PROCEDURES

Procedure frequently utilized to treat neck, mid back, and low back pain.

Patients with degenerative changes in their spine (including disc bulges, protrusions, and/or herniations) also known as degenerative disc disease, will frequently develop significant nerve inflammation resulting in debilitating pain. 

Utilizing x-ray guidance (fluoroscopy), our physicians are able to place a strong anti-inflammatory and pain relieving medication around the disc and nerves.

The procedure frequently decreases the nerve inflammation, which can result in a marked decrease and/or potential resolution of pain without surgery.

More specific procedure than regular epidural injections. 

Frequently utilized to treat patients with pain radiating into the arms or legs (also known as radiculopathy or sciatica). Our physicians carefully place medication under x-ray around the nerves causing the pain.  Often utilized to treat what is commonly known as a “pinched nerve” in hopes of avoiding surgery.

Neck and back pain is sometimes unrelated to a problem with the disc itself.  

We have joints in our neck and back somewhat similar to joints in other parts of the body.  These joints can become inflamed and painful due to a variety of reasons, including repetitive use, arthritic change, overlying degenerative disc disease, and trauma.  If deemed appropriate, our physicians can place medication into specific joints under x-ray guidance, significantly decreasing inflammation and frequently providing pain relief without operative measures.  

If successful, some patients may be a candidate for a procedure termed radiofrequency (or rhizotomy) in which the nerves innervating the joints are heated so that they no longer send pain signals to the brain for an extended period of time.

This can often result in long-term pain relief.  The nerves that innervate facet joints are different than the nerves that control and/or cause pain in your arms and legs.

Patients sometimes present with pain in their tailbone area often worse with sitting or specific activities.

An x-ray may be warranted.  If appropriate, our physician can place medicine at the region of the coccyx (tailbone) often resulting in significant pain relief. The procedure frequently allows patients to sit or perform other activities for an extended period of time without discomfort.

In some cases, the pain resolves completely.

Many patients present with a bad disc that is significantly degenerated. An imaging study called an MRI will often reveal that the disc is herniated (ruptured) or has a tear. 

The outer part of the disc is called an annulus which is made up of cartilage. Over time or due to trauma, the cartilage may weaken resulting in what is termed an annular tear.

This finding can frequently be a source of pain in the low back and potentially the legs.

Some individuals with these findings do not respond to traditional treatment such as physical therapy, epidural steroid injections, or nerve blocks.  

As a nonsurgical option, our physicians are able to inject dye into a disc to determine the source of pain.  If the source of pain is identified, medication can then be placed directly into the disc itself often resulting in significant relief of pain for an extended period of time.  

The procedure has proven to be a viable alternative to surgery for a number of patients.

Some patients with chronic lumbar pain may have more than one disc that appears abnormal on MRI.  

Some of these patients only receive short-term relief from injections, oral medications, and physical therapy.  If the definitive source of pain remains unknown, our physicians can inject dye into one or more discs under x-ray in hopes of determining the exact source of pain.  

If a particular disc is identified as a source of pain, treatment options can be narrowed in focus to potentially address the pain more effectively.

Options at that point may include therapeutic discography as discussed above and/or a more focused surgical measure as a last resort.

In patients that present with pain isolated to the gluteal (buttocks) region, it is possible that the pain may not be related to a bad disc or facet joint (see website description of facet pain).  

Some individuals will have inflammation of the joint that attaches the sacrum (lowest part of the spine) to the pelvic region.  This is referred to medically as a sacroiliac or SI joint.  

If the pain is significant, our physicians can place medication directly into the SI joint under x-ray guidance, decreasing inflammation, frequently resulting in significant pain relief.  

Further stabilization of the joint may be required with physical therapy and/or chiropractic measures if deemed necessary by your physician.

Many patients present to our office with complaints of generalized hip pain.  In actuality, the majority of symptoms in the low back, buttocks region, and the back of the legs are frequently related to the spine and not the hip joint itself. 

However, patients that present with discomfort in the groin region aggravated with certain activities may in fact have a problem with the hip joint itself.  An x-ray and/or MRI of the hip itself may be warranted. 

If deemed appropriate, our physicians can place medicine directly into the hip joint under x-ray guidance in hopes of providing pain relief and avoiding orthopedic surgery.

Patients will often present with pain on the side of their hips. The area may be extremely tender to the touch.  These individuals will often describe significant pain while lying on their side at night and it can frequently interfere with sleep. 

