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87 Cards in this Set
- Front
- Back
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An epidural steroid injection (ESI)
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is a minimally invasive procedure that can help relieve neck, arm, back, and leg pain caused by inflamed spinal nerves.Flushes out inflammatory agents and reduces inflammation
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ESI may be performed to relieve pain caused by?
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ESI may be performed to relieve pain caused by
spinal stenosis, spondylolysis, or disc herniation. |
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For ESI where are the medicines are delivered?
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Medicines are delivered to the spinal nerve through the epidural space, the area between the protective covering of the spinal cord and vertebrae. The effects of ESI tend to be temporary. Pain relief may last for several days or even years. The goal is to reduce pain so that you may resume normal activities and a physical therapy program.
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An epidural steroid injection includes what meds and where is it delivered?
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An epidural steroid injection includes both a long-lasting corticosteroid (e.g., triamcinolone, betamethasone) and an anesthetic numbing agent (e.g., lidocaine, bupivacaine). The drugs are delivered into the epidural space of the spine, which is the area between the protective covering (dura) of the spinal cord and the bony vertebrae. This area is filled with fat and small blood vessels
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Who is a candidate for ESI? |
Patients with pain in the neck, arm, low back, or leg (sciatica) may benefit from ESI. Specifically, those with the following conditions:
Spinal stenosis Spondylolysis Degenerative disc Sciatica |
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Spinal stenosis
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A narrowing of the spinal canal and nerve root canal can cause back and leg pain, especially when walking
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Spondylolysis
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A weakness or fracture between the upper and lower facets of a vertebra. If the vertebra slips forward (spondylolisthesis), it can compress the nerve roots causing pain.
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Degenerative disc disease
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Degenerative disc: A breakdown or aging of the intervertebral disc causing collapse of the disc space, tears in the annulus, and growth of bone spurs.Sciatica: Pain that courses along the sciatic nerve in the buttocks and down the legs. It is usually caused by compression of the 5th lumbar or 1st sacral spinal nerve.
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Sciatica
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Pain that courses along the sciatic nerve in the buttocks and down the legs. It is usually caused by compression of the 5th lumbar or 1st sacral spinal nerve.
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Herniated disc
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The gel-like material within the disc can bulge or rupture through a weak area in the surrounding wall (annulus). Irritation, pain, and swelling occur when this material squeezes out and comes in contact with a spinal nerve.
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ESI should NOT be performed on people who?
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have an infection,
are pregnant, or have bleeding problems. |
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Steroid injections may |
It may slightly elevate the blood sugar levels in patients with diabetes, typically for less than 24 hours. It may also temporarily elevate blood pressure
or cause spotting |
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Translaminar ESI
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The needle is placed between the lamina of two vertebrae directly from the middle of the back. Also called interlaminar, this method accesses the large epidural space overlying the spinal cord. Medication is delivered to the nerve roots on both the right and left sides of the inflamed area at the same time
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Transforaminal ESI
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The needle is placed to the side of the vertebra in the neural foramen, just above the opening for the nerve root and outside the epidural space. Use of a contrast dye helps to confirm where the medication will flow when injected. This method treats one side at a time. It is preferred for patients who have undergone a previous spine surgery because it avoids any residual scars, bone grafts, metal rods, and screws (Fig. 3).
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What are the risks with ESI?
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ESI is considered an appropriate nonsurgical treatment for some patients. The potential risks associated with inserting the needle include spinal headache from a dural puncture, bleeding, infection, allergic reaction, and nerve damage / paralysis (rare). Corticosteroid side effects may cause weight gain, water retention, flushing (hot flashes), mood swings or insomnia, and elevated blood sugar levels in people with diabetes. Any numbness or mild muscle weakness usually resolves within 8 hours in the affected arm or leg (similar to the facial numbness experienced after dental work). Patients who are being treated for chronic conditions (e.g., heart disease, diabetes, rheumatoid arthritis) or those who cannot temporarily discontinue anti-clotting medications should consult their personal physician for a risk assessment.
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RFA stands for? provides? |
Radiofrequency neurotomy (also called radiofrequency ablation or lesioning) is a minimally invasive procedure that can provide lasting relief to those suffering from facet joint pain.
