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Common Procedures

Epidural Steroid Injections

Genicular Nerve Radiofrequency Ablations

Epidural Steroid Injections

 

Epidural steroid injection (ESI) is a minimally invasive procedure that involves the injection of a steroid medication into the epidural space of the spine. This procedure is often used to treat pain and inflammation in the lower back and legs or neck and arms caused by conditions such as herniated discs, radiculopathy, pinched nerves, spinal stenosis, and sciatica.


Procedure: The ESI procedure typically takes about 10-15 minutes to complete. You will be asked to lie on your stomach  on an X-ray table, and the injection site will be cleaned and numbed with a local anesthetic. The physician will then use a small needle to inject the steroid medication into the epidural space of your spine using X-ray guidance to ensure accuracy.


Aftercare: You will be discharged home after the procedure.  You may experience some pain relief within a few days to a week, but it may take up to two weeks for the medication to take full effect. You may resume your normal activities  but avoid any heavy lifting, bending, or twisting for at least 2 weeks.


Risks: LESI is generally a safe procedure, but there are some potential risks associated with it, including:

  • Infection at the injection site
  • Nerve damage
  • Bleeding
  • Headache
  • Allergic reaction to the medication
  • Increased blood sugar levels (for diabetic patients)
  • Temporary facial flushing

It is important to discuss any concerns or questions you may have with your healthcare provider before undergoing the procedure.


Conclusion: ESI is a safe and effective treatment option for many patients suffering from lower back and leg pain or neck and arm pain. If you are experiencing chronic pain and conservative treatments have not worked, ESI may be an option for you. It is important to discuss this procedure with your healthcare provider to determine if it is the right treatment option for you.

Facet Joint Procedures

Genicular Nerve Radiofrequency Ablations

Epidural Steroid Injections

 

Medial branch blocks (MBBs) and radiofrequency ablations (RFAs) are minimally invasive procedures used to diagnose and treat pain caused by facet joint pain or spondylosis, a condition that affects the small joints between the vertebrae in the spine. MBBs are used to diagnose the source of pain, while RFAs are used to treat the pain by temporarily disrupting the nerves that transmit pain signals from the facet joints.


Medial Branch Blocks (MBBs): MBBs are a diagnostic procedure used to identify the source of pain in the facet joints of the spine. The procedure involves injecting a local anesthetic onto the medial branch nerves that supply the facet joint. If the pain is relieved after the injection, it indicates that the facet joint is the source of pain. The procedure is performed using fluoroscopy (X-ray)  to ensure accuracy.


Radiofrequency Ablations (RFAs): RFAs are a minimally invasive procedure used to treat chronic pain caused by facet joint pain or spondylosis. The procedure involves using heat to destroy the nerves that transmit pain signals from the facet joint. The procedure is performed using fluoroscopy (X-ray)  to ensure accuracy. The nerves typically grow back over time, so the procedure may need to be repeated every 6-12 months.


Aftercare: After the procedure, you will be discharged home. It is important to rest for the remainder of the day and avoid any strenuous activity. You may experience some pain relief within a few days, but it may take up to two to four weeks for the full effect. You may resume your normal activities after a few days but avoid any heavy lifting, bending, or twisting for at least 2 weeks.


Risks: MBBs and RFAs are generally safe procedures, but there are some potential risks associated with them, including:

  • Infection at the injection site
  • Bleeding
  • Nerve damage
  • Allergic reaction to the medication
  • Increased pain or discomfort after the procedure
  • Temporary numbness or weakness in the affected area

It is important to discuss any concerns or questions you may have with your healthcare provider before undergoing the procedure.


Conclusion: MBBs and RFAs are safe and effective treatment options for diagnosing and treating chronic pain caused by facet joint syndrome. If you are experiencing chronic back or neck pain and conservative treatments have not worked, MBBs or RFAs may be an option for you. It is important to discuss these procedures with your healthcare provider to determine if they are the right treatment options for you.

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Genicular Nerve Radiofrequency Ablations

Genicular Nerve Radiofrequency Ablations

Genicular Nerve Radiofrequency Ablations

 

Genicular nerve blocks and genicular radiofrequency ablation (RFA) are minimally invasive procedures used to treat knee pain caused by various conditions such as osteoarthritis, rheumatoid arthritis, and other chronic pain syndromes. These procedures involve blocking or disrupting the nerves that transmit pain signals from the knee joint.


