Dr. Lewis performs the following diagnostic (designed to identify the source of the pain) and therapeutic (designed to relieve pain) procedures including but not limited to:
Botulinum toxin is a chemical from the organism that causes botulism. This sounds alarming but, in actuality, we would need to use 3,000 times as much as we do in order to give you botulism. Botulinum toxin forces muscles to relax by preventing the release of acetylcholine from nerve endings. It is this acetylcholine which activates the muscle, causing it to contract or tighten up. Without acetylcholine, the muscle cannot stay tight. Botulinum toxin injections are typically performed for muscle knots or "trigger points." The botulinum toxin does not actually begin to work for one to two weeks, but many patients feel better in a few days just from the needle breaking up the muscle knot. Trigger points are thought to be very tight bands in muscles. When other measures, such as trigger point injections, fail to produce relaxation in the muscle knot, we consider botulinum toxin injections.
Naturally, before botulinum toxin injections are tried, we always try to find what is causing the muscle knots. This can be anything from inflammation inside the spinal column to a disc problem, or serious illness that might cause muscle knots or trigger points. This needs to be investigated and ruled out before botulinum trigger point injections are performed. Very frequently after various traumas or injuries, people develop painful muscle knots, often in their shoulders, neck or under their scapulae. Trigger points can also develop in the low back, buttocks and thighs. Trigger points can occur in the upper arms and forearms. When a patient gets good relief from their muscle knot pain with a simple trigger point injection of numbing medicine, but the pain returns, that is felt to be an indication for botulinum toxin injection.
Botulinum toxin injections are usually done in the office, similar to trigger point injections. The area over the painful trigger point is sterilely cleaned and a small gauge needle is used to inject the medicine into the trigger point.
Happily, the risks of botulinum toxin are few. Typically, there are no real side effects from the botulinum toxin. It tends to act locally where it is injected and usually does not cause body-wide side effects. One effect of the botulinum toxin is that it can produce weakness in the muscle into which it is injected. This is usually not a problem. If used frequently, a patient can develop antibodies to the botulinum toxin and it will begin to lose its effectiveness. We also warn patients about bleeding, infection, and drug reaction, but these problems are extremely rare.
Botulinum toxin injections are relatively new, and all of the studies to give precise answers to these questions have not been performed. The effect of botulinum toxin on the acetylcholine produced by the nerve ending typically wears off in three to four months. Interestingly, in many patients we have seen the effect of the injections last considerably longer; however, we do not have adequate information to predict how long the injection will last if it is effective. Trigger points, or muscle knots, treated with botulinum toxin injection may return and repeat injection may be required. It would probably not be worth repeating the injection if it does not last at least three to four months.
Yes and no. Botulinum toxin injections usually are not as painful as injections with numbing medicine. The muscle knot, however, can be very sensitive. For patients who have benefited from botulinum toxin injection, they typically report the pain of injection is worth the relief.
You will probably be put into a gown and seated or positioned lying down. The trigger point areas to be injected are marked with a pen and then carefully cleaned. At that point, a cold spray is used to numb the skin, and the botulinum toxin mixed with normal saline, with or without numbing medicine, is injected. The whole process takes a few minutes. The injection site is bandaged and the patient is instructed to take it easy for the rest of the day, and to place ice or a cold pack on the injected areas for a few minutes several times a day for a day or two. A return office visit appointment will be made in four to eight weeks for follow up. The patient is encouraged to call at any time if they have any problems.
Botulinum toxin injections have proven to be a valuable tool in the battle against pain from painful muscle knots or trigger points. Typically, botulinum toxin injections are not performed unless the patient has already responded favorably, but only temporarily, to regular trigger point injections with numbing medicine. Before botulinum toxin injections are performed, every effort should be made to understand the cause of the muscle knots or trigger points, and any serious illness should be dealt with first. The main side effects of botulinum toxin are weakness and the development of antibodies if used excessively.
The membrane that covers the spinal cord and nerve roots in your neck is called the dura membrane. The space surrounding the dura is epidural space in your neck. Inflammation of the nerve roots in the neck may cause pain in the arms and shoulders due to irritation from a damaged (protruding/herniated) disc or from contact with the bony structure of the spine (spinal stenosis) in some way.
