Bone Scan
A bone scan is a highly sensitive test that
shows areas of increased activity in bone that may indicate
fractures, tumors, infection, osteomyelitis, or osteoarthritis.
Because the bone scan measures activity, it can detect problems
before they will show structural changes on x-rays. Recent
fractures will show increased activity whereas old ones will
not. Increased activity indicates an abnormality that may
need to be followed by other imaging (X-ray, CT and/or MRI)
to determine the exact nature of the problem.
Prior to the bone scan, you may eat and drink
normally up to the time of the test. Prior to the test you
will be asked questions about your history of broken bones,
arthritis, or cancer.
The bone scan involves two steps:
• A small amount of radioactive
tracer (less than that of an x-ray) is injected, usually
in the arm. The tracer is given about 3 hours to circulate
throughout the body. During this time, you will be encouraged
to drink as much fluid as you can. The extra hydration will
increase the tracer uptake in bone throughout your body.
• After about 3 hours, you will
be placed on a table and a gamma camera that resembles a
regular x-ray scanner, will sweep over your body. This may
take about 30 minutes. The computer will record an image
of the concentration of the tracer throughout your body.
The test itself is not painful. However,
the actual scan involves lying flat on a fairly hard table
for 30 minutes. Please advise your doctor or the technician
prior to injection of the tracer if that will be a problem
for you.
Before the bone scan, you should let your
doctor know of any allergies, if you are pregnant, or if
you are nursing.
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Botulinum Toxin Type A (BOTOX) Injections
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What is Botulinum Toxin Type A?
Botulinum toxin is a chemical from the organism
that causes botulism. This sounds alarming but, in actuality,
we would need to use 3,000 times as much as we do in order to
give you botulism.
Botulinum toxin forces muscles to relax by preventing
the release of acetylcholine from nerve endings. It is this acetylcholine
which activates the muscle causing it to contract or tighten
up. Without acetylcholine, the muscle cannot stay tight. Botulinum
toxin injections are typically performed for muscle knots or "trigger
points."
The botulinum toxin does not actually begin to
work for one to two weeks, but many patients feel better in a
few days just from the needle breaking up the muscle knot.
Trigger points are thought to be very tight bands
in muscles. When other measures, such as trigger point injections,
fail to produce relaxation in the muscle knot, we consider botulinum
toxin injections.
When is it time to do botulinum toxin injection?
Naturally, before botulinum toxin injections
are tried, we always try to find what is causing the muscle knots.
This can be anything from inflammation inside the spinal column
to a disc problem, or serious illness that might cause muscle
knots or trigger points. This needs to be investigated and ruled
out before botulinum trigger point injections are performed.
Very frequently after various traumas or injuries,
people develop painful muscle knots, often in their shoulders,
neck, or under their scapulae. Trigger points can also develop
in the low back, buttocks, and thighs. Trigger points can occur
in the upper arms and forearms.
When a patient gets good relief from their muscle
knot pain with a simple trigger point injection of numbing medicine,
but the pain returns, that is felt to be an indication for botulinum
toxin injection.
How is the injection performed?
Botulinum toxin injections are usually done through
a special needle that can inject the medicine, but also serves
as a microphone to listen to the electrical activity of the muscle
knot. The purpose of using this electromyography (EMG) is to
try to inject the bulk of the botulinum toxin into the tightest
part of the muscle knot and to avoid injecting the botulinum
toxin into areas where it will not be useful. The EMG needle
guidance is sometimes used to avoid injection into structures
such as blood vessels or the lungs.
What are the risks of botulinum toxin injection?
Happily, the risks of botulinum toxin are few.
Typically, there are no real side effects from the botulinum
toxin. It tends to act locally where it is injected and usually
does not cause body wide side effects. One effect of the botulinum
toxin is that it can produce weakness in the muscle into which
it is injected. This is usually not a problem. If used frequently,
a patient can develop antibodies to the botulinum toxin and it
will begin to lose its effectiveness. We also warn patients about
bleeding, infection, and drug reaction, but these problems are
extremely rare.
How long does a botulinum toxin injection last?
Botulinum toxin injections are relatively new
and all of the studies to give precise answers to these questions
have not been performed. The effect of botulinum toxin on the
acetylcholine produced by the nerve ending typically wears off
in three to four months. Interestingly, however, in many patients
we have seen the effect of the injections last considerably longer;
however, we do not have adequate information to predict how long
the injection will last if it is effective.
Trigger points, or muscle knots, treated with
botulinum toxin injection may return and repeat injection may
be required. It would probably not be worth repeating the injection
if it does not last at least three to four months.
Is the injection painful?
Yes and no. Botulinum toxin injections usually
are not as painful as injections with numbing medicine. The muscle
knot, however, can be very sensitive. For patients who have benefited
from botulinum toxin injection, they typically report the pain
of injection is worth the relief.
What will happen during and after the procedure?
You will probably be put into a gown and seated
or positioned lying down. The trigger point areas to be injected
are marked with a pen and then carefully cleaned. At that point,
a cold spray is used to numb the skin, and the botulinum toxin
mixed with normal saline, with or without numbing medicine, is
injected. The whole process takes a few minutes. The injection
site is bandaged and the patient is instructed to take it easy
for the rest of the day, and to place ice or a cold pack on the
injected areas for a few minutes several times a day for a day
or two.
A return office visit appointment will be made
in four to eight weeks for follow up. The patient is encouraged
to call at any time if they have any problems.
Summary:
Botulinum toxin injections have proven to be
a valuable tool in the battle against pain from painful muscle
knots or trigger points. Typically, botulinum toxin injections
are not performed unless the patient has already responded favorably,
but only temporarily, to regular trigger point injections with
numbing medicine. Before botulinum toxin injections are performed,
every effort should be made to understand the cause of the muscle
knots or trigger points, and any serious illness should be dealt
with first. The main side effects of botulinum toxin are weakness
and the development of antibodies if used excessively.
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CAUDAL EPIDURAL INJECTION
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What is the epidural space?
The membrane that covers the spinal cord and
nerve roots in your spine is called the dura membrane. The space
surrounding the dura is the epidural space. Nerves travel through
the epidural space to your back and into your legs. Inflammation
of these nerve roots may cause pain in these regions due to irritation
from a damaged disc or from contact in some way with the bony
structure of the spine.
What is an epidural and why is it helpful?
An epidural injection places anti-inflammatory
medicine into the epidural space to decrease inflammation of
the nerve roots, hopefully reducing the pain in your back or
legs. The epidural injection may help the injury to heal by reducing
inflammation. It may provide permanent relief or provide a period
of pain relief for several months while the injury or cause of
your pain is healing.
What will happen during the procedure?
An IV will be started so that relaxation medication
can be given. You will be placed lying on your stomach on the
x-ray table and positioned in such a way that your doctor can
best visualize your back using x-ray guidance. The skin on your
back will be scrubbed using two types of sterile scrub (soap).
Next, the physician will numb a small area of skin on your low
back with numbing medicine. This medicine stings for several
seconds. After the numbing medicine has been given time to be
effective, your doctor will direct a small needle using x-ray
guidance into the tiny bony opening (sacral hiatus) just above
the crease in your buttocks. A small amount of contrast (dye)
is then injected to insure proper needle position in the epidural
space. If the medicine does not travel high enough to reach the
affected area, a small catheter will be placed into the epidural
space and advance up to the area of abnormality. Then, a mixture
of numbing medicine (anesthetic) and anti-inflammatory (cortisone/steroid)
will be injected.
What will happen to me after the procedure?
You will go back to the recovery area where you
will be monitored for 30 - 60 minutes. You will then record the
relief you experience during the next week on a post injection
evaluation sheet ("pain diary"). This will be given
to you when you are discharged to go home. You will also be given
a follow-up appointment for a repeat block if indicated. These
injections are usually done in a series of three (3), about two
(2) weeks apart. PLEASE mail this completed pain diary to NeuroCare
Network and our office will contact you if it is necessary to
change your next appointment.
