procedure is performed to decrease the discomfort in your area of pain. The amount and duration of pain relief varies with all individuals.
This procedure is performed for pain control in patients with pancreatitis, pancreatic cancer, and stomach cancer. The patient is positioned prone on the X-Ray table. Under fluoroscopic guidance, a spinal needle is inserted through an anesthetic area of your skin next to your spine until it reaches the body of L1 vertebrae. The needle is then repositioned so its tip lies on the anterolateral aspect of the vertebral body. Dye is sometimes injected through the needle to confirm correct needle placement. A second needle is positioned in the same manner on the other side. After negative aspiration for blood and cerebrospinal fluid a local anesthetic, like Novocain, is injected over the celiac plexus.
The celiac plexus is a fusion of nerves near the celiac arterial trunk that supplies the upper portions of the digestive tract, the spleen, and the liver. Your physician has decided to inject this area with a local anesthetic and possibly a steroid to relieve your discomfort. The amount and duration of pain relief varies with all individuals. Pain relief is expected within 15 to 20 minutes.
This procedure is performed sitting in a chair with your forehead resting on the bed. If X-Ray is used then you will be lying on your stomach with a pillow under your chest. Sterile technique is maintained throughout the procedure. Your physician will use a very small needle to anesthetize the skin on the back of your neck. The doctor will then insert the epidural needle until it reaches the epidural space. The doctor will inject a solution of preservative-free normal saline, a steroid called Depo-Medrol, and/or local anesthetic. The epidural space is a potential space found above the space containing your spinal cord; it consists of fatty tissue, blood vessels, and nerve roots. The purpose of this injection is to reduce inflammation around the nerve roots to reduce pain sensation.
Cervical Facet Joint Injection
This procedure is performed with you lying on your back for the upper cervical facet joint injections and on your stomach for the lower levels. Under sterile conditions and with X-Ray guidance, your physician will insert a small gauge needle next to these joints. Once satisfied of the correct needle placement, he will inject a small amount of local anesthetic mixed with steroid to decrease inflammation in those joints. This procedure is performed for patients who complain of neck pain and headache due to irritation of the facet joints.
Cryoanalgesia
Cryoanalgesia refers to interrupting pain signals with the use of extremely cold temperatures. This procedure offers long term pain relief without the use of drugs. This technique is very acceptable for intractable pain of any origin, even if a mixed (motor/sensory) nerve is involved.
During the procedure, the patient remains conscious. Often the procedure is performed under fluoroscopy (a type of X-Ray). During stimulation the patient will feel a pulse or beat which is normally not painful. The nerve is being frozen which results in numbness in the area of pain. Within a few weeks the numbness disappears, but a majority of patients continue to feel pain relief for several months.
Discogram
A discogram is a diagnostic test performed to view and assess the internal structures of a disc and determine if it is a source of pain. The patient is given intravenous medication as a relaxant and pain reliever. A local anesthetic is injected into the patient’s skin 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. A saline solution and dye are injected into the disc, or discs if more than one disc is being examined. A CT Scan is usually performed on the painful disc after the dye is injected to obtain images of the dye distribution. This will display annular tears, scarring, disc bulges, and changes in the nucleus of the disc.
Disc Nucleoplasty
A contained herniated disc bulges outward and causes pain by decompressing a nerve root or the spinal cord against an adjacent bony structure of the spine.
A Disc Nucleoplasty is an outpatient procedure to decompress herniated discs. During a Disc Nucleoplasty, a catheter is inserted into the disc under X-Ray guidance. The decompression device is introduced through the catheter.
Epidural Steroid Injection
Epidural Steroid Injections are of value to patients with both spinal stenosis and acute herniations. In cases of chronic stenosis, especially among the elderly, patients can remain functional despite a relatively high degree of pain, but they are often incapacitated by acute attacks. Pain management injections are very useful in fighting these acute episodes. The alternative to injection may be surgery or, in those for whom surgery is not an option, a life of pain. Patients need to understand that one injection is not a cure. Many patients will require a few injections per year. Epidural Steroid Injections can result in significant relief of pain.