In fact, multiple clinical studies show that radiofrequency neurotomy significantly reduces pain severity and frequency for 1 to 2 years in the majority of patients. Radiofrequency neurotomy involves applying heat to certain nerve pathways to "shut off" the transmission of pain signals to the brain. Low complication rate |
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Benefits of radiofrequency ablation include?
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Low complication and morbidity ratesSignificant and longer lasting pain relief compared to steroid injections Appreciable pain relief compared to surgery: Nearly half of back pain sufferers are not helped by surgery Greater range of motion Lower use of analgesics Improved quality of life Short recovery time |
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RFA uses? Creates? works in which area |
Radiofrequency neurolysis is a technique that uses high frequency radio waves to produce a heat lesion. The lesion created can safely ablate, or inactivate, a nerve that is responsible for transmitting pain. This technique is most commonly applied to treat spinal pain caused by facet joint disease. It works in the lumbar area for facet joint arthritis, as well as in the cervical neck region where facet pain is caused by arthritis or from whiplash injuries.
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herniated disc pain |
TFE x3 |
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localized pain |
MBB x2, if not conclusive MBB x3 Then RFA |
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RFA how many months apart |
6 months apart for the same level/ region |
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When do you consider the TFE |
After 3 TFE's or RFAs |
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After discogram with CT, you can consider |
discectomy |
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Before ordering a MRI, ask? |
Do you have metal |
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What is a MBB |
The medial branch nerve transmits pain from an arthritic facet joint. Therefore, blocking this nerve with local anesthetic will temporarily relieve facet joint pain. This procedure is utilized as a diagnostic tool to determine whether facet radiofrequency neurolysis will be useful to relieve back pain.
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discography |
Not all disc injuries cause pain.
Discography is a diagnostic procedure used to determine whether an injured disc is the source of back pain. It is a provocative test, meaning that we are attempting to provoke, or replicate, the pain rather than eliminate the pain. This will provide important diagnostic information that is used to help formulate a definitive treatment plan. |
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Why percutaneous disc decompression |
(aka Percutaneous Discectomy)
Patients with contained disc herniations who do not respond to conservative treatment may be helped by percutaneous discectomy. This minimally invasive procedure reduces pressure on the nerve root by removing disc nucleus. It results in minimal annular disruption, preserving disc strength and future treatment options, including surgery. |
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How is percutaneous disc decompression performed? Length of time? Resume work? |
Using a standard discography approach, a cannula and stylet are guided into the problem disc under fluoroscopic guidance. After position in the disc is confirmed, the stylet is removed and the Dekompressor® probe is advanced into the disc through the cannula. Once activated, the Dekompressor probe is used to remove the desired amount of intervertebral disc nucleus, thereby reducing the size of the disc herniation and relieving the pain.The procedure generally takes only 15 to 30 minutes to perform and doesn't require a hospital stay. Patients can typically go home within 1 to 3 hours of treatment. Recovery time varies with each person, but many patients are able to resume work and daily activities in one week.
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stellate ganglion block |
What is a stellate ganglion block?A stellate ganglion block is an injection of local anesthetic in the sympathetic nerve tissue of the neck. These nerves are a part of the sympathetic nervous system. The nerves are located on either side of the voice box, in the neck.
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What is the purpose of a stellate ganglion block? and face. |
What is the purpose of a stellate ganglion block?A stellate ganglion block blocks the sympathetic nerves that go to the arms, and, to some degree, the sympathetic nerves that go to the face. This may in turn reduce pain, swelling, color and sweating changes in the upper extremity and may improve mobility. It is done as a part of the treatment of Reflex Sympathetic Dystrophy (RSD), Sympathetic Maintained Pain, Complex Regional Pain Syndrome and Herpes Zoster (shingles) involving an arm or the head and face.
only takes a few minutes |
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lumbar sympathethic ganglion block |
A lumbar sympathetic block is an injection in the middle of the lower back, toward the left or right side. The “lumbar sympathetic nerves” are a small bundle of nerves that carries “sympathetic” nerve signals from the lower extremities. In some instances, certain injuries to the lower extremities can cause a burning, unusual pain called complex regional pain syndrome or reflex sympathetic dystrophy. Injecting a small amount of local anesthetic on the lumbar sympathetic nerves can identify whether or not this pain is carried by the sympathetic nervous system.