An epidural injection places anti-inflammatory medicine into the epidural space to decrease inflammation of the nerve roots, hopefully reducing the pain in your neck, shoulders and arms. The epidural injection may help the injury to heal by reducing inflammation. It may provide permanent relief or provide a period of pain relief for several months while the injury/cause of your pain is healing.
An IV will be started so that relaxation medication can be given. You will be placed lying on your stomach and positioned in such a way that your doctor can best visualize your neck using X-ray guidance. The skin on the back of your neck will be scrubbed with a cleaning solution. Next, the physician will numb a small area of skin with numbing medicine. This medicine stings for several seconds. After the numbing medicine has been given time to be effective, your doctor will direct a small needle using X-ray guidance into the epidural space. A small amount of contrast (dye) is then injected to ensure proper needle position in the epidural space. Then, a small mixture of numbing medicine (anesthetic) and anti-inflammatory (cortisone/steroid) will be injected.
You will go back to the recovery area, where you will be monitored for 30 - 60 minutes. You will also be given a follow-up appointment for the Clinic or a repeat block if indicated. You will not be able to drive the day of your procedure. Your arm may feel weak or numb for a few hours.
You should have nothing to eat for seven hours prior to your procedure. Clear liquids can be taken up to four hours prior to your procedure. Please take your routine medications (i.e., high blood pressure and diabetic medications) with a sip of water at your usual time. If you are on Coumadin, Heparin, Plavix, or any other blood thinners you must notify the office so the timing of these medications can be explained. For your own safety, if you do not follow the above instructions your procedure may be cancelled. A driver must accompany you and be responsible for getting you home. No driving is allowed the day of the procedure. You may return to your normal activities the day after the procedure, including returning to work.
The discs are cushion-like pads that separate the hard vertebral bones of your spine. A disc may be painful when it presses on nerves or the spinal cord, herniates, tears or degenerates and may cause pain in your neck, mid-back, low back and arms, chest wall, abdomen and legs. Other structures in your spine may also cause similar pain, such as the muscles, joints, and nerves. Usually, we have first determined that these other structures are not the sole pain source (through history and physical examination, review of X-rays, CTs, MRIs, myelograms, and/or other diagnostic injection procedures such as facet and sacroiliac joint injections and nerve root blocks) before performing discography.
Discography helps confirm or rule out the disc(s) as a source of your pain. This procedure utilizes the placement of a needle into the discs themselves and injecting contrast (dye). CT and MRI scans only demonstrate anatomy and cannot absolutely prove your pain source. In many instances, the discs may be abnormal on MRI or CT scans but not be a source of pain. Only discography can tell if the disc itself is probably a source of your pain. Therefore, discography is done to identify painful disc(s) and help the surgeon plan the correct surgery, or avoid surgery that may not be beneficial. Discography is usually done only if you think your pain is significant enough for you to consider surgery.
An IV will be started so that antibiotics (to prevent infection) and relaxation medication can be given. The skin will be scrubbed with a cleaning solution. Next, the physician will numb a small area of skin with numbing medicine. This medicine stings for several seconds. After the numbing medicine has been given time to be effective, your doctor will direct a small needle using X-ray guidance into the disc space. You may feel temporary discomfort as the needle passes through the muscle or near a nerve root. Your doctor may perform this at more than one disc level. After the needles are in their proper locations, a small amount of contrast (dye) is injected into each disc. Your doctor will ask you about your experience as the dye is being injected. It is important that you describe what you feel as accurately as you can. You need to be alert enough to be aware of and describe the sensations you experience.
Immediately afterwards you will be taken to a recovery room or to a CT scan, where additional pictures will be taken. You will be monitored for 30 - 60 minutes. You may be given a prescription for pain medication over the next 2 - 3 days for muscle discomfort that may exist after this procedure. You will not be able to drive the day of your procedure. You will follow up with your physician in the Pain Clinic in 1-2 weeks to discuss the results of the procedure, or be scheduled immediately for another procedure or referral.
You should have nothing to eat for seven hours prior to your procedure. Clear liquids can be taken up to four hours prior to your procedure. Please take your routine medications (i.e., high blood pressure and diabetic medications) with a sip of water at your usual time. If you are on Coumadin, Heparin, Plavix, or any other blood thinners you must notify the office so the timing of these medications can be explained. For your own safety, if you do not follow the above instructions your procedure may be cancelled. A driver must accompany you and be responsible for getting you home. No driving is allowed the day of the procedure. You may return to your normal activities the day after the procedure, including returning to work.