Facet Joint Injection
The purpose of this procedure is to decrease pain and inflammation due to facet joint discomfort. The duration of pain relief varies with each patient. The injections are performed at multiple facet joints. The local anesthetic medication used will provide a temporary numbing effect, lasting from one or two hours to several hours. The steroid injection begins to take effect two or three days after the injection and continues to be effective for an extended period of time.
Greater & Lesser Occipital Nerve Blocks
These nerves are located on both sides in the back of your head. When irritated they can cause occipital headaches. The procedure consists of injecting a small amount of local anesthetic mixed with steroid through a small gauge needle around these nerves.
Intercostal Nerve Block
The intercostal area describes the spaces between your ribs that are supplying nearby muscles and structures such as the ribs with sensation. The purpose of this procedure is to decrease pain and inflammation in the area of your pain. The duration of pain relief varies with each patient. The local anesthetic medication used will provide a temporary numbing effect, lasting from one or two hours to several hours. The steroid injection begins to take effect two or three days after the injection and then continues to be effective for an extended period of time.
Intradiscal Block
Intradiscal describes the space between your discs that are supplying nearby discs with sensation. The purpose of this procedure is to decrease pain and inflammation in the area of your pain. The duration of pain relief varies with each patient. The local anesthetic medication used will provide a temporary numbing effect, lasting from one or two hours to several hours. The steroid injection begins to take effect two or three days after the injection and continues to be effective for an extended period of time.
Interscalene Brachial Plexus Block
This procedure is performed to numb the nerves of your shoulder, arm, and hand. You will be lying on your back. After adequate monitoring, your physician will locate a small groove in-between two muscles in your neck. The doctor will then insert a small gauge needle attached to a syringe in that groove until it touches the nerves. At that point, you will feel a transient small “electric” shock going down your arm. Your physician will withdraw the needle a few millimeters and inject a local anesthetic, like Novocain, over the nerves. The arm on the side of the procedure will be numb and possibly weak for a few hours.
Intrathecal Morphine Pump
This device is implanted inside your body and delivers a controlled amount of medication through a catheter into the subarachnoid space, which is the space that surrounds your spinal cord. The receptors where Morphine works are found predominantly at the level of the spinal cord. When taking Morphine orally, the medication is widely distributed throughout the body before a small amount reaches the spinal cord. The intrathecal pump delivers the medication where it is most effective. Therefore, the same or even better pain control can be achieved with less medication and less side effects. The system consists of two parts; a catheter and a pump with or without an access port.
The system is surgically implanted in the operating room with you lying on your side. Under X-Ray guidance, a special spinal needle is inserted into the subarachnoid space. The catheter is then inserted through the needle. Your surgeon will then make a pocket under your skin to hold your pump. Once the catheter and pump are in place, the surgeon will attach the catheter to the pump and close the pocket. You will be asked to come to your doctor’s office regularly for pump refill and follow-up visits.
Lumbar Sympathetic Nerve Block
The purpose of this procedure is to decrease pain and increase circulation in the area of your discomfort; it will improve blood flow to your legs as well as reduce burning pain with nerve diseases. This procedure is done under sterile technique with you lying on your stomach on the X-Ray table. The entry point of the needle next to your spine in the middle of your back is anesthetized. Under fluoroscopic guidance, a spinal needle is advanced until it touches the body of the L2 vertebrae. The doctor will then inject a local anesthetic medication, such as Novocain, in an area where a group of nerves (sympathetic nerves) that supply the legs come together in the back.
Increasing circulation provides more blood flow and oxygen in the area of your pain. The duration of pain relief varies with each patient. In addition to pain reduction, an increase in temperature will be expected in the involved leg at the conclusion of the procedure.
If your pain is relieved by this procedure then a series of blocks may be desired to help break the pain cycle.