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vertebroplasty |
Vertebroplasty is a procedure to treat pain caused by vertebral compression fractures. Vertebral compression fractures usually are the end result of osteoporosis, and they affect millions of people every year. Vertebroplasty is a safe and effective outpatient procedure in which a cement mixture is placed into the collapsed vertebral body, thus stabilizing the fracture and eliminating the pain. The procedure is done through a needle under fluoroscopic guidance.How is it done?Using fluoroscopic guidance, the compressed vertebra is identified. A needle is inserted through the skin and carefully and precisely guided into the center of the vertebral body. A syrupy cement mixture is then injected through the needle into the vertebra. When the cement hardens, it will stabilize the fracture and eliminate the pain.
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Expected results of vetebroplasty?
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Decreased spinal pain caused by a vertebral compression fracture.
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How long does a veterbroplasty take?
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The procedure takes thirty to forty minutes plus recovery time.
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kyphoplasty |
The goals of a kyphoplasty surgical procedure are designed to stop the pain caused by a spinal fracture, to stabilize the bone, and to restore some or all of the lost vertebral body height due to the compression fracture.Kyphoplasty is a type of Vertebral Augmentation for Compression Fractures
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hypogastric plexus block for pelvic pain |
Hypogastric plexus blocks are injections of medication that help relieve pelvic pain. The pain may come from the colon, bladder, lower intestines, uterus or ovaries, prostate or testicles, or other parts of the pelvis. The procedure also can help reduce pelvic pain from endometriosis, irritable bowel syndrome, radiation injury and cancer in the pelvis.The hypogastric plexus is a bundle of nerves near the bottom of your spinal cord. Blocking these nerves from carrying pain information can help you stop feeling pain in your pelvis.
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spinal cord stimulator trial and implantation |
Spinal cord stimulation (SCS) or neurostimulation is a pain treatment that delivers low voltage electrical stimulation to the spinal cord to inhibit or block the sensation of pain. SCS is used to treat various types of chronic pain. A spinal cord stimulator is an implanted device, but it is fully reversible and removable. Also, a non-implanted trial is done before an implant of SCS in order to test the results.
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Permanent SCS done? |
This is a surgical procedure in which permanent electrodes are implanted over the spinal cord, and connected to a battery that is implanted under the skin. The battery is programmed to provide the electrical spinal cord stimulation.Expected results:The electrical impulses block and/or alter pain signals from being transmitted through the spinal cord on their way to the brain. Therefore pain is eliminated or greatly reduced.
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How long does it take?
SCS trail? implant? |
The SCS trial typically takes 30 to 60 minutes depending on how easily the electrodes can be guided to precise location. A spinal cord stimulation implant is a surgery which takes two to three hours.
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What is Radiofrequency Neurolysis?
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Radiofrequency neurolysis is a technique that uses high frequency radio waves to produce a heat lesion. The lesion created can safely ablate, or inactivate, a nerve that is responsible for transmitting pain. This technique is most commonly applied to treat spinal pain caused by facet joint disease. It works in the lumbar area for facet joint arthritis, as well as in the cervical neck region where facet pain is caused by arthritis or from whiplash injuries.
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How is RFA done?
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The location of the targeted nerve is identified by fluoroscopic guidance. An insulated needle is placed through the skin and guided very close to the nerve. Stimulation testing is then carried out on the nerve to verify safe and accurate needle placement. The nerve is then treated with radio waves to produce a thermal lesion that inactivates the nerve for a period of 6 to 24 months.
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Expected results for RFA pain?
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For facet pain, radiofrequency neurolysis of the nerve supply will produce substantial pain relief in 70% of patients for a period of 6 to 24 months. The treatment can safely be repeated if and when the pain returns.
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How long does RFA take?
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The procedure takes thirty to forty-five minutes
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How is a discography done? |
Using fluoroscopic guidance, the intervertebral disc space is identified. A fine needle is carefully and precisely inserted into the center of the disc. With the patient awake and able to reliably report pain, the disc is injected with a small amount of contrast dye which pressurizes and stimulates the disc. The patient immediately reports whether back pain is provoked and reproduced. Usually several discs are thus tested, including one “normal” or unaffected disc which serves as a control for comparison to other potentially affected or painful discs.
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Expected results of discography?
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Determination if one or more intervertebral discs are causing back pain.
