Lumbar Epidural Steroid Injection
Cervical Epidural Steroid Injection
Caudal Epidural Steroid Injection
Selective Nerve Root/Epidural Injection
Intradiscal Electrothermal Therapy(IDET)
Pain Medicine
Sendero Imaging offers the following services.
FEATURING…
- C-Arm Fluoroscopy
- Six Operating/Treatment Rooms
- Eight-Bed Recovery Room
- On-Site Pharmacy
- ACLS Staff
- IV Conscious Sedation
SPECIAL SERVICES FOR PAIN MEDICINE INCLUDE…
- Skilled Physicians and Nurses Specializing in the Treatment of Pain
- Pre-and Post-Procedure Calls by Nursing Staff
- Pre-Procedure Insurance Verification
- Family Support and Discharge Planning
- Privacy and Confidentiality
- Same-Day Appointments
- Financial Arrangements
- Complimentary City-Wide Transportation
- Convenient Free Parking
LUMBAR EPIDURAL STEROID INJECTION
The purpose of the steroid injection is to decrease swelling of the nerve roots thereby decreasing pain transmission in your back. This injection should provide some pain relief as well as improvement in your symptoms. The duration of pain relief from the local anesthetic can vary from one to eight hours, days or even longer. It may take up to 72 hours for the steroid to take full effect. Back and leg soreness may increase for 24-48 hours after the injection. Depending on your response, your physician may recommend additional injections or other treatments.
CERVICAL EPIDURAL STEROID INJECTION
The purpose of the steroid injection is to decrease swelling of the nerve roots thereby decreasing pain transmission in your neck. This injection should provide some pain relief as well as improvement in your symptoms. The duration of pain relief from the local anesthetic can vary from one to eight hours, days or even longer. It may take up to 72 hours for the steroid to take full effect. Neck and arm soreness may increase for 24-48 hours after the injection. Depending on your response, your physician may recommend additional injections or other treatments.
CAUDAL EPIDURAL STEROID INJECTION
The purpose of the steroid injection is to decrease swelling of the nerve roots thereby decreasing pain transmission in your lower back. This injection should provide some pain relief as well as improvement in your symptoms. The duration of pain relief from the local anesthetic can vary from eight hours days or even longer. It may take up to 72 hours for the steroid to take full effect. Leg or buttock soreness may increase for 24-48 hours after the injection. Depending on your response, your physician may recommend additional injections or other treatments.
TRIGGER POINT INJECTION
The purpose of the injection is to decrease swelling of the muscle decreasing pain transmission. This injection should provide some pain relief as well as improvement in your symptoms. The duration of pain relief from the local anesthetic can vary from one to eight hours, days or even longer. It may take up to 72 hours for the steroid to take full effect. Injection sight soreness may increase for 24-48 hours after the injection. Depending on your response, your physician may recommend additional injections or other treatments.
FACET JOINT INJECTIONS
One source of chronic pain in the spine is the facet joints. Spinal facet joints are true "synovial joints" (like the shoulder and the knee). These joints have a joint capsule lubricated with fluid and richly innervated by a network of pain-sensitive nerve fibers. Facet joints are numerous, with two at each spinal level. These joints are prone to injury, and are one of the major structures damaged in whiplash injuries. They can be associated with disc disease at any one particular spinal level, or be painful by themselves.
SELECTIVE NERVE ROOT/EPIDURAL INJECTION
This technique has largely replaced the old "epidural steroid injections" which were performed without fluoroscopic guidance. Studies have shown that the "blind" injections made it difficult to predict if the medication ever actually reached the intended target. In fact, in these studies, a large percentage of the medication was never even deposited into the epidural space.
This procedure and almost all other pain procedures are performed, under fluoroscopic guidance to ensure precise placement of the needle. Selective Nerve Root /Epidural injections are utilized in the following way:
- To precisely target specific painful nerves and/ or discs
- To help diagnose which nerves or discs may be involved
- To treat specific disc herniations
- To treat spinal stenosis
- To treat irritated nerves after surgery
NERVE ROOT BLOCK
The purpose of the block is to decrease swelling of the nerve roots thereby decreasing pain transmission. This block should provide some pain relief as well as improvement in your symptoms. The duration of pain relief from the local anesthetic can very from one to eight hours, days or even longer. It may take up to 72 hours for the steroid to take full effect. Back and leg or arm soreness may increase for 24-48 hours after the injection. Depending on your response, your physician may recommend additional blocks or other treatments.