Nerve Block
Many different types of nerve blocks can be performed depending on the area where you feel your pain. The purpose of this procedure is to decrease pain and inflammation in the area of your pain. The duration of pain relief varies with each patient. The local anesthetic medication used will provide a temporary numbing effect, lasting from one or two hours to several hours. The steroid injection begins to take effect two or three days after the injection and continues to be effective for an extended period of time.
Minimally Invasive Lumbar Decompression (MILD)
More than 1.5 million Americans suffer from chronic pain and immobility caused by lumbar spinal stenosis (LSS), a degenerative, age-related narrowing of the lower spinal canal that causes pressure on the nerves. Approximately, 700,000 of them are in some form of treatment for LSS every year. Many address their LSS symptoms with either pain medications or steroid injections, but these treatments either eventually stop working or just wear off. For years, the next line of treatment for LSS has been lumbar spine decompression surgery involving the insertion of artificial implants (interspinous spacers), removal of portions of the vertebrae and attached ligaments (laminectomy), and/or fusion of the spine.
MILD is a safe and effective alternative that is the least invasive surgical procedure for LSS. MILD, or Minimally Invasive Lumbar Decompression, is FDA approved for decompression of the lumbar spine. It is an image-guided, percutaneous (skin puncture) procedure that is most often performed on an outpatient basis. The physician removes the bone or tissue causing the pressure on the nerve through a puncture the diameter of a pencil. This procedure provides immediate and lasting relief for patients by addressing a primary cause of lumbar spinal stenosis.
Myofascial Trigger Point Injection
A myofascial trigger point is a hyper-irritable spot located in a muscle or its associated tendon and ligament. A trigger point is active when it causes pain. Trigger points are found in the skeletal muscles because, being the larger organ of the body, they are subject to all the stresses of routine daily activities. When the involved muscle is stretched, pain is experienced in the local area. When the point of maximum tenderness is identified, compressed pain is referred to adjacent areas.
The goal of therapy is to reduce pain and improve function. This can be accomplished by the stretch and spray technique to relax the muscle, trigger point injections with local anesthetic into the point of maximal tenderness, and a graded exercise program.
Phenol (Chemical) Sympathectomy
Phenol (Chemical) Sympathectomy is often performed to prevent or reduce constriction in the small blood vessels in your legs and feet. The aim is to improve the circulation in the leg or foot but is occasionally done to reduce pain from other conditions, where disease of blood vessels is not the primary problem. Excessive sweating is also a reason to have phenol (chemical) sympathectomy.
RACZ Catheter - also known as Lysis of Adhesions
This procedure is performed to remove excessive scarring in the epidural space, otherwise inaccessible by normal epidural. The epidural space is a thin area between the inside of the spine and the protective layer around the spinal cord. Scar tissue may restrict the natural movement of nerves causing inflammation, therefore creating pain.
Step 1: A local anesthetic numbs the skin and tissue.
Step 2: The physician inserts the catheter into the epidural space under X-Ray guidance at the nearest convenient region, usually the caudal canal, via the sacral hiatus. The sacral hiatus is a natural opening in the spine near the end of the tailbone. The catheter can be seen and directed to the affected nerve root.
Step 3: A contrast solution is injected so the physician can use the fluoroscope to locate and confirm the correct location of the catheter.
Step 4: A steroid-anesthetic solution is injected to relieve pain, dissipate scar tissue and reduce inflammation.
You will be observed in the patient recovery area. It is important to remember that this procedure is only part of your treatment. The steroid anesthetic solution will help to break up scarring around the nerve root and reduce swelling. This procedure may need to be repeated if scar tissue returns.
Indications: Post-Laminectomy Syndrome, Epidural Adhesions, Vertebral Body Compression Fracture, Disc Disruption, Radiculopathy and history of lumbar surgeries.
Rhizotomy (Radiofrequency)
A rhizotomy, or RFTC, is a procedure in which the roots of the spinal nerves within the spinal canal are interrupted with high temperatures. This procedure is performed to decrease your discomfort in the area of your pain sensation. The duration of pain relief varies with each patient. During the procedure your physician will ask you where and when you feel the pain sensation.