This is a more aggressive approach to a typical Epidural Steroid Injection. An epidural lysis of adhesions is a procedure that was developed to help decrease chronic low back pain due to adhesions and scar tissue formation. This is a catheter injected procedure and is inserted into the epidural space in order to access the area of adhesions.
Epidural adhesions are most commonly observed following surgical intervention of the spine, leakage of disc material into the epidural space following annular tear or an inflammatory response. Scar tissue may restrict movement of nerves causing inflammation, therefore, creating pain.
The physician will inject local anesthetic to numb up the area prior to placing the catheter through the skin. Once the local anesthetic has set in, the epidural needle will then be introduced through the skin and into the sacral hiatus. Mild sedation will also be administered to ease any anxiety, however, general anesthesia is not an option since your participation in the procedure is critical to reduce the risk of any complication. Following placement of the epidural needle, the catheter is advanced into the injection site. The movement of the catheter is continuously monitored with the C-arm (X-ray) to assure safe and effective positioning. Contrast material (a metallic fluid that shows up on X-ray) will then be injected into the epidural space to outline the epidural space, this is called and epidurogram. Other fluids will then be injected to relieve pain, dissipate scar tissue, and reduce inflammation.
Medial branch nerves are the very small nerve branches that communicate pain caused by the facet joints in the spine. These nerves do not control any muscles or sensation in the arms or legs. They are located along a bony groove in the low back and neck and over a bone in the mid back. If this procedure has been scheduled, there is strong evidence to suspect that the facet joints are the source of your pain. Therefore, benefit may be obtained from having these medial branch nerves blocked with an anesthetic to see if a more permanent way of blocking these nerves would provide pain relief long term. Blocking these medial branch nerves temporarily stops the transmission of pain signals from the joints to the brain.
An IV may be started, to provide relaxation medication. You will be placed on the X-ray table and positioned in such a way that the physician can best visualize the bony areas where the medial branch nerves pass, using X-ray guidance. The skin is scrubbed with a cleaning solution. Next, the physician numbs a small area of skin with numbing medicine. This medicine stings for several seconds. After the numbing medicine has been given time to be effective, the physician directs a very small needle, using X-ray guidance near the specific nerve being tested. A small amount of contrast (dye) is injected to ensure proper needle position. Then, a small mixture of numbing medicine (anesthetic) is injected. This usually does not provoke your usual pain. The injection will be repeated at several (usually 3-4) levels.
You will be observed in the recovery room for 30 - 60 minutes. There is unlikely to be much discomfort. You should start feeling some relief in about 24 - 72 hours. Keep track of the amount of pain relief and duration. If successful you may be a candidate for radiofrequency lesioning (RFR). You will be scheduled to follow up with your physician in the Pain Clinic in 1 - 2 weeks to discuss results of the procedure. You will not be able to drive the day of your procedure. The arm(s), chest wall, or leg(s) may feel weak or numb for a few hours.
You should have nothing to eat for seven hours prior to your procedure. Clear liquids can be taken up to four hours prior to your procedure. Please take your routine medications (i.e. high blood pressure and diabetic medications) with a sip of water at your usual time. If you are on Coumadin, Heparin, Plavix, or any other blood thinners you must notify the office so the timing of these medications can be explained. For your own safety, if you do not follow the above instructions your procedure may be cancelled. A driver must accompany you and be responsible for getting you home. No driving is allowed the day of the procedure. You may return to your normal activities the day after the procedure, including returning to work.
This is a minimally invasive treatment that can repair VCF (Vertebral Compression Fractures) caused by primary or secondary (steroid-induced) osteoporosis, cancer, or benign lesions. Orthopedic balloons are used as an attempt to elevate the bone fragments of the fractured vertebra and return them to the correct position. Balloon kyphoplasty has been shown to benefit patients with osteoporotic or cancer-induced VCF. Balloon kyphoplasty can be done under local or general anesthesia; your doctor will decide which option is appropriate for you. Typically, the procedure takes less than one hour per fracture treated and may require an overnight hospital stay.