You will not be able to drive the day of your
procedure. Your legs may feel weak or numb for a few hours.
General Pre/Post Instructions
You should eat a light meal within a few hours
before the procedure. If you are an insulin dependent diabetic,
you must not change your normal eating pattern prior to the procedure.
You may take your routine medications (i.e. high blood pressure
and diabetic medications). You should not take pain medications
or anti-inflammatory medications the day of your procedure. You
need to be hurting prior to this procedure. You may not take
medications that may give pain relief or lessen your usual pain.
These medicines can be restarted after the procedure if they
are needed. If you are on Coumadin (blood thinners) or Glucophage
(a diabetic medicine) you must notify the office so the timing
of these medications can be explained.
These procedures are performed either at one
of the hospitals or at the NeuroCare Network facility. You are
generally asked to be at the appropriate location one hour before
the procedure and can expect to be at NeuroCare or at one of
the hospitals approximately 2-3 hours.
A driver must accompany you and be responsible
for getting you home. No driving is allowed the day of the procedure.
You may return to your normal activities the day after the procedure,
including returning to work.
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CERVICAL EPIDURAL INJECTION
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What is the epidural space?
The membrane that covers the spinal cord and
nerve roots in your neck is called the dura membrane. The space
surrounding the dura is epidural space in your neck. Inflammation
of the nerve roots in the neck may cause pain in the arms and
shoulders due to irritation from a damaged disc or from contact
with the bony structure of the spine in some way.
What is an epidural and why is it helpful?
An epidural injection places anti-inflammatory
medicine into the epidural space to decrease inflammation of
the nerve roots, hopefully reducing the pain in your neck, shoulders,
and arms. The epidural injection may help the injury to heal
by reducing inflammation. It may provide permanent relief or
provide a period of pain relief for several months while the
injury/cause of your pain is healing.
What will happen to me during the procedure?
An IV will be started so that relaxation medication
can be given. Depending on your physician's preference, you will
be placed in a prone position or sitting in a chair, positioned
in such a way that your doctor can best visualize your neck using
x-ray guidance. The skin on the back of your neck will be scrubbed
using two types of sterile scrub (soap). Next, the physician
may numb a small area of skin with numbing medicine. This medicine
stings for several seconds. After the numbing medicine has been
given time to be effective, your doctor will direct a small needle
using x-ray guidance into the epidural space. A small amount
of contrast (dye) is then injected to insure proper needle position
in the epidural space. Then, a small mixture of numbing medicine
(anesthetic) and anti-inflammatory (cortisone/steroid) will be
injected.
What will happen after the procedure?
You will go back to the recovery area where you
will be monitored for 30 - 60 minutes. You will then record the
relief you experience during the next week on a post injection
evaluation sheet ("pain diary"). This will be given
to you when you are released to go home. You will also be given
a follow-up appointment for a repeat block if indicated. These
injections are usually done in a series of three (3), about two
(2) weeks apart. PLEASE return this completed pain diary to NeuroCare
Network and our office will contact you if it is necessary to
change your next appointment.
You will not be able to drive the day of your
procedure. Your arm may feel weak or numb for a few hours.
General Pre/Post Instructions
You should eat a light meal within a few hours
before the procedure. If you are an insulin dependent diabetic,
do not change your normal eating pattern prior to the procedure.
Please take your routine medications (i.e. high blood pressure
and diabetic medications). If you are on Coumadin, Heparin, Plavix,
or any other blood thinners (including aspirin), or the diabetic
medication Glucophage, you must notify the office so the timing
of these medications can be explained.
You will either be at one of the hospitals or
at the NeuroCare Network facility approximately 2 - 3 hours for
your procedure. You will need to bring a driver with you.
You may return to your normal activities the
day after the procedure, including returning to work.
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Cervical Facet Joint Injection
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What are cervical facet joints and why are facet
joint injections helpful?
Cervical facet joints are small joints about
the size of the thumb nail located in pairs on the back of the
neck. They provide stability and guide motion in the neck. If
the joints become painful they may cause pain in the head, neck,
shoulders, down between the shoulder blades or in the arms.
A facet joint injection serves several purposes.
First, by placing numbing medicine into the joint, the amount
of immediate pain relief experienced will help confirm or deny
the joint as a source of pain. Additionally, the temporary relief
of the numbing medicine may better allow a chiropractor or physical
therapist to treat that joint. Also, time release cortisone (steroid)
will help to reduce any inflammation that may exist within the
joint.
What happens during the procedure?
An IV will be started so that relaxation medication
can be given. You are placed on the x-ray table and positioned
in such a way that the physician can best visualize these joints
in the neck using x-ray guidance. The skin on the back and side
of the neck is scrubbed using two types of sterile scrub (soap).
Next, the physician may numb a small area of skin with numbing
medicine. This medicine stings for several seconds. After the
numbing medicine has been given time to be effective, the physician
directs a very small needle, using x-ray guidance into the joint.
A small amount of contrast (dye) is injected to insure proper
needle position inside the joint space. Then, a small mixture
of numbing medicine (anesthetic) and anti-inflammatory (cortisone/steroid)
is injected. One or several joints may be injected depending
on location of your usual pain.
What happens after the procedure?
Immediately after the procedure, you will move
your neck, shoulders and arms around and try to imitate something
that would normally bring about your usual pain. You are then
asked to report the percentage of pain relief and record the
relief experienced immediately and during the next week on a
post injection evaluation sheet ("pain diary"). This
will be given to you when you are discharged home.
Your arm(s) may feel weak or numb for a few hours.
This is fairly uncommon, but does occasionally happen. You may
be referred to a chiropractor or physical therapist immediately
after the injection(s) while the numbing medicine is still working
for manipulation or massage.
General Pre/Post Instructions
You should eat a light meal within a few hours
before the procedure. If you are an insulin dependent diabetic,
do not change your normal eating pattern prior to the procedure.
Please take your routine medications (i.e. high blood pressure
and diabetic medications). Do not take pain medications
or anti-inflammatory medications the day of your procedure .
You need to be hurting prior to this procedure. Please do not
take medications that may give pain relief or lessen your usual
pain. These medicines can be restarted after the procedure if
they are needed. If you are on Coumadin, Heparin, Plavix, or
other blood thinners (including Aspirin), or the diabetic medication
Glucophage, you must notify the office so the timing of these
medications can be explained.
You will either be at one of the hospitals or
at the NeuroCare Network facility approximately 2 - 3 hours.
You will need to bring a driver with
you . You may return to your normal activities the
day after the procedure, including returning to work.
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Cervical and Lumbar Sympathetic Nerve Block
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What are the sympathetic nerves?
The sympathetic nerves run on the front surface
of the spinal column (not in the spinal canal with the nerves
from your central nervous system). The sympathetic nerves are
part of the autonomic nervous system which basically controls
functions like blood flow to the extremities, sweating, heart
rate, digestion, blood pressure, goose bumps and many other functions.
In other words, the autonomic nervous system
is responsible for controlling things you do not think about
or have direct control over. However, there is a connection between
the central and autonomic nervous systems. Sometimes arm or leg
pain is caused by a malfunction of the autonomic system secondary
to an injury.
What is a sympathetic nerve block and why is
it helpful?
A sympathetic nerve block involves injecting
medicine around the sympathetic nerves in the lumbar or cervical
area. By doing this, the system is temporarily blocked in hopes
of reducing or eliminating your pain. If the initial block is
successful, then additional blocks are generally repeated in
7-10 days and repeated again until your pain diminishes.
What will happen to me during the procedure?
An IV will be started so that relaxation medication
can be given. You will be placed on the x-ray table on your back
for a cervical block and on your side for a lumbar block. The
skin on your neck or the skin on your low back will be scrubbed
using two types of sterile scrub (soap).
Next, the physician will numb a small area of
skin with numbing medicine. This medicine stings for several
seconds. After the numbing medicine has been given time to be
effective, your doctor will direct a very small needle using
x-ray guidance to the area of the sympathetic nerves. A small
amount of contrast (dye) is then injected to insure proper needle
position. Then, a small mixture of numbing medicine (anesthetic),
normal saline and anti-inflammatory (cortisone/steroid) will
be injected.