SACROILAC JOINT BLOCK
The purpose of the block is to decrease swelling of the nerves and joint thereby decreasing pain transmission. This block should provide some pain relief as well as improvement in your symptoms. The duration of pain relief from the local anesthetic can very from one to eight hours, days or even longer. It may take up to 72 hours for the steroid to take full effect. Back, buttock, hip or leg soreness may increase for 24-48 hours after the injection. Depending on your response, your physician may recommend additional blocks or other treatments.
DISCOGRAPHY
Discography is a study that is used to answer two questions:
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Which disc (or discs) is painful?
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What is the specific anatomy of the disc?
As a diagnostic procedure, its usefulness is almost unmatched. It allows your doctors to correlate your pain to abnormal anatomy. No other diagnostic test does this reliably (even MRI). This has been shown by many studies in the medical literature. Therefore, in order to diagnose your pain and plan future therapy, your physician may request a discogram. This procedure is performed under fluoroscopy so that precise needle placement can be assured. You will have an intravenous (I.V.) catheter placed so that medication can be given to you before and during the procedure. You will be awake during the procedure so that you can communicate with us regarding your pain. Generous local anesthetic is injected into the back muscles to make needle placement as comfortable as possible. When correct placement is assured, the discs are injected with a solution containing X-ray dye.
LUMBAR OR CERVICAL DISCOGRAM
Discography involves the injection of a water soluble imaging material directly into the nucleus pulposus of the disc which is done under x-ray control. Information is recorded about the amount of dye accepted, the pressure necessary to inject the material, the configuration of the opaque material, and the reproduction of the patient’s pain. This is a special study of the disc with contrast injected into the disc. If you are allergic to iodine or seafood, please advise the nurse and physician. As a routine, discography is completed with a CT scan to follow. This study will give information about the disc that cannot be obtained more beneficially by any other study. Some noted side effects are increased back or neck pain for a few days because of irritation by the dye. There are two diagnostic objectives: (1) to radiographically evaluate the extent of disc damage on discogram (sometimes with the addition of CT); and (2) to characterize the pain response (if any) on the disc injection to see if it compares with the typical pain of the patient.
INTRADISCAL ELECTROTHERMAL THERAPY (IDET)
This is an exciting new treatment for the back pain associated with torn, cracked, or disrupted discs. The condition is diagnosed by discography with CT Scan. Actually, studies show that the majority of persistent back pain is caused by these abnormalities within the disc itself. This treatment has been done since 1997 and more than 185,000 procedures have been performed without significant complications.
INTERVENTIONAL TREATMENTS
Just as epidural injections are used to treat disc-related pain within the spinal column, facet joint injections are sometimes used to diagnose and treat pain emanating from the facet joints. For this intervention, the medial branch nerve is first blocked with local anesthetic in order to confirm that the joint is the true source for pain. If the nerve block reduces pain for the duration of the local anesthetic, then the nerve can be coagulated with radiofrequency heat current, rendering the joint anesthetic and reducing pain long term. The procedure is relatively painless, requires no incision, and is performed as an outpatient. Studies have shown that it is the most effective treatment for facet joint pain after whiplash injury.
INTERVENTIONAL PAIN MEDICINE AND SPINAL DIAGNOSTICS
This specialty has grown rapidly in recent years and has lead to an increased sophistication in the diagnosis and treatment of pain. Many of the procedures performed in this area are used to both treat the pain and help in the diagnosis of the actual cause of the pain. They include the following:
- Selective Nerve Root Block/Epidural Injections
- Facet Injection
- Facet Rhizotomy
- Sympathetic Blockade
- Kyphoplasty/Vertbroplasty
- Spinal Cord Stimulation
- Discography
- Intradiscal Electrothermal Therapy (IDET)
Once the diagnosis is clear, we are able to render any number of state-of-the-art treatments. These may consist of physical therapy/rehabilitation, injections, minimally invasive procedures, and surgery.
At times, as you all know, there may be nothing else to do to "fix" the problem and people are left with a chronic pain condition. That doesn’t mean that there is no hope. Our pain specialist is experienced in identifying chronic pain and developing a treatment plan with you. This plan may consist of a combination of rehabilitation, counseling, medication, and other components of a chronic pain prescription.