Sacroiliac Nerve Block
The sacroiliac joint is a weight bearing joint formed by the surfaces of the Ilium and Sacrum, commonly known as the tail bone. The purpose of a sacroiliac nerve block is to decrease pain and inflammation in the area of your pain. The duration of pain relief varies with each patient. The local anesthetic medication used will provide a temporary numbing effect, lasting from one or two hours to several hours. The steroid injection begins to take effect two or three days after the injection and continues to be effective for an extended period of time.
Spinal Cord Stimulator (SCS)
SCS is an implantable medical device that delivers small electrical pulses to your spinal cord which block the sensations of pain. You will experience paresthesia (a tingling sensation) that alters the perception of pain - in the area where you would normally feel pain. This procedure is offered to patients who have chronic intractable nerve pain, particularly in their extremities after oral medications, nerve blocks, and surgeries fail to adequately control their pain.This device has three components: A power source and a lead or wire with four electrodes at the end. This sterile procedure is performed in the operating room with you lying on your stomach under monitored anesthesia care. The entry point of the needle in your skin near your spine is numbed with local anesthetic. A special epidural needle is inserted into your epidural space under fluoroscopic guidance. The lead is inserted through the epidural needle and threaded upward until the electrodes lie over the area where you experience pain. An extension wire connected to a power source is attached to the lead. The power source is turned on and parameters (amplitude, frequency, rate) are maneuvered until you experience comfortable tingling sensation in your pain area. Your cooperation is requested during the testing period. Once satisfied, the extension is taped to your back and you are sent home with a temporary power source, called a screener. You will be taught how to use it. If you and your doctor are satisfied with the trial screening period, then a second surgery will be performed during which the lead and power source (pulse generator or receiver depending on the type of SCS selected) will be implanted.
The stellate is a group of nerves in the neck area. The purpose of this procedure is to decrease pain and increase circulation in the area of your discomfort. A stellate ganglion block is an injection of a local anesthetic (pain relieving medication) around this group of nerves to relieve pain. The pain relief will affect one side of the head and neck, the upper arm and upper part of the chest on the same side of the body. A stellate ganglion block may be performed to decrease pain and increase the circulation and blood supply to the affected arm. Increasing circulation provides more blood flow and oxygen to the area of your pain. The duration of pain relief varies with each patient. If your pain is relieved by this procedure then a series of blocks may be desired to help break the pain cycle.
Trigger Point Injection
A trigger point can be defined as a tender point in your muscles usually associated with a strain that persists beyond the normal healing period of a strain, usually three to six months. Trigger points feel like firm nodules or bands and upon compression can refer pain away from the initial site. The purpose of this procedure is to decrease pain and inflammation in the area of your muscle. The local anesthetic medication used provides a temporary numbing effect, lasting from one or two hours to several hours. The steroid injection begins to take effect two or three days after the injection and continues to be effective for an extended period of time.
TruFUSE Facet Fusion®
Lumbar Facet Fusion is a common diagnosis for patients who suffer from back pain. TruFUSE® Facet Fusion represents a surgical option for back pain sufferers. TruFUSE® can be used as a standalone procedure for degenerative facet joint disease and other indications for facet fusion or in conjunction with a lumbar laminectomy decompression to provide stability to the affected spine segments.
TruFUSE® Facet Fusion “is a minimally invasive procedure that has been designed to address facet degenerative disease and long-term back pain issues. The TruFUSE® procedure eliminates the ‘cause’ of the pain without drugs, screws, rods or major surgery.”
Vertebroplasty
Vertebroplasty is a procedure used for vertebral compression fractures, usually in patients with Osteoporosis. Vertebroplasty stabilizes the collapsed vertebra using a specially formulated acrylic bone cement. This is typically an outpatient procedure (no hospitalization, no surgery) and requires only a local anesthetic. Once the area of the spine is numb, the physician inserts one or two needles through a small incision. The surgeon will inject a bone cement into the affected vertebra. Most patients experience pain reduction within hours.