Spine Procedures
Disc FX System Overview
The Disc FX System is an innovative, minimal access spine system to efficiently access the damaged disc without injury to surrounding disc anatomy. Disc FX permits multiple treatment options compared to other 'single treatment' devices in the marketplace. In addition to manual decompression, Disc FX can help to clean the disc and seal tears in the annulus. Disc FX provides an option for those people who have failed conservative care, and are not yet ready for major surgery. This is a same day procedure with only a small bandage and no large incisions. Following manual removal of the offending herniation, the Trigger- Flex device is activated to help clean the disc and seal the tears in the annulus. As a result, pressure in the disc is reduced, which eases symptoms.
Who is a candidate for the procedure ?
Patients with symptomatic contained disc herniations that have not responded to conservative treatment, may experience relief from Disc FX. Typical signs of a contained lumbar disc herniation is lower back with or without radiation symptoms of numbness and tingling down the legs.
Potential Benefits of the Procedure
● Out patient procedure● Short Procedure times● Minimally invasive procedure● MInimal incision● Can treat multiple disc levels● Quick relief of symptoms● Prevent having surgery with large open incisions.
Prior to the procedure
● Physical exam and diagnostic testing of MRI should be conducted. ● Patient has failed conservative care including medications, physical therapy, or spinal injection therapy. ● On certain occasions a discography may be necessary to diagnose and locate the symptomatic disc herniation.
During the Procedure
The Disc Fx system require the patient to lie prone on their stomach. Minimal anesthesia with IV sedation may be necessary. A needle is inserted into the skin near the affected disc level, followed by an incision through which a slightly (larger than the needle) hollow tube is placed. Graspers are inserted through the tube and used to manually remove and decompress the interior of the disc which is herniated and and causing pressure against the nerve. The patented trigger-Flex can then be used to help clean the disc and seal the tears in the annulus. This will intern reduce the overall pressure inside of the disc which eases pain symptoms. At the conclusion of the procedure, once the annulus is sealed, the tube is removed and a small bandage is applied.
After the Procedure
Patients are required to remain at the facility for 30 minutes to an hour for recovery. Upon release, patients are driven home by the surgery center. Patient should rest for one to three days with limited standing and walking. There may be soreness or bruising at the site of the procedure for up to a week. In most cases, symptoms caused by the disc herniation are gone or decreased within two weeks. After one week of the procedure, patient should return back to physical therapy, which is important for full recovery. Patient can return to work after 3-5 days depending upon the patient's recovery.
Are there complications with the procedure?
As with any minimally invasive disc treatments, side effects of the Disc FX are relatively rare. This is very safe procedure because patients are monitored with live nerve monitoring to ensure the safety of the patient and prevent any complications.
What is Epidural Steroid Injection?
Epidural Steroid Injection is the placement of cortisone, a powerful anti-inflammatory agent mixed with preservative free lidocaine an anesthetic into the epidural space. It has been used for over 40 years as treatment for back pain. It can be placed in centrally or antero- laterally based upon the location of the disc herniation on MRI review. The main goal of the epidural injection is to shrink the swelling in the bulging or herniated discs and decrease any inflammation that surrounds the spinal nerves.
What is epidural space?
Epidural space is a potential space within the spinal canal. It surrounds the outermost covering of the spinal cord (dura mater). It contains nerve roots, blood vessels & fatty tissue.
Who needs an Epidural Steroid Injection ?
Epidural Steroid Injections help patients with disc herniations, spinal stenosis and sciatica which is a burning type pain into the extremities. It is considered to be an effective means for the nonsurgical treatment of spinal pain syndromes.
How long does the injection take and will it hurt?
The actual injection takes only a few minutes. The procedure is done anesthesia or under local anesthesia to minimize discomfort.
How is the injection performed?
It is done with the patient lying on the stomach with fluoroscopic (x-ray) guidance. The skin is cleansed with anti-septic solution and then the injection is carried out based upon the exact location of the spinal nerves affected. After the injection, you are taken to a recovery area to rest.
What are the risk and the complications?
Epidural injections are generally safe procedures. Any interventional procedure within the spine may have very minimal risk of infection, bleeding, spinal headache and injury to blood vessels or nerves. The complications are prevented by the use of anti septic techniques and x-ray and dye to visualize exact needle placement.
What should I expect after the procedure?
Epidural injections are generally safe procedures. Immediately after the injection, you may feel that your pain may be gone or quite less. This is due to the local anesthetic injected. This will last for a few hours. The steroid medication will take about 3-5 days to work and cause overall anti-inflammatory effect and pain reduction. The steroid will offer relief for several months duration.
What is facet joint injection/medial branch block?
A facet joint injection is an injection of an anesthetic with a long lasting steroid (“cortisone”) into the facet joints. Facet joints are located in the back and neck at each vertebral level. They are surrounded by a capsule that has nerves both inside the capsule of the joint and outside which can cause pain.
What is the purpose of facet joint injections?
The steroid injected reduces the inflammation in the joint space. This can reduce pain, and other symptoms caused by inflammation such as nerve irritation.
How long does the injection take and will it hurt?
The actual injection takes only a few minutes. The procedure is done under local anesthesia to minimize discomfort.
How is the injection performed?
It is done with the patient lying on the stomach with fluoroscopic (x-ray) guidance. The skin is cleansed with anti-septic solution and then the injection is carried out. After the injection, you are taken to a recovery area to rest.