What will happen after the procedure?
Immediately after the procedure, you will go
back to the recovery area where you will be monitored for 30
- 60 minutes. The recovery room nurse will be checking you periodically
to see if you get good arm/hand or good leg/foot warming.
You will then report the percentage of pain relief
and record the relief you experience during the next week of
a post injection evaluation sheet ("pain diary"). This
will be given to you when you are discharged home. PLEASE mail
this completed "pain diary" to NeuroCare Network.
If a good block is accomplished with good pain
relief, a repeat block will be scheduled for you in 7-10 days.
You will not be able to drive the day of your
procedure. Your arm or leg may feel weak or numb for a few hours.
General Pre/Post Instructions
You should eat a light meal within a few hours
before the procedure. If you are an insulin dependent diabetic,
do not change your normal eating pattern prior to the procedure.
Please take your routine medications (i.e. high blood pressure
and diabetic medications). Do not take pain medications
or anti-inflammatory medications the day of your procedure. You
need to be hurting prior to this procedure. Please do not take
medications that may give pain relief or lessen your usual pain.
These medicines can be restarted after the procedure if they
are needed. If you are on Coumadin, Heparin, Plavix, or any other
blood thinners (including aspirin), or the diabetic medication
Glucophage, you must notify the office so the timing of these
medications can be explained.
You will either be at one of the hospitals or
at the NeuroCare Network facility approximately 2 - 3 hours for
your procedure. You will need to bring a driver with
you.
These procedures are performed either at one
of the hospitals or at the NeuroCare Network facility. You are
generally asked to be at the appropriate location one hour before
the procedure and can expect to be at that facility approximately
2-3 hours. You may return to your normal activities the day after
the procedure, including returning to work.
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CERVICAL, THORACIC, AND LUMBAR DISCOGRAPHY
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What are the discs?
The discs are cushion-like pads that separate
the hard vertebral bones of your spine. A disc may be painful
when it presses on nerves or the spinal cord, herniates, tears
or degenerates and may cause pain in your neck, mid-back, low
back and arms, chest wall, abdomen and legs. Other structures
in your spine may also cause similar pain such as the muscles,
joints, and nerves. Usually, we have first determined that
these other structures are not our sole pain source (through
history and physical examination, review of x-rays, CTs, MRIs,
myelograms, and/or other diagnostic injection procedures such
as facet and sacroiliac joint injections and nerve root blocks)
before performing discography.
What is discography and why is it helpful?
Discography helps confirm or deny the disc(s)
as a source of your pain. This procedure utilizes the placement
of a needle into the discs themselves and injecting contrast
(dye). CT and MRI scans only demonstrate anatomy and cannot
absolutely prove your pain source. In many instances, the discs
may be abnormal on MRI or CT scans but not be a source of pain.
Only discography, can tell if the disc itself is probably a
source of your pain. Therefore, discography is done to identify
painful disc(s) and help the surgeon plan the correct surgery
or avoid surgery that may not be beneficial. Discography is
usually done only if you think your pain is significant enough
for you to consider surgery.
What will happen to me during the procedure?
An IV will be started so that antibiotics (to
prevent infection) and relaxation medication can be given.
The skin will be scrubbed using two types of sterile scrub
(soap). Next, the physician will numb a small area of skin
with numbing medicine. This medicine stings for several seconds.
After the numbing medicine has been given time to be effective,
your doctor will direct a small needle using x-ray guidance
into the disc space. You may feel temporary discomfort as the
needle passes through the muscle or near a nerve root. Your
doctor may perform this at more than one disc level. After
the needles are in their proper locations, a small amount of
contrast (dye) is injected into each disc. Your doctor will
ask you about your experience as the dye is being injected.
It is important that you describe what you feel as accurately
as you can. You need to be alert enough to be aware of and
describe the sensations you experience.
What will happen after the procedure?
Immediately afterwards you will be taken to
Cat Scan where additional pictures will be taken. Then, you
will go back to the recovery area where you will be monitored
for 30 - 60 minutes. You may be given a prescription for pain
medication over the next 2 - 3 days for muscle discomfort that
may exist after this procedure. You will not be able to drive
the day of your procedure.
General Pre/Post Instructions
You should eat a light meal within a few hours
before the procedure. If you are an insulin dependent diabetic,
you must not change your normal eating pattern prior to the
procedure. Please take your routine medications (i.e. high
blood pressure and diabetic medications). If you are on Coumadin,
Heparin, Plavix, or other blood thinners (including aspirin),
or the diabetic medication Glucophage, you must notify the
office so the timing of these medications can be explained.
You will be at NeuroCare or at one of the hospitals
approximately 3 - 4 hours for your procedure. You will
need to bring a driver with you . You may return to
your normal activities 1 - 2 days after the procedure, including
returning to work.
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Cervical, Thoracic, and Lumbosacral Selective
Epidural Injection
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What are the medial branch nerves and why are
medial branch blocks helpful?
Medial branch nerves are the very small nerve
branches that communicate pain caused by the facet joints in
the spine. These nerves do not control any muscles or sensation
in the arms or legs. They are located along a bony groove in
the low back and neck and over a bone in the mid back.
If this procedure has been scheduled, there is
strong evidence to suspect that the facet joints are the source
of your pain. Unfortunately, facet joint injections and other
treatments done earlier have not provided long term relief. Therefore,
benefit may be obtained from having these medial branch nerves
blocked with an anesthetic to see if a more permanent way of
blocking these nerves would provide pain relief long term. Blocking
these medial branch nerves temporarily stops the transmission
of pain signals from the joints to the brain.
What happens during the procedure?
An IV may be started, to provide relaxation medication.
You will be placed on the x-ray table and positioned in such
a way that the physician can best visualize the bony areas where
the medial branch nerves pass, using x-ray guidance. The skin
is scrubbed using two types of sterile scrub (soap). Next, the
physician numbs a small area of skin with numbing medicine. This
medicine stings for several seconds. After the numbing medicine
has been given time to be effective, the physician directs a
very small needle, using x-ray guidance near the specific nerve
being tested. A small amount of contrast (dye) is injected to
insure proper needle position. Then, a small mixture of numbing
medicine (anesthetic) is injected. This usually does not provoke
your usual pain like joint injections may have.
What happens after the procedure?
Immediately after the procedure, you will move
around and to try to imitate something that would normally bring
about your usual pain. You are then asked to report the percentage
of pain relief and record the relief experienced during that
day on a post injection evaluation sheet ("pain diary").
This will be given to you when you are released to go home. PLEASE
mail this completed "pain diary" to NeuroCare Network
and our office will contact you when we receive your diary.
You will not be able to drive the day of your
procedure. The arm(s), chest wall, or leg(s) may feel weak or
numb for a few hours.
General Pre/Post Instructions
You should eat a light meal within a few hours
before the procedure. If you are an insulin dependent diabetic,
you must not change your normal eating pattern prior to the procedure.
You may take your routine medications (i.e. high blood pressure
and diabetic medications). You should not take pain medications
or anti-inflammatory medications the day of your procedure. You
need to be hurting prior to this procedure. You may not take
medications that may give pain relief or lessen your usual pain.
These medicines can be restarted after the procedure if they
are needed. If you are on Coumadin Heparin, Plavix, or any other
blood thinners (including aspirin), or the diabetic medication
Glucophage, or the diabetic medication Glucophage, you must notify
the office so the timing of these medications can be explained.
You will either be at one of the hospitals or
at the NeuroCare Network facility approximately 2 - 3 hours for
your procedure. You will need to bring a driver with
you. You may return to your normal activities the day
after the procedure, including returning to work.
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Cervical, Thoracic, and Lumbosacral Medial Branch
Block
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What are the medial branch nerves and why are
medial branch blocks helpful?