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How long does a discography take?
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The procedure takes twenty to thirty minutes plus recovery time.
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How is temp SCS done?
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Initially, a trial of SCS is done in which one or two electrodes are placed into the epidural space through a needle (no incision). The electrodes are guided into precise locations in order to provide optimal stimulation for the location and type of pain involved. The trial electrodes are left in place for approximately seven days in order to provide a thorough period to test the pain relief. If the trial is successful, implantation of a permanent SCS system is performed.
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What is SI pain?
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The sacroiliac joints are located on both sides of the body and they form the connection between the lower portion of the spine (sacrum) and the pelvis (iliac bones). These joints can be affected by degeneration (arthritis) or trauma, and be a common cause of lower back pain. A sacroiliac injection places medication directly into the joint to diagnose and treat pain.
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How is SI injection done?
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Using fluoroscopic guidance, the sacroiliac joint is identified. A needle is carefully guided directly into the joint. A small volume of dye is injected first to verify accurate location within the joint. Then a combination of local anesthetic and corticosteroid is injected into the joint.
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Expected results from SI injection?
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Decreased inflammation inside the sacroiliac joint results in decrease of associated lower back and sacroiliac pain.How long does it take?The procedure takes five to ten minutes plus recovery time.Demonstrations
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What are TPI? |
Painful and hypersensitive regions or bands of muscle are called trigger points, and they are a hallmark of myofascial pain syndrome. Trigger point injections are placed directly into the sites of maximal muscle spasm and hypersensitivity, thus breaking up the spasm and adhesions to relieve the pain.
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How are TPI done?
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A trigger point injection is a relatively safe and simple procedure that can be performed in the office. The painful trigger points are identified by direct examination. The overlying skin is cleansed with alcohol, and then a very thin needle is inserted through the skin directly into the trigger point. A mixture of local anesthetic and corticosteroid is injected into the trigger point. If necessary, several trigger points can be injected in the same sitting.
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Expected results of TPI?
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The painful trigger point is anesthetized and the muscle spasm and adhesions are broken up by the injection, usually resulting in immediate relief of pain.How long does it take?The procedure usually takes no longer than five minutes.
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How is MBB done?
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Using fluoroscopic guidance, the anatomic landmarks of the medial branch nerve are located. A very fine needle is placed through the skin and directed to the proper location. A small amount of contrast dye is injected first to verify proper needle location. Then a small amount of local anesthetic is injected to block the nerve.
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Expected results of MBB?
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The patient will report whether or not the back pain is relieved. If back pain is relieved, then it is determined that the pain is originating from the corresponding facet joint. If the pain is not relieved, the facet joint can be ruled out and another source of pain will be investigated.
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How long does an MBB take?
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The procedure takes ten to fifteen minutes plus recovery time.
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How are hypogastric plexus blocks done? |
First, you’ll be given an intravenous medication to relax you. Then, you’ll lie on your stomach on an x-ray table.The doctor will numb an area of skin on your back with a local anesthetic. Then, guided by an x-ray, he or she will:Insert two needles into your back, near each hip boneInject dye to confirm that medication will go to the correct spotInject pain medication, including a steroid for longer-term relief; alcohol or phenol also may be injected to destroy the nerves
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How long does a hypogastric plexus block done |
Usually, the procedure takes about 30 minutes. Then you’ll stay for observation for at least 30 minutes. Most people go home soon after.
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How effective is a hypogastric plexus block?
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Some patients report pain relief within 30 minutes after the injection, but pain may return a few hours later as the anesthetic wears off. Longer term relief usually begins in two to three days, once the steroid begins to work.How long the pain stays away is different for each patient. For some, the relief lasts weeks. For others, the relief lasts years.If the pain returns, you can have another hypogastric plexus block every few months.
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What are the risks of a hypogastric plexus block?
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The risk of complication from a hypogastric plexus block is very low
bruising or soreness at the injection site. Serious complications, such as infection, nerve damage and bleeding, are uncommon. Side effects of the steroid medication are rare but can include: Flushed face Slight fever Hiccups Insomnia Headache Water retention Increased appetite Increased heart rate Abdominal cramping or bloatingThese effects resolve within a few days |
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What happens after the hypogastric procedure?