With a hollow instrument, the surgeon creates a small pathway into the fractured bone. A small, orthopaedic balloon is guided through the instrument into the vertebra. Next, the balloon is carefully inflated in an attempt to raise the collapsed vertebra and return it to its normal position. Once the vertebra is in the correct position, the balloon is deflated and removed. This process creates a void (cavity) within the vertebral body. The cavity is filled with a special cement to support the surrounding bone and prevent further collapse. Generally, the procedure is done on both sides of the vertebral body.
After the procedure, you will most likely be transferred to the Recovery Room for about an hour. Generally, patients are discharged from the hospital within 24 hours. Your doctor will have you schedule a follow-up visit and explain limitations, if any, on your physical activity. After treatment with balloon kyphoplasty, mobility is often quickly improved. Most patients are very satisfied with the procedure and are able to gradually resume activity once discharged from the hospital.
The membrane that covers the spinal cord and nerve roots in your spine is called the dura membrane. The space surrounding the dura is the epidural space. Nerves travel through the epidural space to your back and into your legs. Inflammation of these nerve roots may cause pain in these regions due to irritation from a damaged disc (disc protrusion/herniation) or from contact in some way with the bony structure of the spine (spinal stenosis).
An epidural injection places anti-inflammatory medicine into the epidural space to decrease inflammation of the nerve roots, hopefully reducing the pain in your back or legs. The epidural injection may help the injury to heal by reducing inflammation. It may provide permanent relief, or provide a period of pain relief for several months while the injury or cause of your pain is healing.
An IV will be started so that relaxation medication can be given. You will be placed lying on your stomach on the X-ray table and positioned in such a way that your doctor can best visualize your back using X-ray guidance. The skin on your back will be scrubbed using a cleaning solution. Next, the physician will numb a small area of skin on your low back with numbing medicine. This medicine stings for several seconds. After the numbing medicine has been given time to be effective, your doctor will direct a small needle using X-ray guidance into the epidural space. A small amount of contrast (dye) is then injected to ensure proper needle position in the epidural space. Then, a mixture of numbing medicine (anesthetic) and anti-inflammatory (cortisone/steroid) will be injected.
You will go back to the recovery area, where you will be monitored for 30-60 minutes. You will be given a follow-up appointment for the Clinic or a repeat block if indicated. You will not be able to drive the day of your procedure. Your legs may feel weak or numb for a few hours.
You should have nothing to eat for seven hours prior to your procedure. Clear liquids can be taken up to four hours prior to your procedure. Please take your routine medications (i.e., high blood pressure and diabetic medications) with a sip of water at your usual time. If you are on Coumadin, Heparin, Plavix, or any other blood thinners you must notify the office so the timing of these medications can be explained. For your own safety, if you do not follow the above instructions your procedure may be cancelled. A driver must accompany you and be responsible for getting you home. No driving is allowed the day of the procedure. You may return to your normal activities the day after the procedure, including returning to work.
This procedure is done to treat pain caused by the facet joints by creating a lesion or burn in the pain fibers to the facet joint, also known as the medial branch of the posterior primary ramus. The purpose of RFR of the medial branch is to decrease pain and improve function. This is done only if pain is relieved temporarily by medial branch nerve blocks.
It is accomplished by placing a special needle alongside the facet joint under X-ray control. Following this, a controlled heat lesion is made to decrease the sensation of the facet joints. Nerve testing is performed to verify the proper position of the needle. An intravenous solution will be started so that medications or a short-acting sedative, if necessary, can be given during the procedure. The procedure will take approximately 20 - 60 minutes. You will then be monitored for an additional 30 - 60 minutes. All measures will be taken to ensure your comfort and safety. After you return home, you may use ice packs to relieve any discomfort.
You should have nothing to eat for seven hours prior to your procedure. Clear liquids can be taken up to four hours prior to your procedure. Please take your routine medications (i.e. high blood pressure and diabetic medications) with a sip of water at your usual time. If you are on Coumadin, Heparin, Plavix, or any other blood thinners you must notify the office so the timing of these medications can be explained. For your own safety, if you do not follow the above instructions your procedure may be cancelled. A driver must accompany you and be responsible for getting you home. No driving is allowed the day of the procedure. You may return to your normal activities the day after the procedure, including returning to work.