SPINAL CORD STIMULATION
This is a procedure that is indicated for the following conditions:
- Continued back and/or leg pain after surgery
- Intractable back pain
- Nerve pain due to injury
- Neck/Arm Pain
- Conditions such as Arachnoiditis and Reflex Sympathetic Dystrophy
The theory is that electrical stimulation from a small electrode placed over the spinal cord will "short circuit" the pain impulses as they travel from the painful area to the brain.
The procedure is done in two steps (or phases). The first phase is the TRIAL phase. The small electrode is placed under fluoroscopy (Xray) guidance in order to ensure exact placement. This is done under local anesthetic with the patient awake. No incisions are made and there is usually very little pain involved. When the temporary electrode is in place, it is turned on and the patient lets us know if the area of their usual pain is covered by the electrode’s "tingle". If the electrode is in the right place, it is taped to the skin and the procedure is over. The patient will keep the temporary electrode in place for about a week and carry on their usual activities (with some exceptions). They will control the stimulation with a small device the size of a transistor radio. During this TRIAL phase, they will evaluate how much the stimulation decreases their pain. If the benefits are significant, they may elect to enter phase 2.
Phase 2 is the Implantation phase. This occurs about 3-4 weeks after phase 1. It involves actually implanting a spinal cord stimulator into the patient. The patient is brought into the hospital and taken to the operating room. Under local anesthesia (with some sedation), a small incision is made in the mid-back. The electrode is placed and then implanted under the skin. At the same time, the battery pack (about the size of a pacemaker) is implanted into the upper buttock. The system is now completely under the skin. A hand-held device periodically placed over the battery pack can control stimulation.
The patient may be observed over night or allowed to go home the same day. The amount of discomfort is usually minimal.
You are responsible for three things:
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Please DO NOT eat or drink anything four hours before your block. If you do eat or drink, we will need to reschedule your injections.
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If you have any questions regarding taking your prescribed medications the morning of your injection, please ask your nurse or your physician. Your physician will obtain a copy of your medical records as well as x-ray reports prior to your arrival. If you have x-rays of your neck or back, please bring them with you.
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Please have someone available to drive you home after your injection. Reasons for this include:
- You may receive some medicine to help you relax before your injection. Some people are sleepy afterwards. This is optional and will be discussed with you at the time of treatment.
- Sometimes people experience soreness or transient weakness in their legs or arms, which may affect response time in driving (this is temporary).
- Sometimes people experience soreness in their back and are uncomfortable.
Please be prepared to hold very still when asked to do so by the physician or the nurse.
You can expect the following:
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You will need to sign a consent form that explains the procedure with its potential risks and benefits. Some people experience almost immediate relief from pain or discomfort. On the other hand, some people have experienced dizziness, weakness, numbness, backache or headache.
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The nurse or physician will start an IV in your arm and may give you relaxing medication.
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You will be connected to a heart monitor, automatic blood pressure cuff, and a pulse oximeter finger probe (this measures the oxygen in your blood). These monitors should not cause you any discomfort. These monitors help your staff to monitor your condition at all times.
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After you are connected to the monitors, have signed the consent, and have your IV; you may receive some medication to help you relax.
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The injection itself takes only a few minutes.
- The physician will clean your back and then position you either lying on your stomach, sitting up or lying on your side with your knees bent and tucked up under your chin.
- The physician will use and x-ray machine during this injection. If you are pregnant, you need to inform your nurse or physician. The amount of radiation you are exposed to with this machine is minimal. A small amount of radio opaque dye will be injected to assure the medication is placed in the proper location. If you are allergic to iodine or seafood, please advise the nurse or physician.
- When you are positioned, your physician will insert a small needle into the epidural space of your spine and inject a steroid medication with or without local anesthetics. You may feel some slight pressure in your back at this time.
- If local anesthetic is injected, it is possible that you may have some mild weakness and numbness of your legs for a short period afterwards.
We will continue to monitor you for at least thirty minutes after your injection.
After the monitoring period is completed, we will remove your IV. You should eat or drink something within an hour or two after the injection.
If your pain is relieved by this procedure, a series of injections may be desired in an attempt to break the pain cycle. You will need to follow these same instructions before each injection.
Remember, please call (210) 614-8899 if you have any questions.
