The goal of pain management is to provide relief of painful symptoms originating from irreversible conditions of the spine in place of oral medications that could have adverse side effects. Interventional pain management involves a series of therapeutic injections to very specific areas of the spine to alleviate pain, restoring your quality of life.
Interventional treatment options for pain management at Azura Vascular Care include:
- Epidural Injections
- Facet Joint Injections
- Kyphoplasty
Epidural Injections
An epidural injection is a fast, simple, safe, and effective non-surgical treatment that involves the injection of a steroid medication into the epidural space of the spine. The epidural space is the portion of the spine where inflamed nerves are located. The goal of this procedure is to reduce inflammation, thereby relieving pain. Epidural injections are a minimally invasive technique used to relieve a variety of painful conditions anywhere in the spine.
The most common technique used by interventional pain management specialists to administer an epidural injection is with fluoroscopy, usually with the patient lying face down. A fluoroscope is a special camera that uses X-rays which allows the doctor to see in real time the exact placement of the needle and to verify its correct position. The injection is performed under local anesthesia and, on occasion, with intravenous sedation. Patients are not deeply sedated or completely asleep for this procedure because it is unnecessary and unsafe to do so. The procedure usually takes no more than five to ten minutes, followed by a brief 15-20 minute recovery before being discharged to your home.
If you suffer from chronic neck and back pain, you may be a good candidate for epidural injections. The most common diagnoses treated include herniated or bulging discs, spinal stenosis, and recurrent pain following spine surgery.
What are the risks associated with Epidural Injections?
Fortunately, with epidural steroid injections serious complications are quite rare. Minor side effects from the injected medications are not uncommon and can include:
- Nausea
- Itching
- Rash
- Facial flushing
- Sweating
- Steroid side effects
Some patients notice a mild increase or worsening of their pain for the first day or two after injection.
Facet Joint Injections
Facet joints are the joints in your spine that make your back flexible and enable you to bend and twist. When your facet joints become swollen and painful due to osteoarthritis, you may need an injection into your spine to alleviate the pain and restore your quality of life.
Facet joint injections are performed using a local anesthetic and possibly a steroid to reduce inflammation. Fluoroscopy is used by your physician to make sure the needle is in the joint before injecting any medication. A fluoroscope is a special camera that uses X-rays which allows the doctor to see in real time the exact placement of the needle and to verify its correct position. Your facet joints are located fairly deep in the upper buttocks and are covered by thick muscle so on some patients it may be difficult to place a needle into the facet joint without some type of X-ray guidance.
Once the needle is in the correct place, an anesthetic is injected to numb your joint. If the pain subsides, your doctor can be relatively sure that the source of your back pain is the facet joint that was injected and not somewhere else in your spine. The effect of the medication is usually temporary, but may provide relief for several months. The procedure usually takes 10-20 minutes, followed by a brief recovery before being discharged to your home.
You may be a good candidate for facet joint injections if you have arthritic or thickened facet joints seen on X-rays that also have chronic back or neck pain with movement. Some patients have facet joints injured due to a whiplash injury or other traumatic injuries to the neck or back. Most patients receiving facet injections have already tried other, more conservative, treatments including anti-inflammatory medication, chiropractic or physical therapy.
What are the risks associated with Facet Joint Injections?
As with all invasive medical procedures, there are potential risks and complications associated with facet joint injections. However, in general, the risk is low and complications are rare.
Potential risks and/or complications that may occur from a facet joint injection include:
- Allergic reaction to the X-ray contrast or steroid
- Bleeding
- Minor infection
- Discomfort at the injection site or worsening of pain symptoms
- Nerve or spinal cord damage
Kyphoplasty
Kyphoplasty is a minimally invasive procedure that may help you recover faster from vertebral compression fractures and avoid the need for an open surgical procedure. This procedure is performed to strengthen your fractured vertebra with an injection of a cement-like material. The goals of kyphoplasty are to treat painful compression fractures, prevent further collapse of your vertebral fracture and to restore normal spinal alignment.
Kyphoplasty involves placing two specialized tubes directly into your fractured vertebra. This is performed using image guidance via flouroscopy (a type of x-ray) to allow precise placement of the tubes. Small specialized balloons are inserted into the collapsed vertebra through each tube. The balloons are inflated with a liquid under x-ray guidance to re-establish the original height of the collapsed vertebra and when deflated, they leave an empty cavity within your bone that has now been expanded. Bone cement is inserted into your vertebra through both tubes under x-ray guidance to assure the cement is not leaking out of the vertebra. The procedure generally takes about forty-five minutes for each bone that is treated and is usually performed using a local anesthetic.
If you have significant back pain caused by a broken bone in your back, and the pain is not relieved after one to two weeks of bed rest and pain medicine, you may be a candidate for kyphoplasty. Kyphoplasty does not help with chronic back pain or herniated discs.
What are the risks associated with Kyphoplasty?
The risks are relatively low, but the following side effects may occur:
- Bleeding
- Infection
- Allergic reactions to medicines
- Minor risks associated with anesthesia
- Cement leaks into surrounding area leading to other treatments to remove the cement
How does Kyphoplasty differ from Vertebroplasty?
Kyphoplasty and Vertebroplasty are common treatments for vertebral compression fractures. Both minimally invasive procedures offer potential benefits and are effective in reducing pain.
With Kyphoplasty, an inflatable balloon is used to create a cavity for the cement with the additional potential goals of restoring height and reducing kyphosis.
Vertebroplasty is a percutaneous injection of bone cement into the vertebral body with the goals of pain alleviation and preventing further loss of vertebral body height.
How we can help you with Interventional Pain Management
Many of our physicians at Azura Vascular Care offer minimally invasive procedures including epidural injections, facet joint injections, or kyphoplasty to treat specific spinal pain. The clinical staff at our outpatient vascular centers combines medical expertise and compassion to guide you through your treatment journey, providing symptomatic relief and restoring your quality of life.
At Azura, we work every day to deliver far more than our patients expect, bringing our full range of medical capabilities and service excellence to every patient, every visit at each of our centers nationwide.
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