Procedures

Our physicians focus on helping you feel better by offering both surgical and non-surgical options, since they recognize all patients are different and pain management can take many forms. There is no single fix for everybody. The procedure that is right for you will depend on your circumstances.

Below are some of the procedures conducted in our office:

Epidural Steroid Injection

An epidural steroid injection relieves pain by reducing the inflammation of irritated nerves within the spinal canal. An epidural steroid injection is very safe; its potential benefits include decreased pain, decreased numbness and/or tingling, and increased mobility. As with any procedure, there are risks involved, such as infection, bleeding, nerve injury, and worsened pain. There are also possible side effects relating to the steroid itself including blood sugar increases, weight gain, water retention, and suppression of the body’s production of cortisone.

The procedure is performed at an outpatient surgery center. Usually, patients are mildly sedated for the procedure. During the injection of steroid, you may feel slight discomfort from the pressure effects of the injected solution. After the procedure is over, you will be taken to the recovery area for approximately 30 minutes before being discharged.

Afterward, there may be some slight discomfort from the mechanical process of needle insertion or from pressure effects from the solution. The procedure is typically well tolerated, and most patients can resume their normal activities the next day. The steroid takes approximately one to two days to take effect and it is common for it to take two or three epidural steroid injections to obtain the greatest benefit.

Trigger Point Injections

Trigger point, or myofascial pain, refers to points that are painful to the touch. Trigger points are divided into active and latent groups. Active trigger points cause constant pain and inhibit movement, leading to a reduction in the use of the muscle group. Latent trigger points are formed by injuries or microtrauma and may be present for years after the inciting event. They do not manifest themselves or become active until movement in the involved joint is extended beyond the usual range.

To treat trigger point pain, our physicians find and eliminate the trigger points that perpetuate the pain cycle, prevent normal range of motion, and shorten the active length of the involved muscle. Trigger point injections are very safe and effective in decreasing or eliminating myofascial pain. In certain circumstances, Botox® may be used to lengthen the duration of pain relief.

Complications are extremely rare and involve the risks of the needle placement (infection, bleeding, or local tissue injury) and the local anesthetic injection. A series of trigger point injections are most likely to be effective when added to ongoing physical therapy, followed by home stretching exercises.

Intraspinal Delivery System

In certain conditions, it is advantageous to deliver medications directly into the spinal canal rather than taking pills. This therapy is intended to increase the effectiveness of the medication and decrease potential side effects.

Not all patients suffering from chronic pain or spasticity will benefit from an intraspinal delivery system so a trial procedure is necessary to determine possible candidates. This is done in the operating room at Tallahassee Memorial Hospital. During the trial, you will be given light sedation – you have to be awake enough to communicate with the surgeon. The surgeon will use an x-ray machine to visualize your spinal anatomy. Next, you will be given a local anesthetic to numb your skin and subcutaneous tissues. The medication will then be injected into the spinal fluid and you will stay overnight at the hospital for observation.

You should feel significant pain relief or a decrease in spasticity during the trial. Based on the results of the trial, a decision will be made whether to proceed with implantation. Intraspinal delivery systems can significantly decrease pain or spasticity, but as with any surgical procedure, there are risks involved. These include infection, bleeding, injury to the spinal cord, equipment failure, or future lack of benefit.

Before the surgery, you will be made aware of the cosmetic changes from the implantation. The medication reservoir/pump has the same shape as a hockey puck, although slightly larger. This is implanted in your abdomen, just underneath your skin and on top of the abdominal musculature. Depending on the amount of fatty tissue present, the profile of the implant may range from relatively flat to a significant bulge.

In addition, you will be informed of the “maintenance” involved with intraspinal delivery systems. The electronic pump/reservoir only holds a limited amount of medication, and it will need to be refilled approximately every 4–8 weeks. For refills, the reservoir is accessed via a needle that is placed through the skin. Any remaining old medication is removed and new medication is added.

Spinal Cord Stimulators

A spinal cord stimulator is an advanced treatment for chronic pain. With this therapy, a small implanted device generates electrical signals within your spinal cord to modify pain messages before they reach your brain. Previous areas of pain are replaced with a different sensation. Usually, patients describe this as a tingling feeling.

If you are a potential candidate for spinal stimulation, you will undergo a trial procedure. You should feel significant pain relief and comfort with the sensations of the stimulation. During the trial, you will be given a light sedation so you can still communicate with the surgeon. The surgeon will use an X-ray machine to visualize your spinal anatomy. Next, you will be given a local anesthetic to numb your skin and subcutaneous tissues. After that, a wire or lead will then be threaded through the needle along the spinal canal. You will then tell the surgeon where you feel stimulation, and the wire/lead will be adjusted appropriately. The needle is then pulled out, leaving the wire/lead in place. Thus, there will be a wire coming out of your skin that will be taped down. The wire will be attached to an external battery. You will then go home for several days to assess the amount of pain relief you experience. The trial wire/lead will be pulled out when you return to the doctor’s office.

At this point, a decision will be made on whether to proceed with the implantation. Spinal cord stimulators can significantly decrease pain, but as with any surgical procedure, there are risks involved. These include infection, bleeding, injury to the spinal cord, equipment failure, or future lack of benefit. You should also note that after the implantation, you will no longer be able to have an MRI. Prior to the procedure, you will be referred to a psychologist. The psychologist will assess your understanding and expectations of the implantation.

For the actual implantation, the wire/lead will be placed just as during the trial; however, the lead will be connected to a small battery placed underneath your skin. The battery is placed in either your upper buttock or abdomen. Today, most batteries implanted are rechargeable. From time to time, you will have to recharge the battery at home using a remote-control device. The charger is placed on top of your skin, over the implanted battery, and only takes a few hours to fully recharge.

Radiofrequency Block Procedure

Radiofrequency lesioning is a procedure in which sensory nerves are purposefully altered by a heated probe. This technique is usually performed for focal back or neck pain caused by degenerative facet joints (the joints that connect your posterior spinal column). They are subject to degeneration and inflammation and become a common cause of pain, especially for the elderly. A diagnostic block of each nerve with local anesthetic will determine which of the presumed facet joints is the cause of pain. If you feel significant pain relief after the diagnostic block, then you will return for the radiofrequency lesioning procedure.

The aim of radiofrequency lesioning is to reduce your pain and improve your function. The procedure is not permanent; recent studies have determined the average pain relief lasts nine months. However, Radiofrequency lesioning can be repeated on an as-needed basis. As with any procedure, there are potential risks, such as infection, bleeding, nerve injury, and worsened pain.

The procedure is performed at an outpatient surgery center. You are given mild sedation and then brought to the procedure suite. The physician uses an X-ray machine to visualize your spinal anatomy and the intended targets. Next, your skin and subcutaneous tissues are anesthetized with a local anesthetic. A special needle is then inserted and placed next to the sensory nerve. Sensory and motor testing is then performed by a special machine, which informs the physician of his proximity to the sensory nerve. When appropriate, the physician will give you some local anesthetic prior to heating the needle. The lesioning (heating) process itself only takes 90 seconds.

After the procedure, there may be some slight discomfort from the process of needle insertion. Usually, the procedure is very well-tolerated, and you can resume your normal activities the next day. The full effect can take several days, so you may not perceive any immediate benefit.