What are the risks and complications?
It is generally a safe procedure. But as with any interventional procedure, it carries a small risk of potential complications such as bleeding, infection, leaking spinal fluid & injury to blood vessels or nerves in and around the spine.
What should I expect after the injection?
Immediately after the injection, you may feel that your pain may be gone or quite less. This is due to the local anesthetic injected. This will last for a few hours. The steroid medication will take about 3-5 days to work and cause overall anti-inflammatory effect and pain reduction. The steroid will offer relief for several months duration.
What is Radiofrequency Lesioning or ablation?
Radiofrequency Lesioning is a procedure using electrical impulses to interrupt conduction on a semi-permanent basis. The radio frequency waves are used to produce heat on specifically identified nerves. The nerves to be ablated are identified through injections of local anesthesia prior to the procedure during medial branch blocks. By generating heat around the nerve, its ability to transmit pain signals to the brain is destroyed, thus ablating the nerve.
Who needs this procedure?
Patients who have responded to previous facet nerve blocks or medial branch blocks with greater than 80% relief in symptoms can benefit from this procedure. The blocks are used in effort to identify the source of the pain. The RFA procedure helps to permanently reduce the pain in the back or neck. The procedure takes about 40-60 minutes. Pain relief can last anywhere from six months to two years.
How is the procedure performed?
The patient is given mild anesthesia to minimize discomfort. After numbing the skin with generous amount of local anesthetic, a special needle is advanced near the pain causing nerve under X- ray guidance. The pain causing nerve is tested to confirm the correct placement of the needle before the nerve is numbed with lidocaine solution followed by the Radiofrequency Ablation.
What are the risks and complications?
It is generally a safe procedure. But as with any interventional procedure, it carries a small risk of potential complications such as bleeding, infection, leaking spinal fluid & injury to blood vessels or nerves in and around the spine.
What should I expect after the injection?
Immediately after the injection, you may feel that your pain may be gone or quite less. This is due to the local anesthetic injected. This will last for a few hours. The heated nerve may cause an initial sensation of burning or numbness as it is dying that may last 3 weeks. The neck and lower back pain should be reduced from 6 months up to 2 years duration. The procedure may be repeated as the nerves grow back and the pain returns around the facet joint.
What is sacro-iliac joint injection?
A sacro-iliac joint injection is an injection of an anesthetic with a long lasting steroid (“cortisone”) in the sacro-iliac joints. Sacro iliac joints are located in the back where the lumbosacral spine joins the pelvis. They are paired (right and left) and are surrounded by a joint capsule like the facet joints.
What is the purpose of sacro-iliac joint injections?
The steroid injected reduces the inflammation in the joint space. The injection can reduce pain and inflammation from a hypermobile joints.
How long does the injection take and will it hurt?
The actual injection takes only a few minutes. The procedure is done under local anesthesia to minimize discomfort.
How is the injection performed?
It is done with the patient lying on the stomach with fluoroscopic (x-ray) guidance. The skin is cleansed with anti-septic solution and then the injection is carried out. After the injection, you are taken to a recovery area to rest.
What are the risks and complications?
It is generally a safe procedure. But as with any interventional procedure, it carries a small risk of potential complications such as bleeding and infection.
What should I expect after the injection?
Immediately after the injection, you may feel that your pain may be gone or quite less. This is due to the local anesthetic injected. This will last for a few hours. The steroid medication will take about 3-5 days to work and cause overall anti-inflammatory effect and pain reduction. The steroid will offer relief for several months duration.
What is Discography?
Discography is a diagnostic procedure, not a treatment. X-ray dye is injected into the spinal discs and then the patient is sent for a CT scan of the spine to evaluate for tears or fissures in the discs. The results of the procedure can be helpful to locate the exact site of pain for both interventional and surgical procedures.
How is discography performed?
The procedure is done under fluoroscopic (x-ray) guidance. The patient is lying on his stomach. The skin over the injection site is cleansed with an antiseptic solution. The patients are usually given a light sedative after which the needles are positioned.
Will I feel during the injection?
When a normal healthy disc is injected with dye, there is a sensation of pressure but not pain. When an abnormal disc is injected, there s a feeling of pain. It is important to try to determine whether the pain is the similar "typical pain" or a different pain. When each disc is injected, you will be asked if it is painful, where you feel the pain, and whether it is the same area as your "usual pain".
How many discs will be injected and how long does it take?
Based on your MRI findings, your doctor will determine which discs will be injected and evaluated. In addition, a normal disc is injected to serve as a reference point. The procedure takes about 45 minutes.
Will the injection hurt?
A small amount of anesthesia will be given to help alleviate discomfort. The procedure involves inserting a needle through the skin and deeper tissues, so there is some discomfort involved. However, your doctor will numb the skin and deeper tissues with local anesthetic using a very thin needle prior to inserting the needle into the disc. Despite this, the procedure is intended to reproduce your "usual pain”.
What are the risk and complications?
It is generally a safe procedure. The most common side effect is temporary discomfort. Sometimes the discogram needle brushes past a nerve root and the nerve root is irritated. This gets better quickly. The other risks are infection, bleeding, and worsening of symptoms. Patients are given antibiotics prior to the procedure and injected within the discs which virtually eliminates all risk for infection.
Will my pain be better after the injection?
No, Discography does not treat your condition. It is a diagnostic test that allows your doctor to plan your treatment.