Prior to this procedure, a written consent will be obtained that will include the possible risks and hazards. Certain effects are to be expected: bruising at the injection sites, soreness and swelling. Possible side effects include burning sensation at the injection site, numbness, itching, and occasionally 2 - 3 weeks of increased pain. This is only temporary.
The sacroiliac joint is a large joint in the region of the low back and buttocks where the pelvis actually joins with the spine. If the joints become painful they may cause pain in the low back, buttocks, abdomen, groin or legs. A sacroiliac joint injection serves several purposes. First, by placing numbing medicine into the joint, the amount of immediate relief experienced will help confirm or deny the joint as a source of pain. Additionally, the temporary relief of the numbing medicine may better allow a chiropractor or physical therapist to treat that joint. Also, time release cortisone (steroid) will help to reduce any inflammation that may exist within the joint(s).
You are placed on the X-ray table on your stomach in such a way that the physician can best visualize these joints in the back using X-ray guidance. The skin on the low back is scrubbed using two types of sterile scrub (soap). Next, the physician numbs a small area of skin with numbing medicine. This medicine stings for several seconds. After the numbing medicine has been given time to be effective, the physician directs a very small needle, using X-ray guidance into the joint. A small amount of contrast (dye) is injected to ensure proper needle position inside the joint space. Then, a small mixture of numbing medicine (anesthetic) and anti-inflammatory (cortisone/steroid) is injected. One or several joints may be injected depending, on location of your usual pain.
Immediately after the procedure, you will walk around and try to imitate something that would normally bring about your usual pain. You are then asked to report the percentage of pain relief and record the relief experienced during the next week on a post-injection evaluation sheet ("pain diary"). This will be given to you when you are discharged to gohome. Your leg(s) may feel numb for a few hours. This is fairly uncommon, but does occasionally happen. You may be referred to a chiropractor or physical therapist immediately after the injection(s) while the numbing medicine is still working for manipulation or massage. If you get good relief but of short duration, you may be a candidate for radiofrequency lesioning (RFR).
You should have nothing to eat for seven hours prior to your procedure. Clear liquids can be taken up to four hours prior to your procedure. Please take your routine medications (i.e., high blood pressure and diabetic medications) with a sip of water at your usual time. If you are on Coumadin, Heparin, Plavix, or any other blood thinners you must notify the office so the timing of these medications can be explained. For your own safety, if you do not follow the above instructions your procedure may be cancelled. A driver must accompany you and be responsible for getting you home. No driving is allowed the day of the procedure. You may return to your normal activities the day after the procedure, including returning to work.
It is a therapy that uses electrical impulses to block pain from being perceived in the brain. Instead of pain, the patient feels a more pleasant tingling sensation.
Intrathecal pain therapy works by delivering small doses of analgesic directly to the pain receptors in the spinal cord, blocking the message to the brain. Because the doses are small and applied directly at the site of pain receptors, the entire body is not flooded with medications, and therefore negative side effects such as grogginess, confusion and over-sedation are usually avoided.
Doctors will generally consider the following:
After you and your physician discuss the SCS and determine that you would like to proceed, a trial will be arranged to learn if it will be effective in treating your pain. The trial involves a surgical procedure to implant a temporary stimulator to determine if the area of your pain will be covered by stimulation, and if the stimulation actually reduces your pain. The trial may last a minimum of 24 hours or as long as 10 days. You will want to be certain that you have satisfactory pain control and that you are comfortable with the sensations of stimulation. If the trial is successful, the permanent stimulator implantation will be scheduled.
The procedure will take place in an operating room. You will be given a local anesthetic and sedation so that you can be awake during the procedure with minimal discomfort in order to give feedback to the physician regarding effective lead placement. After the local anesthetic has time to numb the area where the lead will be placed, the lead is inserted within the spinal column through a needle or through an incision. Once the lead is in place, your physician will activate the system. You will help the physician determine how well the stimulation pattern covers your pain pattern. You will also get a sense of how stimulation feels to help determine if it is right for you.