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Your pelvic area may feel warm or “different,” and you may begin to feel less pelvic pain.You can continue your regular diet and medications immediately, but do not drive or do any rigorous activity for 24 hours after the procedure. Take it easy. You can return to your normal activities the next day.
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What is actually injected for stellate ganglion block?
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The injection consists of a local anesthetic. Epinephrine or steroid medication may be added to prolong the effects of the stellate ganglion block.
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What is actually injected for the stellate ganglion block?
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The injection consists of a local anesthetic. Epinephrine or steroid medication may be added to prolong the effects of the stellate ganglion block.
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Will I be "put out' for the stellate ganglion block?
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Maybe. The stellate ganglion block can be done under local anesthesia only. However, most of the patients also receive enough intravenous sedation that they may fall asleep for a few minutes during the actual injection. Patients breathe on their own throughout the procedure. The amount of sedation given generally depends upon the patient tolerance, but can often be enough that the patient has amnesia for the actual injection.
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How is the stellate ganglion block performed?
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It is done either with the patient slightly sitting up. The chin is slightly raised and turned away from the side to be injected. The patients are monitored with EKG, blood pressure cuff and an oxygen-monitoring device. Temperature sensing probes are also placed on your hands. The skin in the front of the neck, next to the "voice box" is cleaned with antiseptic solution and then the injection is carried out.
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What should I expect after the stellate ganglion block?
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Immediately after the injection, you may feel your arm getting warm. In addition, you may notice that your pain may be gone or quite less. You may also notice "a lump in the throat" as well as hoarse voice, a droopy and red eye and some nasal congestion on the side of the injection. You may rarely also develop a headache.
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What should I do after the stellate ganglion block?
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You should have a ride home. We advise patients to take it easy for a day or so after the procedure. You can perform the activities that you can reasonably tolerate. Some patients may go for immediate physical therapy.
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Can I go to work to work the next day after a stellate ganglion block?
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Unless there are complications, you should be able to return to work the next day.
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The most common thing you may feel after a stellate ganglion block is?
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soreness in the neck at the injection site.
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How long the effect of the medication last of a stellate ganglion block last?
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The local anesthetic wears off in a few hours. However, the blockade of sympathetic nerves may last for many more hours. Usually, the duration of relief gets longer after each injection.
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How many stellate ganglion blocks do I need to have?
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If you respond to the first injection, you will be recommended for repeat injections. Usually, a series of such injections is needed to treat the problem. Some may need only 2 to 4 and some may need more than 10. The response to such injections varies from patient to patient
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Will the stellate ganglion block help me?
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It is sometimes difficult to predict if the injection will indeed help you or not. The patients who present early during their illness tend to respond better than those who have had symptoms for a very long time. Patients in advanced stages of disease may not respond adequately.
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What are the risks and side effects of a stellate ganglion block?
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This procedure is safe. However, with any procedure there are risks, side effects and possibility of complications. The most common side effect is temporary pain at the injection site. Other less common risks include bleeding, infection, spinal block, epidural block and injection into blood vessels and surrounding organs. Fortunately, serious side effects and complications are uncommon.Who should not have a stellate ganglion block?If the patient is allergic to any of the medications to be injected, on a blood thinning medication, has an active infection going on near the injection site, or has poorly controlled diabetes or heart disease, they should not have the injection or at least consider postponing it if postponing it would improve your overall medical condition.
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How is kyphoplasty performed?
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Kyphoplasty Surgery
During kyphoplasty surgery, a small incision is made in the back through which the doctor places a narrow tube. Using fluoroscopy to guide it to the correct position, the tube creates a path through the back into the fractured area through the pedicle of the involved vertebrae.Using X-ray images, the doctor inserts a special balloon through the tube and into the vertebrae, then gently and carefully inflates it. As the balloon inflates, it elevates the fracture, returning the pieces to a more normal position. It also compacts the soft inner bone to create a cavity inside the vertebrae.The balloon is removed and the doctor uses specially designed instruments under low pressure to fill the cavity with a cement-like material called polymethylmethacrylate (PMMA). After being injected, the pasty material hardens quickly, stabilizing the bone.Kyphoplasty surgery to treat a fracture from osteoporosis is performed at a hospital under local or general anesthesia. |
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Time for kyphoplasty procedure:
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The kyphoplasty procedure takes about one hour for each vertebra involvedPatients will be observed closely in the recovery room immediately following the kyphoplasty procedurePatients may spend one day in the hospital after the kyphoplasty procedurePatients should not drive until they are given approval by their doctor. If they are released the day of the kyphoplasty surgery, they will need to arrange for transportation home from the hospital.