Medial branch nerves are the very small nerve
branches that communicate pain caused by the facet joints in
the spine. These nerves do not control any muscles or sensation
in the arms or legs. They are located along a bony groove in
the low back and neck and over a bone in the mid back.
If this procedure has been scheduled, there is
strong evidence to suspect that the facet joints are the source
of your pain. Unfortunately, facet joint injections and other
treatments done earlier have not provided long term relief. Therefore,
benefit may be obtained from having these medial branch nerves
blocked with an anesthetic to see if a more permanent way of
blocking these nerves would provide pain relief long term. Blocking
these medial branch nerves temporarily stops the transmission
of pain signals from the joints to the brain.
What happens during the procedure?
An IV may be started, to provide relaxation medication.
You will be placed on the x-ray table and positioned in such
a way that the physician can best visualize the bony areas where
the medial branch nerves pass, using x-ray guidance. The skin
is scrubbed using two types of sterile scrub (soap). Next, the
physician numbs a small area of skin with numbing medicine. This
medicine stings for several seconds. After the numbing medicine
has been given time to be effective, the physician directs a
very small needle, using x-ray guidance near the specific nerve
being tested. A small amount of contrast (dye) is injected to
insure proper needle position. Then, a small mixture of numbing
medicine (anesthetic) is injected. This usually does not provoke
your usual pain like joint injections may have.
What happens after the procedure?
Immediately after the procedure, you will move
around and to try to imitate something that would normally bring
about your usual pain. You are then asked to report the percentage
of pain relief and record the relief experienced during that
day on a post injection evaluation sheet ("pain diary").
This will be given to you when you are released to go home. PLEASE
mail this completed "pain diary" to NeuroCare Network
and our office will contact you when we receive your diary.
You will not be able to drive the day of your
procedure. The arm(s), chest wall, or leg(s) may feel weak or
numb for a few hours.
General Pre/Post Instructions
You should eat a light meal within a few hours
before the procedure. If you are an insulin dependent diabetic,
you must not change your normal eating pattern prior to the procedure.
You may take your routine medications (i.e. high blood pressure
and diabetic medications). You should not take pain medications
or anti-inflammatory medications the day of your procedure. You
need to be hurting prior to this procedure. You may not take
medications that may give pain relief or lessen your usual pain.
These medicines can be restarted after the procedure if they
are needed. If you are on Coumadin Heparin, Plavix, or any other
blood thinners (including aspirin), or the diabetic medication
Glucophage, or the diabetic medication Glucophage, you must notify
the office so the timing of these medications can be explained.
You will either be at one of the hospitals
or at the NeuroCare Network facility approximately 2 - 3 hours
for your procedure. You will need to bring a driver with
you. You may return to your normal activities the day
after the procedure, including returning to work.
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CERVICAL, THORACIC, AND LUMBAR SELECTIVE NERVE
ROOT BLOCK
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What is a nerve root and why is a selective
nerve root block helpful?
Nerve roots exit the spinal cord and form nerves
that travel into the arms or legs. These nerves allow movement
of the arms, chest wall, and legs. These nerve roots may become
inflamed and painful due to irritation, for example, from a damaged
disc or a bony spur.
A selective nerve root block provides important
information to physicians but is not a primary treatment. It
serves to prove which nerve is causing pain by placing temporary
numbing medicine over the nerve root of concern. If your usual
pain improves after the injection, that nerve is most likely
causing the pain. If the pain remains unchanged, that nerve is
generally not the reason you may be experiencing pain.
By confirming or denying the exact source of
pain, it provides information allowing for proper treatment,
which may include additional nerve blocks and /or surgery at
a specific level.
What happens during the procedure?
An IV will be started so that relaxation medication
can be given. You will be placed on the x-ray table and positioned
in such a way that the physician can best visualize the bony
openings in the spine where the nerve roots exit the spine using
x-ray guidance. The skin on your back is scrubbed using two types
of sterile scrub (soap). Next, the physician numbs a small area
of skin with numbing medicine. This medicine stings for several
seconds. After the numbing medicine has been given time to be
effective, the physician directs a very small needle, using x-ray
guidance near the specific nerve being tested. A small amount
or contrast (dye) is injected to insure proper needle position.
This may increase your usual pain for about 30 minutes. Then
a small mixture of numbing medicine (anesthetic) and anti-inflammatory
(cortisone/steroid) in injected.
What happens after the procedure?
Immediately after the procedure, you will move
around and try to imitate something that would normally bring
about your usual pain. You are then asked to report the percentage
of pain relief and record the relief experienced during the next
week on a post injection evaluation sheet ("pain diary").
This will be given to you when you are released to go home. PLEASE
mail this completed pain diary to NeuroCare Network.
Your arm(s), chest wall, or leg(s) may feel weak
or numb for a few hours following the procedure. This is fairly
common and happens following a selective nerve root block.
General Pre/Post Instructions
You should eat a light meal within a few hours
before the procedure. If you are an insulin dependent diabetic,
do not change your normal eating pattern prior to the procedure.
Please take your routine medications (i.e. high blood pressure
and diabetic medications). Do not take pain medications or anti-inflammatory
medications the day of your procedure. You need to be hurting
prior to this procedure. Please do not take medications that
may give pain relief or lessen your usual pain. These medicines
can be restarted after the procedure if they are needed. If you
are on Coumadin, Heparin, Plavix, or any other blood thinners
(including aspirin), or the diabetic medication Glucophage, you
must notify this office so the timing of these medications can
be explained.
You will either be at one of the hospitals or
the NeuroCare Network facility approximately 2 - 3 hours for
your procedure. You will need to bring a driver with you. You
may return to your normal activities the day after your procedure,
including returning to work.
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CT Scan (Computed Axial Tomography)
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What is a CT scan (or CAT scan)?
A CT scan is a kind of x-ray that makes pictures
of internal organs, bones, discs, and blood vessels. Images are
stored on a computer and can produce a series of detailed pictures-called "slices"--of
the part of the body that is being studied. Each slice just takes
a few seconds to record. CT scans may be done for any part of
the body, including the brain.
Why is a CT scan ordered for me?
Your doctor uses the CT scan of the neck, thoracic
spine or lumbar spine to rule out or detect spine problems such
as herniated discs, osteoporosis (thinning of the bones), injuries,
tumors, deformities, and problems with the spinal cord. It can
be used to show internal organs: liver, kidneys, heart, lungs,
pancreas, etc. It is particularly good at showing bones and for
looking for fractures.
A CT of the head may be ordered to obtain information
about tumors, bleeding in the head, bulging blood vessels (aneurysm),
blood clots, infection, and to determine the damage caused by
a stroke. There are other things a CT of the head can show, including
problems with eyes and optic nerves, inner ear bones and nerves
leading from the ear to the brain, and to evaluate problems with
the sinus cavities.
A CT scan often shows bony structures better
than with MRI (Magnetic Resonance Imaging).
What happens during the CT?
You will be asked to remove all jewelry. You
will lie on a hard table that will slide into a cylindrical opening
in a large machine called a scanner, which contains the x-ray
tube. While the table slides into the scanner a small distance
at a time, the cylindrical part rotates around you. As this happens
you may hear a clicking sound. Each time the table stops, a new
picture of a different view ("slice") is taken.
You will be able to talk with the x-ray technologist
at all times even though you will be alone in the scanning room.
The technologist will be able to see you at all times.
Any movement that you make will cause the image
to be blurred; therefore, it is very important that you lie completely
still.
How is a CT with contrast (dye) done?
Your doctor may order the CT with "IV contrast" before
surgery to pinpoint nerve or spinal cord pinches, and so that
blood vessels and certain organs can be better imaged. If you
have had a previous spine fusion, sometimes IV contrast may be
ordered to help determine the status of the fusion. (Contrast,
a dye that contains iodine, is either injected through an IV,
taken by mouth or injected into the intrathecal sac, the thin
sac-like covering of the spinal cord, depending on the part of
the body to be studied.) A CT scan may be done before and after
the contrast material is given.