Genicular Nerve Blocks: Genicular nerve blocks are a diagnostic procedure used to identify the source of knee pain. The procedure involves injecting a local anesthetic onto the genicular nerves that supply the knee joint. If the pain is relieved after the injection, it indicates that the nerves are the source of pain. The procedure is performed using fluoroscopy (X-ray) to ensure accuracy.


Genicular Radiofrequency Ablation: Genicular RFA is a minimally invasive procedure used to treat knee pain by disrupting the nerves that transmit pain signals from the knee joint. The procedure involves using heat to destroy the nerves. The procedure is performed using fluoroscopy (X-ray)  to ensure accuracy. The nerves typically grow back over time, so the procedure may need to be repeated every 6-12 months.


Aftercare: After the procedure, you will be discharged home. It is important to rest for the remainder of the day and avoid any strenuous activity. You may experience some pain relief within a few days, but it may take up to two weeks for the full effect. You may resume your normal activities after a few days but avoid any heavy lifting, bending, or twisting for at least 2 weeks.


Risks: Genicular nerve blocks and genicular RFAs are generally safe procedures, but there are some potential risks associated with them, including:

  • Infection at the injection site
  • Bleeding
  • Nerve damage
  • Allergic reaction to the medication
  • Increased pain or discomfort after the procedure
  • Temporary numbness or weakness in the affected area

It is important to discuss any concerns or questions you may have with your healthcare provider before undergoing the procedure.


Conclusion: Genicular nerve blocks and genicular RFAs are safe and effective treatment options for knee pain caused by various conditions such as osteoarthritis, rheumatoid arthritis, and other chronic pain syndromes. If you are experiencing chronic knee pain and conservative treatments have not worked, these procedures may be an option for you. It is important to discuss these procedures with your healthcare provider to determine if they are the right treatment options for you.

Joint Injections

Neuromodulation: Spinal Cord Stimulation

Genicular Nerve Radiofrequency Ablations

 

Steroid injections of a joint are a minimally invasive treatment option for reducing inflammation and pain in a specific joint. This procedure involves injecting a corticosteroid medication directly into the joint to reduce inflammation and relieve pain caused by various conditions such as arthritis, bursitis, and tendinitis.


Procedure: The procedure typically takes about 5-10 minutes to complete. You will be asked to sit or lie down while the injection site is cleaned. The physician will then use a small needle to inject the steroid medication directly into the joint. Depending on the joint being injected, ultrasound or X-ray imaging may be needed to ensure accuracy.


Aftercare: After the injection, you will be monitored for a short time and then discharged home.  You may experience some pain relief within a few days, but it may take up to 2 weeks for the medication to take full effect. You may resume your normal activities after a few days but avoid any heavy lifting, bending, or twisting for at least 2 weeks.


Risks: Steroid injections of a joint are generally safe, but there are some potential risks associated with it, including:

  • Infection at the injection site
  • Nerve damage
  • Bleeding
  • Allergic reaction to the medication
  • Temporary increase in blood sugar levels (for diabetic patients)
  • Temporary facial flushing


It is important to discuss any concerns or questions you may have with your healthcare provider before undergoing the procedure.


Conclusion: Steroid injections of a joint are a safe and effective treatment option for reducing inflammation and pain in a specific joint. If you are experiencing chronic joint pain and conservative treatments have not worked, a steroid injection may be an option for you. It is important to discuss this procedure with your healthcare provider to determine if it is the right treatment option for you.

Nerve Blocks

Neuromodulation: Spinal Cord Stimulation

Neuromodulation: Spinal Cord Stimulation

 

Therapeutic peripheral nerve blocks are minimally invasive procedures used to treat chronic pain caused by nerve damage or injury in specific areas of the body such as the arms, legs, or face. These procedures involve injecting medication directly into the nerves that transmit pain signals to provide pain relief.

Types of Therapeutic Peripheral Nerve Blocks: There are several types of therapeutic peripheral nerve blocks, including:

  1. Cluneal nerve blocks: This block is used to treat pain in the lower back, buttocks, or legs caused by nerve damage or injury.
  2. Occipital nerve blocks: This block is used to treat pain in the head or neck caused by nerve damage or injury.
  3. Trigeminal nerve blocks: This block is used to treat pain in the face or head caused by nerve damage or injury.
  4. Carpal tunnel injections: This injection is used to treat pain in the hand and wrist caused by carpal tunnel syndrome.
  5. Ilioinguinal nerve blocks: This block is used to treat pain in the groin or genital area caused by nerve damage or injury.


Procedure: The procedure for a therapeutic peripheral nerve block varies depending on the type of block being performed. Generally, the area to be injected is cleaned and then a needle is inserted to deliver the medication directly onto the affected nerve. The procedure is performed by feel or sometimes by using fluoroscopy (X-ray) or ultrasound guidance to ensure accuracy.