On many occasions, the pain is not related to the spine or the hip joint. Often, the diagnosis is hip bursitis which is simply inflammation of a protective sac that sits on top of the hip bone.  This condition is generally easily treated as our physicians place medicine directly into the hip bursa without x-ray guidance. 

The procedure itself takes less than 30 seconds and can significantly relieve pain in the hip area on either side.  Hip bursitis is frequently caused by an altered gait (walk) or repetitive activities.  It is also often seen in patients that have chronic back and/or leg pain as they tend to favor one side or the other when they walk. This can place excessive stressors on the hip region resulting in hip bursitis.

Patients frequently present to our office with complaints of shoulder, elbow, and knee pain.  Common diagnoses are arthritis, tendinitis, bursitis, and tennis/golfers elbow.  An x-ray or MRI may be warranted.  Pending findings, our physicians can place medicine into the shoulder, knee, or elbow if warranted in hopes of pain relief.

Sometimes, oral medications and physical therapy may be recommended by the physician.

A common source of neck and back pain is muscular strain.  Many individuals will strain their neck or back with certain activities and experience pain for a temporary period of time. 

If symptoms are significant, our physicians may deem it appropriate to place medication into the muscle region itself in hopes of decreasing inflammation and expediting resolution of pain symptoms in the most timely manner possible. 

Frequently performed as an initial option in combination with oral medications and physical therapy. Imaging studies such as x-ray, CT, and/or MRI may ultimately prove necessary if symptoms do not resolve with initial treatment provided.

In combination with oral medications and non-surgical spine procedures, the physician may incorporate a physical therapy regimen in hopes of quicker symptom resolution. Our physicians only utilize therapists with considerable training in the treatment of spine conditions. 

They are frequently able to educate the patient on daily activities, exercise programs, proper lifting techniques, and preventative measures in addition to pain relieving modalities.

Many patients participate in therapy in combination with our physician treatment regimen. The goal is fewer exacerbations of pain and long term improvement of symptoms.

Some patients continue to have significant symptoms in spite of treatment regimens, including oral medications, physical therapy, chiropractic measures, injections, and/or surgery. 

Other patients may have debilitating pain and are simply not an ideal candidate for surgery or prefer no additional operative measures.  In some cases, these individuals may be a candidate for a spinal cord stimulator trial.  Our physicians are able to place a small wire under x-ray guidance in close proximity to the nerves causing chronic back and leg pain. 

The stimulator then remains in place for approximately one week, sending signals to the brain, often described by patients as a nonpainful electrical sensation.  This sensation overrides the feeling of pain because your brain is unable to interpret the electrical stimulation and the pain sensation at the same time.  For many patients, stimulation provides significant pain relief. In those individuals, a permanent stimulator can be put in place around the nerves for an indefinite period of time.

This frequently allows the patient to enjoy to a more active lifestyle.  Our physicians will discuss whether you are a candidate for this procedure if appropriate.

Many patients deal with pain, numbness, and/or weakness in their arms and legs.

These symptoms are frequently related to nerve irritation or compression.

Occasionally, patients may even have some degree of nerve damage.  Optimal treatment often depends on the physician having an accurate diagnosis of symptoms.  

If warranted, our physicians may recommend that some patients have a nerve test in hopes of pinpointing the exact source of pain, numbness, or weakness.

The examination is performed in our office so patients do not have to travel to a hospital for testing.  The test is commonly utilized to diagnose such conditions as carpal tunnel syndrome, peripheral neuropathy, and pinched nerves in the neck or back resulting in arm/leg pain.

During the examination, a brief electrical signal will be utilized to test specific nerves.  It will feel like a mild shocking sensation, usually well tolerated by the patient.  In some cases, certain muscles in the arms, legs, neck, or low back may need to be tested.  

Proper attire is recommended.  Patients are encouraged not to utilize any oils or lotion on the day of testing.

For more details, please contact our office.

A CT is basically a very high quality x-ray.  It does utilize a small amount of radiation.  It allows physicians to visualize the bones and openings where the nerves travel.  It does not show details as well as an MRI but is often utilized in patients with pacemakers or stents. If dye is added to the spine before the CT, it is called a myelogram and helps physician locate a pinched nerve.

An MRI is taking a high quality picture of a body region such as the neck or back.  It involves no radiation.  Images are created with the use of a magnet. 

Unlike an x-ray, an MRI allows the physician to visualize nerves and discs in addition to bone.  It is often the only way to visualize the source of pain in an individual with neck, back, arm, and/or leg symptoms.