This is a diagnostic test.  This procedure helps the doctor determine the source of a patient’s leg or arm pain.  A spinal needle is advanced, with the aid of fluoroscopy.  The fluoroscope shoots real-time low dose x-ray images that aid the physician in safely and precisely guiding the spinal needle to the appropriate epidural level.  The needle is placed on the right side, left side or both sides of the spine (depending on patient’s symptoms) through the skin and muscle and into the foramina which is the “hole” that the spinal nerve exits out of the spinal column.  A local anesthetic, typically Bupivacaine, is injected along the nerve to see if the patient’s pain symptoms are reduced.

This is a procedure for treating back pain originating from a facet joint.  A spinal needle is advanced from either the right side, left side or both sides (depending on patient’s symptoms) through the skin and muscle to the posterior bony part of the spine where the facet joints are located.  Real-time low dose x-ray images (fluoroscopy) will aid the physician in safely and accurately guiding the spinal needle to the facet joint.  The needle tip is gently advanced into the facet joint and a powerful anti-inflammatory steroid is injected.

The facet joints of the low back and neck are common spine pain sources.  They may be painful from arthritis or from injury.  The 2 lowest low back facet joints (L4-5 and L5-S1) frequently cause low back pain that refers to the buttocks area.  The upper cervical facet joints frequently refer pain to the back of the head (occipital headaches).

A medial branch block is a purely diagnostic test.  It helps the doctor determine if the patient’s pain is coming from a particular facet joint.  It is an injection of a local anesthetic along a median branch nerve that goes to a facet joint.  A spinal needle is advanced from either the right side, left side, or both sides (depending on the patient’s symptoms) through the skin and muscle to the posterior bony part of the spine where the medial branch nerve is located.  Real-time low dose x-ray images (fluoroscopy) will aid the physician in safely and accurately guiding the spinal needle to the medial branch nerve.  The needle tip is gently placed next to the medial branch nerve and a local anesthetic is injected.  The nerve will be temporarily be numbed.  The patient will keep a pain diary for 8 hours after the injection recording the levels of their pain every hour.

The facet joints of the low back and neck are common spine pain sources.  They may be painful from arthritis or from injury.  The 2 lowest low back facet joints (L4-5 and L5-S1) frequently cause low back pain that refers to the buttocks area.

This procedure goes by several names including Radiofrequency Ablation, Radiofrequency Neurotomy and Radiofrequency Rhizotomy.  In this procedure a specially designed spinal needle creates a burn or lesion along medial branch nerves.  This will block the pain coming from a particular facet joint.  Radiofrequency ablation is done only after diagnostic medial branch blocks have been performed.  The radiofrequency needle is advanced from either the right side, left side or both sides (depending on patient’s symptoms) through the skin and muscle to the posterior bony part of the spine where the facet joint nerves (median branch nerves) are located.  Real-time low dose x-ray images (fluoroscopy) will aid the physician in safely and accurately guiding the spinal needle to the medial branch nerve.  The needle tip is gently advanced adjacent to the medial branch nerve and the tip of the needle is heated to 80 degrees Celcius (just under water boiling temperature).  The burned nerve regenerates (re-grows) over time.  If successful, the pain relief can last up to 18 months.

This is also called Dorsal Column Stimulation or Neuromodulation.  During the trial, small electrical wires with contact leads are placed in the epidural space (just outside the spinal cord).  The doctor will use real-time low dose x-ray images (fluoroscopy) to safely and accurately guide a spinal needle.  The electrical wires will be threaded into the epidural space.  The trial leads stay in for approximately one week and are removed in the office setting.  If the patient receives excellent pain relief during the trial, then a permanent paddle lead will be placed by the spine surgeon.

A permanent spinal cord stimulator paddle lead is placed by the spine surgeon in the epidural space (just outside the spinal cord) typically under general anesthetic.  A rechargeable battery is surgically placed under the skin.

This is a diagnostic test.  It aides in accessing whether a specific spinal disc (the pad between the bones of the spine) is a significant pain generator.  A spinal needle is gently directed into the disc with the aid of real-time low dose x-ray images (fluoroscopy).  The disc is injected with contrast dye and antibiotic and pressure measurements are made.  When pressurizing the disc, the patient will report if their typical pain is being recreated.

Injection of a patients own blood into the epidural space.  The blood is drawn from the patients arm vein and then injected into the epidural space.  Real-time low dose x-ray images (fluoroscopy) will aid the physician in safely and accurately guiding the spinal needle during the procedure.

The epidural space is the space on top of the thecal sac that surrounds the spinal cord and the cerebrospinal fluid.

Why would a patient need an Epidural Blood Patch?

Certain conditions require patients to have injections into the spinal column below the thecal sac (an example is a spinal tap for the collection of cerebrospinal fluid).  Sometimes after a spinal tap a severe headache occurs from a leak of cerebrospinal fluid through the thecal sac.  This headache is relieved with laying flat and worse when standing.  The Epidural Blood Patch blocks the leak of the cerebrospinal fluid and resolves the headache.

A needle is directed through the skin and muscles and advanced past the joint capsule and into the joint.  A fluoroscope will be used during the joint injection.  Fluoroscopy uses real-time low dose x-ray images to aid the physician in safely and precisely guiding the needle to the site.  Joints frequently injected under fluoroscopy include:  spine facets, hips, shoulders (glenohumeral and acromioclavicular), and sacroiliac joints.

These are injections used to reduce excess muscle activity or spasms.  Botox is made from a toxin produced by the bacterium Clostridium botulinum.  It is the same toxin that casuses a type of food poisoning called botulism.  These are done in the office by injecting small doses to treat spasticity, muscle spasms, cervical dystonia (severe neck and shoulder contractions), blepharospasm (uncontrollable blinking), and wrinkles.

Electrodiagnostics are tests to evaluate the peripheral nervous system and the muscles.  It is used to diagnose nerve and muscle diseases.  Common diagnosis tested include Carpal Tunnel Syndrome, Ulnar Neuropathies, Radiculopathies, Brachial Plexopathies, Peripheral Neuropathies, Myopathies, Amyotrophic Lateral Sclerosis (Lou Gehrig’s Disease).

Do I need a driver?

Yes. A responsible driver is necessary for all procedures done at the Center for Specialty Surgery.

Do you offer IV conscious sedation?

Yes, we offer IV Versed and Fentanyl.  However, for most procedures it is not necessary. We do offer oral Valium as an alternative to IV conscious sedation.  A responsible driver is necessary.

When Should I Arrive for my Procedure?

We recommend arriving early for your procedure:

• 60 minutes, if you are receiving IV sedation.
• 30 minutes, if you are not receiving IV sedation.

What medications do I have to stop prior to my procedure?

• 7 days:  Non-steroidal anti-inflammatory medications (Advil, Motrin, Ibuprofen, Aleve, Naproxen, etc.)
• 7 days:  Aspirin and products containing aspirin (example Alka-Seltzer).
• 5 days:  Coumadin (Warfarin), with a lab draw for PT/INR the day of the procedure.
• 2-3 days:  Pradaxa, Xarelto, Eliquis.  Need to discuss with doctor prescribing this medication for the exact appropriate time to stop.