Aftercare: After the procedure, you will be monitored for a short time and then discharged home. It is important to rest for the remainder of the day and avoid any strenuous activity. You may experience some pain relief within a few days, but it may take up to two weeks for the full effect. You may resume your normal activities after a few days but avoid any heavy lifting, bending, or twisting for at least 2 weeks.


Risks: Therapeutic peripheral nerve blocks are generally safe procedures, but there are some potential risks associated with them, including:

  • Infection at the injection site
  • Bleeding
  • Nerve damage
  • Allergic reaction to the medication
  • Increased pain or discomfort after the procedure
  • Temporary numbness or weakness in the affected area

It is important to discuss any concerns or questions you may have with your healthcare provider before undergoing the procedure.

Conclusion: Therapeutic peripheral nerve blocks are safe and effective treatment options for chronic pain caused by nerve damage or injury in specific areas of the body such as the arms, legs, or face. If you are experiencing chronic pain and conservative treatments have not worked, these procedures may be an option for you. It is important to discuss these procedures with your healthcare provider to determine if they are the right treatment options for you.

Neuromodulation: Spinal Cord Stimulation

Neuromodulation: Spinal Cord Stimulation

Neuromodulation: Spinal Cord Stimulation

 

Spinal cord stimulation is a minimally invasive procedure used to treat chronic pain in the back, legs, arms, or neck. This procedure involves the placement of a small device that sends electrical impulses to the spinal cord to block pain signals from reaching the brain.

Who is a Candidate for Spinal Cord Stimulation? Patients who have chronic pain that has not been successfully treated with other therapies, such as medication or physical therapy, may be candidates for spinal cord stimulation. Common conditions treated with this procedure include:

  • Failed back surgery syndrome
  • Complex regional pain syndrome
  • Peripheral neuropathy
  • Arachnoiditis
  • Degenerative disc disease
  • Chronic back or neck pain

 

Aftercare: After the procedure, you will be monitored for a short time and then discharged home. You may experience some discomfort or pain at the implant site, which can be managed with medication. You should avoid any strenuous activity for at least six weeks to allow the area to heal properly. Once the area has healed, you may resume your normal activities, but avoid any activities that could damage the implant or the leads.

Benefits: Spinal cord stimulation can provide several benefits, including:

  • Significant reduction in pain
  • Reduced use of pain medications
  • Improved quality of life
  • Increased ability to perform daily activities


Procedure:   The first step in moving forward with spinal cord stimulation is the "Stimulator Trial".  During the trial your healthcare provider will  clean then skin and then use fluoroscopy (X-ray)  to guide a needle to insert temporary leads through the skin and into the epidural space around the spinal cord. The leads will be connected to a temporary external generator that will send electrical impulses to the spinal cord. The generator will be worn on a belt outside of the body.

  1. Testing: Once the leads and generator are in place, your healthcare provider will test the SCS by adjusting the settings of the generator and asking you to describe the sensations you feel. The goal is to find a level of stimulation that effectively reduces your pain.
  2. Monitoring: You will be monitored closely during the trial period to ensure that the SCS is providing adequate pain relief and that there are no complications or side effects.
  3. Evaluation: After a trial period of approximately one week, you will meet with your healthcare provider to evaluate the effectiveness of the SCS. If the trial is successful in reducing your pain and improving your quality of life, you may be a candidate for a permanent SCS implant.

It is important to note that the SCS trial is not suitable for everyone, and your healthcare provider will determine whether you are a good candidate based on your medical history and the nature of your pain.


If the trial is successful, the patient is scheduled for a permanent stimulator. The permanent stimulator is placed first by placing the leads through a needle as in the stimulator trial. Once the leads are in the correct location based on imaging and testing, the lead ends and generator are surgically implanted under the skin. 


Risks: Spinal cord stimulation is a safe procedure, but there are some potential risks associated with it, including:

  • Infection at the implant site
  • Bleeding
  • Nerve damage
  • Allergic reaction to the materials used in the implant
  • Pain or discomfort at the implant site

It is important to discuss any concerns or questions you may have with your healthcare provider before undergoing the procedure.


Conclusion: Spinal cord stimulation is a safe and effective treatment option for chronic pain in the back, legs, arms, or neck. If you have chronic pain that has not been successfully treated with other therapies, spinal cord stimulation may be an option for you. It is important to discuss this procedure with your healthcare provider to determine if it is the right treatment option for you.

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