When contrast is injected into the intrathecal
sac, it is essentially a Myelogram. When less dye is used, it
may be refered to as a "low dose CT." If you are having
the CT with intrathecal contrast, the radiologist will usually
give you Valium, taken by mouth for relaxation. On rare occasions,
Valium may be given intravenously.
You will be placed lying on your side on the
x-ray table and positioned in such a way that your doctor can
best visualize your low back using x-ray guidance. The skin on
your back will be scrubbed using two types of sterile scrub (soap).
Next, the physician will numb a small area of skin on your low
back with numbing medicine. This medicine stings for several
seconds. After the numbing medicine has been given time to be
effective, your doctor will direct a small needle using x-ray
guidance into the intrathecal sac. A small amount of contrast
(dye) is then injected. You will be moved to a position that
enables the flow of contrast to reach the area to be imaged.
You will then be transferred to the scanner where pictures will
be taken of the area to be studied.
How long does the CT scan usually take?
The scan may take from 20 to 60 minutes, depending
upon the areas to be scanned.
What will I need to do before and after the
CT?
There are no special instructions before or after
the PLAIN CT , just wear loose, comfortable clothing, such as
a jogging suit or sweat pants, and be at the facility at the
appointed time. You will be able to drive and to go about your
normal life afterward. However, if you are claustrophobic and
require sedation in order to go into the scanner, you will need
a driver in order to go home. Please advise the person who schedules
your appointment if being enclosed in small spaces is a problem
for you.
If you are having a CT WITH INTRATHECAL CONTRAST
there are some special instructions:
• If you are an insulin dependent
diabetic, do not change your normal eating pattern prior to the
procedure.
• Please take your routine medications
(i.e. high blood pressure and diabetic medications).
• If you are on Coumadin (blood thinners)
or Glucophage (a diabetic medicine) you must notify this office
so the timing of these medications can be explained.
• Drink extra fluids the day before
the test, especially caffeinated beverages. This will help increase
fluid in your body and decrease your risk of developing a spinal
headache.
• Do not eat anything after midnight
the night before the test. If you take daily medication, take
it with a sip of water and be sure to tell the nurse or technician
what you have taken and when.
• Bring all your routine medications
and pain medications with you. Do not take any other medications
after you get there without obtaining permission from the nurse.
• Leave valuables at home.
• You will either be at one of the
hospitals or at NeuroCare Network approximately 4 - 5 hours for
your procedure.
• You
will need to bring a driver with you . You may return
to your normal activities two days after the procedure, including
returning to work.
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ELECTRODIAGNOSTICS (EMG / NCS)
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Electrodiagnostics means "using electricity to find out what
is wrong with you." This test has two parts: EMG (Electromyography)
and NCS (Nerve Conduction Studies).
EMG (Electromyography):
Every muscle needs a nerve to stay healthy. If there is trouble
with the nerve, you are going to see problems in the muscle. By
sticking a certain muscle in your arms or legs with a special pin,
we can learn a lot about the condition your nerves. EMG means "an
electrical picture of your muscle."
NCS (Nerve Conduction Studies)
By supplying a little electrical current to your nerves, we can
tell how well your nerves are carrying electricity. This test is
not too uncomfortable and has no side effects. We use this test
to check for pinched nerves at the wrist, elbow, neck, or back.
Your body has two kinds of nerves. Motor nerves carry commands
from your mind to your muscles, and sensory nerves carry feelings
from your fingers and toes to your mind. We usually test both kinds
of nerves. We sometimes test both sides of your body to compare
one side to the other.
Your job during the testing:
Your job during the electrodiagnostic test is to relax. The more
relaxed you are, the more comfortable you will be, and the more
accurate the results will be.
Before the test, gently scrub any dry skin off arms or legs and
hands or feet, whichever is to be studied. Be careful not to overdo
it. Do not use oils or creams on your arms or legs before your
test.
Electrodiagnostics, EMG / NCS, is a very useful test when looking
for nerve damage or muscle problems. If you have any other questions
about Electrodiagnostics, please do not hesitate to ask.
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LUMBAR EPIDURAL INJECTION
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The membrane that covers the spinal cord and
nerve roots in your spine is called the dura membrane. The space
surrounding the dura is the epidural space. Nerves travel through
the epidural space to your back and into your legs. Inflammation
of these nerve roots may cause pain in these regions due to irritation
from a damaged disc or from contact in some way with the bony
structure of the spine.
What is an epidural and why is it helpful?
An epidural injection places anti-inflammatory
medicine into the epidural space to decrease inflammation of
the nerve roots, hopefully reducing the pain in your back or
legs. The epidural injection may help the injury to heal by reducing
inflammation. It may provide permanent relief or provide a period
of pain relief for several months while the injury or cause of
your pain is healing.
What will happen to me during the procedure?
An IV will be started so that relaxation medication
can be given. Depending on your physician's preference, you will
be positioned prone in such a way that your doctor can best visualize
your back using x-ray guidance. The skin on your back will be
scrubbed using two types of sterile scrub (soap). Next, the physician
may numb a small area of skin on your low back with numbing medicine.
This medicine stings for several seconds. After the numbing medicine
has been given time to be effective, your doctor will direct
a small needle using x-ray guidance into the epidural space.
A small amount of contrast (dye) is then injected to insure proper
needle position in the epidural space. Then, a mixture of numbing
medicine (anesthetic) and anti-inflammatory (cortisone/steroid)
will be injected.
What will happen after the procedure?
You will go back to the recovery area where you
will be monitored for 30-60 minutes. You will then record the
relief you experience during the next week on a post injection
evaluation sheet ("pain diary"). This will be given
to you when you are discharged to go home. You will also be given
a follow-up appointment for a repeat block if indicated. These
injections are usually done in a series of three (3), about two
(2) weeks apart. PLEASE mail this completed pain diary to NeuroCare
Network and our office will contact you if it is necessary to
change your next appointment.
You will not be able to drive the day of your
procedure. Your legs may feel weak or numb for a few hours.
General Pre/Post Instructions
You should eat a light meal within a few hours
before the procedure. If you are an insulin dependent diabetic,
do not change your normal eating pattern prior to the procedure.
Please take your routine medications (i.e. high blood pressure
and diabetic medications). If you are on Coumadin, Heparin, Plavix,
or any other blood thinners (including aspirin), or the diabetic
medication Glucophage, you must notify the office so the timing
of these medications can be explained.
You will either be at one of the hospitals
or at the NeuroCare Network facility approximately 2 - 3 hours
for your procedure. You will need to bring a driver with you. You
may return to your normal activities the day after the procedure,
including returning to work.
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LUMBAR FACET JOINT INJECTIONS
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What are lumbar facet joints and why are facet
joint injections helpful?
Lumbar facet joints are small joints a little
larger than the size of your thumb nails located in pairs on
the back of your spine. They provide stability and guide motion
in your low back. If the joints become painful they may cause
pain in your low back, abdomen, buttocks, groin or legs.
A facet joint injection serves several purposes.
First, by placing numbing medicine into the joint, the amount
of immediate pain relief you experience will help confirm or
deny the joint as a source of your pain. Additionally, the temporary
relief of the numbing medicine may better allow a chiropractor
or physical therapist to treat that joint. Also, time release
cortisone (steroid) will help to reduce any inflammation that
you may have within your joint(s).
What will happen to me during the procedure?
You will be placed on the x-ray table in such
a way that your doctor can best visualize these joints in your
back using x-ray guidance. The skin on your back will be scrubbed
using two types of sterile scrub (soap). Next, the physician
may numb a small area of skin with numbing medicine. This medicine
stings for several seconds. After the numbing medicine has been
given time to be effective, your doctor will direct a very small
needle using x-ray guidance into the joint. A small amount of
contrast (dye) is then injected to insure proper needle position
inside the joint space. Then, a small mixture of numbing medicine
(anesthetic) and anti-inflammatory (cortisone/steroid) will be
injected. One or several joints may be injected depending on
the location of your usual pain.
What will happen after the procedure?