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Recovery from Kyphoplasty takes how long
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Pain relief will be immediate for some patients. In others, elimination or reduction of pain is reported within two days. At home, patients can return to their normal daily activities, although strenuous exertion, such as heavy lifting, should be avoided for at least six weeks.Patients should see their physician to begin or review their treatment plan for osteoporosis, including medications to prevent further bone loss.
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Candidates for Kyphoplasty
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Kyphoplasty cannot correct an established deformity of the spine, and certain patients with osteoporosis are not candidates for this treatment.
Patients experiencing painful symptoms or spinal deformities from recent osteoporotic compression fractures are likely candidates for kyphoplasty. The procedure should be completed within 8 weeks of when the fracture occurs for the highest probability of restoring height. |
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Risks and Complications of KyphoplastyVertebroplasty
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Some general surgical risks apply to kyphoplasty, including a reaction to anesthesia and infection. Other risks that are specific to the kyphoplasty procedure and vertebroplasty include:Nerve damage or a spinal cord injury from malpositioned instruments placed in the backNerve injury or spinal cord compression from leaking of the PMMA into veins or epidural space Allergic reaction to the solution used to see the balloon on the X-ray image as it inflates |
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New Study Results:New information is available from a clinical trial on balloon kyphoplasty. Read our review of the findings here:
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It is not known whether kyphoplasty or vertebroplasty will increase the number of fractures at adjacent levels of the spine. Bench studies on treated bone have shown that inserting PMMA does not change the stiffness of the bone, but human studies have not been done. Osteoporosis is a chronic, progressive disease. As stated earlier, patients who have sustained fractures from osteoporosis are at an increased risk for additional fractures due to the loss of bone strength caused by osteoporosis.
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HOW LONG DOES a lumbar sympathetic block TAKE TO DO?
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The actual injection takes only a few minutes. Please allow about an hour for the procedure; this will include talking to your doctor before the procedure, signing the informed consent, positioning in the room, and observation by the recovery room nurse afterwards.
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WHAT MEDICINES ARE INJECTED for a lumbar sympathetic block?
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For diagnostic purposes, only local anesthetics are injected, usually Bupivacaine or Ropivicaine. Sometimes, if the diagnostic injection is successful in blocking your pain, other medications may be used for longer-lasting relief.
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WILL the lumbar sympathetic block HURT?
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All of our procedures begin by injecting a small amount of local anesthetic through a very small needle. It feels like a little pinch and then a slight burning as the local anesthetic starts numbing the skin. After the skin is numb, the procedure needle feels like a bit of pressure at the injection site.
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WILL I “BE ASLEEP” FOR THIS lumbar sympathetic blockPROCEDURE?
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This choice is yours. You can choose to have the procedure done under local anesthetic only. You can also choose to have IV sedation, which can keep you very comfortable. It can range from some drowsiness or you may have little or no memory of the procedure depending upon your comfort level
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Prep for the lumbar sympathetic block |
regardless of the amount of sedation, you must not eat or drink anything for 6 hours prior to this and you must also have a driver when choosing sedation. It is OK to take your medications with a sip of water with either decision.
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HOW IS the lumbar sympathetic blockDONE?
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It is typically done with you lying on your stomach. Your blood pressure and oxygenation will be monitored. In addition to your doctor and the x-ray technician, there will be a nurse in the room at all times if you have any questions or discomfort during the procedure. The skin on the back is cleaned with antiseptic solution and then the procedure is done.
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WHAT SHOULD I EXPECT AFTER THE lumbar sympathetic blockINJECTION?
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shortly after the injection, you may feel your leg becoming warm. The pain may diminish considerably. This is normal. |
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WHAT SHOULD I DO AFTER THE lumbar sympathetic blockPROCEDURE?
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WHAT SHOULD I DO AFTER THE PROCEDURE?We advise the patients to take it easy for a day or so after the procedure. Perform the activities as tolerated by you. Your recovery room nurse will advise you about applying ice to the site
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