Any time surgery is performed there are possible complications. For spinal procedures, these rare risks include:
After a trial, there is usually little discomfort other than that caused by the dressing and tape. You must sponge bathe until the lead is removed at your follow-up visit. As with any surgery, you will have some discomfort at the incision sites, and there will be some swelling which usually lasts for several days. There will be some discomfort over the area where the receiver is implanted. This is normal. Your doctor may prescribe an analgesic until this subsides. You must avoid showering (sponge bath only) until your follow-up visit, unless instructed otherwise. Immediately following implantation, you should avoid lifting, bending, stretching and twisting. Light exercise, such as walking is important to build strength and to help relieve pain.
Leads can remain permanently in place. However, if you engage in extreme bending, stretching, twisting, or strenuous activity such as jumping exercises and diving, etc., the leads may move or become damaged and require surgical repositioning or removal. This can occur especially within the first 8 weeks after implantation. Moving or lifting heavy objects can move or break the leads. Sometimes leads will move as a result of normal bending, stretching, or twisting, or due to your unique physical structure. Check with your doctor before performing any strenuous activity, and limit activity to no excessive bending/stretching or lifting > 10 lbs for the first 8 weeks.
Do not drive a motor vehicle or heavy equipment while using the stimulator. You may use it if you are a passenger. The stimulator will set off metal detectors (such as at airports). You will want to be sure you have your SCS identification card in order to pass through. Department store theft detectors may cause an increase or decrease in stimulation as you pass through. This is temporary and will not harm you or the stimulator however, you may wish to turn the stimulator off before passing through. Anything with magnets can affect your stimulator in addition to theft detectors and metal detectors, be mindful of large stereo speakers with magnets, high voltage power lines, electric arc welding equipment, electric sub-stations and power generators. Magnets can turn an internally powered generator (IPG) on or off. You will want to avoid MRIs as they can damage the stimulator. Normal household equipment will not harm or interfere with the stimulator. This includes cellular or portable phones, microwaves, computers, TVs, appliances, electric blankets and heating pads. The stimulator control magnet may cause damage to certain items or erase information on items with magnetic strips (bank or credit cards), magnetic media (video cassette tapes, computer diskettes, cassette tapes), and home electronic items (computer, VCR, television, camera). The magnet will stop watches and clocks, so you will want to store the magnet at least two inches away. Life of batteries depends upon stimulation settings and usage. Ex ternal batteries last anywhere from several hours to several days. When the battery of an implanted pulse generator is depleted, you may need surgery to replace the IPG. Report to your doctor's nurse changes in stimulation patterns, increase in pain, or unexplained increased / decreased stimulation.
There will be residual discomfort. Most patients report a 50%- 70% decrease in pain. The goal is to lower the level of pain and make it more manageable.
You should have nothing to eat for seven hours prior to your procedure. Clear liquids can be taken up to four hours prior to your procedure. Please take your routine medications (i.e. high blood pressure and diabetic medications) with a sip of water at your usual time. If you are on Coumadin, Heparin, Plavix, or any other blood thinners you must notify the office so the timing of these medications can be explained. For your own safety, if you do not follow the above instructions your procedure may be cancelled. A driver must accompany you and be responsible for getting you home. No driving is allowed the day of the procedure.
Vertebroplasty is an image-guided, minimally invasive, nonsurgical therapy used to strengthen a broken vertebra (spinal bone) that has been weakened by osteoporosis or, less commonly, cancer. Vertebroplasty can increase the patient's functional abilities, allow a return to the previous level of activity, and prevent further vertebral collapse. It is usually successful at alleviating the pain caused by a compression fracture. Often performed on an outpatient basis, vertebroplasty is accomplished by injecting an orthopedic cement mixture through a needle into the fractured bone.
Vertebroplasty is used to treat pain caused by osteoporotic compression fractures. After menopause, women are especially vulnerable to bone loss. More than one-fourth of women over age 65 will develop a vertebral fracture due to osteoporosis. Older people suffering from compression fractures tend to become less mobile, and decreased mobility accelerates bone loss. High doses of pain medication, especially narcotic drugs, further limit functional ability.
Vertebroplasty is often performed on patients too elderly or frail to tolerate open spinal surgery, or with bones too weak for surgical spinal repair. Patients with vertebral damage due to a malignant tumor may sometimes benefit from vertebroplasty. In rare cases, it can be used in younger patients whose osteoporosis is caused by long-term steroid treatment or a metabolic disorder.