Immediately after the procedure, you will get
up and walk and try to imitate something that would normally
bring abut your usual pain. You will then report the percentage
of pain relief and record the relief you experience during the
next week on a post injection evaluation sheet ("pain diary").
This will be given to you when you are discharged to go home.
PLEASE mail this completed "pain diary" to NeuroCare
Network and our office will contact you when we receive your
diary.
You will not be able to drive the day of your
procedure. Your legs may feel weak or numb for a few hours. You
may be referred to a chiropractor or physical therapist immediately
afterwards while the numbing medicine is still working.
General Pre/Post Instructions
You should eat a light meal within a few hours
before the procedure. If you are an insulin dependent diabetic,
do not change your normal eating pattern prior to the procedure.
Please take your routine medications (i.e. high blood pressure
and diabetic medications). Do not take pain medications
or anti-inflammatory medications the day of your procedure .
You need to be hurting prior to this procedure. Please do not
take medications that may give pain relief or lessen your usual
pain. These medicines can be restarted after the procedure if
they are needed.
If you are on Coumadin, Heparin, Plavix, or any
other blood thinners (including aspirin), or the diabetic medication
Glucophage, you must notify this office so the timing of these
medications can be explained.
You will either be at one of the hospitals or
the NeuroCare Network facility approximately 2 - 3 hours for
your procedure. You will need to bring a driver with
you . You may return to your normal activities the day
after your procedure, including returning to work.
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Magnetic Resonance Imaging (MRI)
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What is an MRI
Magnetic Resonance Imaging (MRI) is one of technology's most advanced
diagnostics tools. MRI uses a powerful magnet, low-intensity radio
waves, and computer technology to create detailed images of soft
tissues, muscles, nerves and bones in your body.
How is MRI performed?
The MRI machine is a large cylindrical structure covered in white
plastic. It is similar to a hollow tube that is open at both ends.
You will be asked to lie on a table that slides into the tube.
Your technician will conduct the test from an adjacent room, but
you will be able to speak to the technician through an intercom
system during the entire exam. Should you need assistance, have
any questions, or become uncomfortable please let your technician
know. You should remain as relaxed and as still as possible. You
will hear a knocking sound from the MRI system that ranges from
barely audible to quite noticeable; this is normal. The exam will
last about 1-2 hours. When the test is completed, you can resume
your normal activities.
Preparation:
It is recommended that you wear something soft and comfortable.
You may be asked to change into a gown.
You will be asked to remove any personal objects like jewelry,
belts, and the contents in your pockets. It is best to leave unnecessary
items or valuables at home.
Please bring any medications you routinely take during the day.
Special Concerns:
If you are aware that being in very close places makes you nervous
or anxious (claustrophobic), please notify your physician.
Notify your physician and MRI technician if you have any metal
in your body such as pacemakers, shrapnel, bone plates or pins,
aneurysm clips, metal fragments in your eyes, implanted spinal
cord stimulator, or inner ear implants. The MRI magnet is a very
powerful magnet which has radio waves and the presence of these "implants" may
not allow you to be eligible for the MRI.
If you have had previous back surgery sometimes you will need a small
injection of a contrast agent; this will help differentiate scar
tissue from previous surgeries. It is not like x-ray dye or CT dye,
and does not contain iodine.
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What is a Myelogram?
A myelogram is an invasive diagnostic procedure that allows the
physician to make a definite determination of the type of problem
you may have: spinal cord tumors, bone spurs, or spinal cord compressions
from a herniated disc. A myelogram is basically a spinal tap with
minimal pain followed by an injection of some special dye into
the spinal canal itself. An x-ray (fluoroscope) records the images
formed by the dye. The special dye used in the procedure shows
up white on x-rays whereas regular x-rays will only give you a
picture of bones. This helps the physician and radiologist view
the spinal cord and canal in great detail.
How is a Myelogram Performed?
The myelogram itself is done in the radiology department. You
will be asked to arrive approximately 1-2 hours prior to the test
to complete some paperwork. Any potential complications or side
effects will be explained, and you will be asked to sign a permission
form. You will change into a gown and will usually be given oral
sedation to help you relax. Please be sure to inform the nurse
of any medications taken that day, specifically any pain medications.
The first part of the test consists of the myelogram procedure.
A technician will assist you with getting into position on a table,
usually on your stomach. Your back will be cleansed and a local
anesthetic agent will be injected into the low back site where
the spinal needle will be introduced. The numbing medication will
feel like a “bee” sting. When it is numb, the radiologist will
place a needle into the spinal canal and introduce a contrast material.
This is usually a colorless liquid although it is referred to as
a “dye.” X-rays will then be taken of your spine from various directions.
A cervical (neck) myelogram differs slightly in that the head of
the table will be tilted downward to help the dye localize in the
neck region.
The second part of the test involves you going through a CT scanner
to get the additional pictures taken from a different perspective
that cannot be achieved with routine x-rays. The CT portion is
painless and usually takes approximately one hour. You will return
to a “recovery area” such as a day surgery room and remain on bed
rest for approximately 4-6 hours after the test.
Preparing for your Myelogram test:
• Drink extra fluids the day before the test. This
will help increase fluid in your body and decrease your risk of
developing a spinal headache.
• Do not drink or eat anything after midnight the night
before the test. If you take daily medication, take it with a sip
of water and be sure to tell the nurse or technician what you have
taken and when.
• Bring all of your routine medications and pain medications
with you. Do not take any other medications after you get there
without obtaining permission from the nurse.
• Leave valuables at home.
• Wear comfortable clothing such as a jogging suit
or sweat pants. Plan on spending up to 10 hours at the hospital.
• Bring a driver. You will be unable to drive yourself
home.
• Bring a book or magazines to help pass the time.
• The day after the test drink extra fluids. The more
you drink the better.
• The 48 hour period following the exam should be nothing
but bed rest with your head as flat as possible. This is very important
to prevent a "spinal headache." Only get up if absolutely
necessary. If a headache should develop, please notify your physician's
nurse. Although the risk of a spinal headache is very low, these
preventive tips before and after the procedure can decrease the
chances even further.
• If you experience discomfort at the injection site
you may apply a cold/ice pack periodically, on for 30 minutes and
off for at least an hour.
• If you have other concerns after the test, please
call the nurse.
Notify your physician Special Concerns Before Your Myelogram
if:
• you have ever had an allergic reaction to x-ray dye
or Xylocaine.
• you are allergic to any medication.
• you are or could possibly be pregnant.
• you have epilepsy or seizures.
• you are taking any blood thinner medications, specifically
Coumadin or Heparin.
• you are diabetic or taking the medication "Glucophage," or
if you require insulin injections you may want to check with your
medical doctor on how you should handle the timing of the injections
as your meals will be delayed the day of the test.
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Appropriate treatment follows an accurate diagnosis.
Our pain management specialists provide careful and thorough
diagnostic work-up, and may order laboratory testing, MRI or
CT scans, EMG and nerve conduction studies as part of their pain
assessment. An internal medicine type work-up for pain is a standard
part of pain management. Their goal is to reduce pain while increasing
function.
Physical Medicine
and Rehabilitation Specialists (Physiatrists) treat
the whole person from physical, emotional, psychosocial,
and vocational perspectives. They treat a wide range of
problems, including:
- Low back pain
- Neck Pain
- Acute muscle and ligament injuries
- Acute and chronic pain
- Work injuries
- Spinal Cord Injuries
- Fibromyalgia
- Carpal Tunnel Syndrome
- Amputee Care
- Spondylolysis
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- Stroke
- Rheumatoid arthritis
- Neuro-muscular dystrophy
- Impairment Ratings
- Independent Medical Exams
- Myofascial pain
- Osteoarthritis
- Spastic Torticollis & other nerve entrapment syndromes
- Head injury
- Arthritis pain
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Physical Therapy, Occupational Therapy, Work
Hardening, and Health Psychology may be components of an aggressive
rehabilitative approach.
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RADIOFREQUENCY THERMAL COAGULATION
(RHIZOTOMY)
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As part of your treatment at NeuroCare Network,
your doctor will be performing a procedure called RFTC (radiofrequency
thermal coagulation) or "medial branch neurotomy."
What is a Rhizotomy (RFTC) and why is it helpful?
This procedure is done to treat pain caused by
the facet joints by creating a lesion or burn in the pain fibers
to the facet joint also known as the Medial Branch of the posterior
primary ramus.
The purpose of RFTC of the medial branch is to
decrease pain and improve function. This is done only if pain
is relieved temporarily by facet joint injections and then by
medial branch nerve blocks.
How is it done?
It is accomplished by placing a special needle
along side the facet joint under x-ray control. Following this,
a controlled heat lesion is made to decrease the sensation of
the facet joints.
An intravenous solution will be started so that
medications or short acting sedative, if necessary, can be given
during the procedure.
The procedure will take approximately 20-60 minutes.
You will then be monitored for an additional hour. All measures
will be taken to ensure your comfort and safety. After you return
home, you may use ice packs to relieve any discomfort.
General Pre/Post Instructions
You should eat a light meal within a few hours
before the procedure. If you are an insulin dependent diabetic,
you must not change your normal eating pattern prior to the procedure.
You may take your routine medications (i.e. high blood pressure
and diabetic medications). If you are on Coumadin (blood thinners)
or Glucophage (a diabetic medicine) you must notify the office
so the timing of these medications can be explained.
These procedures are performed either at one
of the hospitals or at the NeuroCare Network facility. You are
generally asked to be at the appropriate location one hour before
the procedure and can expect to be at that facility approximately
2-3 hours.
A driver must accompany you and be responsible
for getting you home. No driving is allowed the day of the procedure.
You may return to your normal activities the day after the procedure,
including returning to work.
Potential Risks
Prior to this procedure, a written consent will
be obtained that will include the possible risks and hazards.
Certain effects are to be expected: Bruising at the injection
sites, soreness and swelling. Possible effects include: burning
sensation at the injection site, numbness, itching, and occasionally
2 - 3 weeks of increased pain. This is only temporary.
It is imperative that you be informed and have
a full understanding of your treatment plan and of this procedure.
If you have any questions, PLEASE contact us at (903) 597-3472
or (800) 846-4205 well in advance of your scheduled appointment
so that we can clear any misconceptions and answer any other
questions you may have.
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SACROILIAC JOINT INJECTION
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The sacroiliac joint is a large joint in the region of the low
back and buttocks where the pelvis actually joins with the spine.
If the joints become painful they may cause pain in the low back,
buttocks, abdomen, groin, or legs.
A sacroiliac joint injection serves several purposes. First, by
placing numbing medicine into the joint, the amount of immediate
relief experienced will help confirm or deny the joint as a source
of pain. Additionally, the temporary relief of the numbing medicine
may better allow a chiropractor or physical therapist to treat
that joint. Also, time release cortisone (steroid) will help to
reduce any inflammation that may exist within the joint(s).
What happens during the procedure?
You are placed on the X-ray table on your stomach in such a way
that the physician can best visualize these joints in the back
using x-ray guidance. The skin on the low back is scrubbed using
two types of sterile scrub (soap). Next, the physician numbs a
small area of skin with numbing medicine. This medicine stings
for several seconds. After the numbing medicine has been given
time to be effective, the physician directs a very small needle,
using x-ray guidance into the joint. A small amount of contrast
(dye) is injected to insure proper needle position inside the joint
space. Then, a small mixture of numbing medicine (anesthetic) and
anti-inflammatory (cortisone/steroid) is injected. One or several
joints may be injected depending on location of your usual pain.
What happens after the procedure?
Immediately after the procedure, you will walk around and try
to imitate something that would normally bring about your usual
pain. You are then asked to report the percentage of pain relief
and record the relief experienced during the next week on a post
injection evaluation sheet ("pain diary"). This will
be given to you when you are discharged home.
Your leg(s) may feel numb for a few hours. This is fairly uncommon,
but does occasionally happen. You may be referred to a chiropractor
or physical therapist immediately after the injection(s) while
the numbing medicine is still working for manipulation or massage.
General Pre/Post Instructions
You should eat a light meal within a few hours before the procedure.
If you are an insulin dependent diabetic, do not change your normal
eating pattern prior to the procedure. Please take your routine
medications (i.e. high blood pressure and diabetic medications).
You should not take pain medications or anti-inflammatory medications
the day of your procedure. You need to be hurting prior to this
procedure. Do not take medications that may give pain relief or
lessen your usual pain. These medicines can be restarted after
the procedure if they are needed.
If you are on Coumadin, Heparin, Plavix, or any other blood thinners
(including aspirin), or the diabetic medication Glucophage, you
must notify this office so the timing of these medications can
be explained.
You will either be at one of the hospitals or the NeuroCare Network
facility approximately 2 - 3 hours for your procedure. You will
need to bring a driver with you. You may return to your normal
activities the day after your procedure, including returning to
work.
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SpineCath* Intradiscal
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The Procedure
Certain lumbar disc problems can be treated with
IDET (Intradiscal Electrothermal Therapy). The thermal treatment
with the Intradiscal Catheter is intended to treat the protein
wall of your disc and reduce the volume of disc material that
causes nerve irritation. Your physician feels this procedure
could improve your symptoms.
This is a minimally invasive procedure and you
will most likely go home the same day. The procedure involves
a wire (the catheter) which is guided into your disc through
a needle and is heated for about 15 minutes. Then the catheter
and needle are removed completely and you will be sent back to
recovery.
Pre-operative Preparation
One week before the procedure:
• Stop all NSAIDS, aspirin, and aspirin-containing
compounds.
• Do NOT discontinue heart, blood
pressure, diabetes medications, or other medications prescribed
by a physician.
Be sure to tell your physican if:
• You are taking blood thinners or
have a history of a bleeding disorder.
• You are allergic to iodine (for
example shellfish or IVP dye).
• You have an infection in any part
of your body.
You should not eat the day of your procedure.
Clear liquids are permitted. Bring your brace with you to the
hospital. Rest well the night before the procedure. Arrange to
have someone drive you to and from the medical facility. You
may not drive until one week after your treatment.
During the Procedure
An I.V. will be placed in your arm and you will
be given sedation. After you are in position on the table, x-ray
equipment will identify the area affected. Your lower back, skin,
and muscle tissue will then be numbed with local anesthetic.
Electrothermal Therapy
Your physician will then place a needle into
your disc under x-ray guidance. Generally, you may experience
mild discomfort during this part of the procedure.
The next step is to insert the electrothermal
treatment catheter through the needle. Patients typically do
not feel any discomfort during this step. However, some patients
have reported a mild discomfort in their back when the catheter
moves through the disc.
When the catheter position is confirmed by x-ray,
the heating element is activated. The heat is slowly increased
and will last for 14 to 17 minutes. As the heat increases into
the treatment range, you might experience your disc-related symptoms.
Your physician will monitor your responses during the procedure
to insure that any pain you feel is well controlled.
At the end of the procedure, a small bandage
will be placed on your back and you will rest in a recovery area
until you are ready to go home.
Post-operative Management: Immediate
For the first 7 - 10 days after your procedure
(the immediate post-operative period), you may experience a moderate
increase in your normal back pain. Rest, ice, pain medication,
and anti-inflammatories will minimize possible discomfort during
this time.
Any unusual or new symptoms (for example, fever,
rash, or numbness) should be reported to your physician immediately
by telephone. Do not expect your usual pain to disappear immediately
after the procedure.
If you experience a marked reduction in your
pain, do not exert yourself during this time. Exertion may negatively
affect the overall outcome. Housework, lifting, or bending should
not be done.
Patient Information
Short walks (15 to 20 minutes) are permitted,
but generally the first seven days should be spent resting.
You should discuss with your physician your plan
to return to work. If your work is sedentary, you can typically
return seven days after the procedure. You will schedule follow-up
visits with your physician for continuing assessment of your
condition.