Typically, vertebroplasty is recommended after simpler treatments—such as bedrest, a back brace or pain medication—have been ineffective, or once medications have begun to cause other problems, such as stomach ulcers. Vertebroplasty can be performed right away in patients who have severe pain requiring hospitalization or conditions limiting bedrest and medications.
Vertebroplasty is generally performed in the morning. The patient will be sedated and receive a local anesthetic to numb the skin and the muscles near the spinal fracture. Intravenous antibiotics may also be administered to prevent infection. Through a small incision and guided by a fluoroscope, a hollow needle is passed through the spinal muscles until its tip is precisely positioned within the fractured vertebra. Once the needle is shown to be in the proper location, the orthopedic cement is injected. Medical-grade cement hardens quickly, over the next 10 to 20 minutes. A CT scan may be performed at the end of the procedure to check the distribution of the cement. The longest part of vertebroplasty involves setting up the equipment and making sure the needle is perfectly positioned in the collapsed vertebra.
The membrane that covers the spinal cord and nerve roots in your spine is called the dura membrane. The space surrounding the dura is the epidural space. Nerves travel through the epidural space to your mid back and along the ribs. Inflammation of these nerve roots may cause pain in these regions due to irritation from a damaged disc or from contact in some way with the bony structure of the spine.
An epidural injection places anti-inflammatory medicine into the epidural space to decrease inflammation of the nerve roots, hopefully reducing the pain in your mid back or around your rib cage. The epidural injection may help the injury to heal by reducing inflammation. It may provide permanent relief or provide a period of pain relief for several months while the injury or cause of your pain is healing.
An IV will be started so that relaxation medication can be given. You will be placed lying on your stomach and positioned in such a way that your doctor can best visualize your upper back using X-ray guidance. The skin on your upper back will be scrubbed with a cleaning solution. Next, the physician will numb a small area of skin with numbing medicine. This medicine stings for several seconds. After the numbing medicine has been given time to be effective, your doctor will direct a small needle using X-ray guidance into the epidural space. A small amount of contrast (dye) is then injected to ensure proper needle position in the epidural space. Then, a small mixture of numbing medicine (anesthetic) and anti-inflammatory (cortisone/steroid) will be injected.
You will go back to the recovery area, where you will be monitored for 30 - 60 minutes. You will then record the relief you experience during the next week on a post-injection evaluation sheet ("pain diary"). This will be given to you when you are released to go home. You will also be given a follow-up appointment for a repeat block if indicated. You will not be able to drive the day of your procedure. Your back may feel weak or numb for a few hours.
You should have nothing to eat for seven hours prior to your procedure. Clear liquids can be taken up to four hours prior to your procedure. Please take your routine medications (i.e. high blood pressure and diabetic medications) with a sip of water at your usual time. If you are on Coumadin, Heparin, Plavix, or any other blood thinners you must notify the office so the timing of these medications can be explained. For your own safety, if you do not follow the above instructions your procedure may be cancelled. A driver must accompany you and be responsible for getting you home. No driving is allowed the day of the procedure. You may return to your normal activities the day after the procedure, including returning to work.
Trigger point injections are a specific type of local injection that your physician can use to treat local areas of muscle pain and spasm. Trigger points are commonly defined as areas of taut muscle bands or palpable knots of the muscle which are painful. Often these trigger points can cause localized pain and even referred pain patterns that can mimic the pain people feel from nerves being pinched in their neck or low back. Your physician may choose to give a trial of trigger point injections to see if they can help these areas of local muscle tenderness to relieve pain.
Common medications used in trigger point injections can include local anesthetic, normal saline and small doses of steroid medications. Many studies have been done on trigger point injections and their efficacy utilizing these different types of medications. Research has demonstrated that just the local placement of the needle can help with muscle spasms, similar to acupuncture. The volume of the solution can affect the muscle spasm as well, and often times the injections of normal saline can be helpful for pain.
Utilizing a local anesthetic to numb the region of pain can help break the cycle of pain. A small dose of steroid medication at the site can help decrease inflammation of muscles as well.
Your physician may choose a combination of the above medications, depending on your symptoms and response. Trigger point injections are sometimes repeated in a series, depending on the results of the injections and the relief of pain that they provide. Often times, more than one injection is performed on various sites, depending on the physician's examination findings of trigger points.