Post-operative Management : Mid Term
For the first month following the procedure,
your disc continues to heal. You may begin to feel a reduction
in pain. However, pain reduction usually occurs over 3 - 4 months.
During the first month, you must treat your back
carefully. Absolutely no bending, twisting, or heavy lifting.
No sport activities including running, biking, golf, tennis,
skiing, etc. You do not have to abstain from sexual activity,
but be careful not to exert your back.
You may resume back exercises under your physician's
guidance. Anti-inflammatory medications and/or pain medication
may be prescribed if needed to control discomfort associated
with your normal back pain. Applying ice 1-2 times per day (10-15
minutes) is advisable to reduce any lower back discomfort.
Rehabilitation Exercises
Your physician will guide you regarding rehabilitation
exercises after your procedure. If you have been performing strenuous
rehabilitation exercises before the procedure, you will not immediately
return to that level of exercise, but to a more moderate level
that will be gradually increased as you improve. Be sure to ask
your physician for a post-operative exercise program.
Post-operative Management: Long Term
In the 2nd, 3rd, and 4th months post-operatively,
continue to maintain good body mechanics and do not bend improperly.
Your physician and physical therapist will help you advance your
strength and flexibility. If you plan to return to athletic pursuits,
special advanced training will probably achieve your goal.
Your physician may allow you to resume sporting
activities 3-4 months after the procedure and may allow you to
resume traveling for work or pleasure during this time as well.
In the end…
Your physician has selected this procedure because
it offers you a less invasive option for your condition. It may
be a promising step in trying to reduce your symptoms. bility.
If you plan to return to athletic pursuits, special advanced
training will probably achieve your goal.
Your physician may allow you to resume sporting
activities 3-4 months after the procedure and may allow you to
resume traveling for work or pleasure during this time as well.
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THORACIC EPIDURAL INJECTION
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What is the epidural space?
The membrane that covers the spinal cord and nerve roots in your
spine is called the dura membrane. The space surrounding the dura
is the epidural space. Nerves travel through the epidural space
to your mid back and along the ribs. Inflammation of these nerve
roots may cause pain in these regions due to irritation from damaged
disc or from contact in some way with the bony structure of the
spine.
What is an epidural and why is it helpful?
An epidural injection places anti-inflammatory medicine into the
epidural space to decrease inflammation of the nerve roots, hopefully
reducing the pain in your mid back or around your rib cage. The
epidural injection may help the injury to heal by reducing inflammation.
It may provide permanent relief or provide a period of pain relief
for several months while the injury or cause of your pain is healing.
What will happen to me during the procedure?
An IV will be started so that relaxation medication can be given.
You will be placed lying on your side on the x-ray table and positioned
in such a way that your doctor can best visualize your back using
x-ray guidance. The skin on your back will be scrubbed using two
types of sterile scrub (soap). Next, the physician may numb a small
area of skin on your low back with numbing medicine. This medicine
stings for several seconds. After the numbing medicine has been
given time to be effective, your doctor will direct a small needle
using x-ray guidance into the epidural space. A small amount of
contrast (dye) is then injected to insure proper needle position
in the epidural space. Then, a small catheter will be placed into
the epidural space and advance up to the area of abnormality. Then,
a mixture of numbing medicine (anesthetic) and anti-inflammatory
(cortisone/steroid) will be injected.
What will happen after the procedure?
You will go back to the recovery area where you will be monitored
for 30 - 60 minutes. You will then record the relief you experience
during the next week on a post injection evaluation sheet ("pain
diary"). This will be given to you when you are released to
go home. You will also be given a follow-up appointment for a repeat
block if indicated. These injections are usually done in a series
of three (3), about two weeks apart. PLEASE mail this completed
pain diary to NeuroCare Network and our office will contact you
if it is necessary to change your next appointment.
You will not be able to drive the day of your procedure. Your
back may feel weak or numb for a few hours.
General Pre/Post Instructions
You should eat a light meal within a few hours before the procedure.
If you are an insulin dependent diabetic, you must not change your
normal eating pattern prior to the procedure. You may take your
routine medications (i.e. high blood pressure and diabetic medications). You
should not take pain medications or anti-inflammatory medications
the day of your procedure . You need to be hurting prior
to this procedure. You may not take medications that may give pain
relief or lessen your usual pain. These medicines can be restarted
after the procedure if they are needed. If you are on Coumadin
(blood thinners) or Glucophage (a diabetic medicine) you must notify
the office so the timing of these medications can be explained.
These procedures are performed either at one of the hospitals
or at the NeuroCare Network facility. You are generally asked to
be at the appropriate location one hour before the procedure and
can expect to be at NeuroCare or at one of the hospitals approximately
2-3 hours.
A driver must accompany you and be responsible for getting
you home . No driving is allowed the day of the procedure.
You may return to your normal activities the day after the procedure,
including returning to work.
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THORACIC FACET JOINT INJECTION
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What are thoracic facet joints and why are facet joint injections
helpful?
Thoracic facet joints are small joints about the size of the thumb
nail located in pairs of the back of the spine. They provide stability
and guide motion in the mid back. If the joints become painful
they may cause pain in the mid back, ribs, chest or abdomen.
A facet joint injection serves several purposes. First, by placing
numbing medicine into the joint, the amount of immediate pain relief
experienced will help confirm or deny the joint as a source of
pain. Additionally, the temporary relief of the numbing medicine
may better allow a chiropractor or physical therapist to treat
that joint. Also, time release cortisone (steroid) will help to
reduce any inflammation that may exist within the joint(s).
What happens during the procedure?
An IV will be started so that relaxation medication can be given.
You will be placed on the x-ray table, face down so your doctor
can best visualize these joints in your mid back using x-ray guidance.
The skin on your back will be scrubbed using two types of sterile
scrub (soap). Next, the physician will numb a small area of skin
with numbing medicine. This medicine stings for several seconds.
After the numbing medicine has been given time to be effective,
your doctor will direct a very small needle using x-ray guidance
into the joint space. Then, a small mixture of numbing medicine
(anesthetic) and anti-inflammatory (cortisone/steroid). One or
several joints may be injected depending on the location of your
usual pain.
What will happen after the procedure?
Immediately after the procedure, you will move around and try
to imitate something that would normally bring about your usual
pain. You will then report the percentage of pain relief and record
the relief you experience during the next week on a post injection
evaluation sheet ("pain diary"). This will be given to
you when you are released to go home. PLEASE mail this completed "pain
diary"to NeuroCare Network and our office will contact you
when we receive your diary.
You will not be able to drive the day of your procedure. Your
chest or mid back may feel weak or numb for a few hours. You may
be referred to a chiropractor or physical therapist immediately
afterwards while the numbing medicine is still working.
General Pre-op and Post-op Instructions
You should eat a light meal within a few hours before the procedure.
If you are an insulin dependent diabetic, do not change your normal
eating pattern prior to the procedure. Please take your routine
medications (i.e. high blood pressure and diabetic medications). Do
not take pain medications or anti-inflammatory medications the
day of your procedure . You need to be hurting prior to
this procedure. Please do not take medications that may give pain
relief or lessen your usual pain. These medicines can be restarted
after the procedure if they are needed.
If you are on Coumadin, Heparin, Plavix, or any other blood thinners
(including aspirin), or the diabetic medication Glucophage, you
must notify this office so the timing of these medications can
be explained.
You will either be at one of the hospitals or the NeuroCare Network
facility approximately 2 - 3 hours for your procedure. You
will need to bring a driver with you . You may return
to your normal activities the day after your procedure, including
returning to work.
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Trigger Point Injections
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Trigger point injections are a specific type of local injection
that your physician can use to treat local areas of muscle pain
and spasm. Trigger points are commonly defined as areas of taut
muscle bands or palpable knots of the muscle which are painful.
Often these trigger points can cause localized pain and even referred
pain patterns that can even mimic the pain people feel from nerves
being pinched in their neck or low back. Your physician may choose
to give a trial of trigger point injections to see if they can
help these areas of local muscle tenderness to relieve pain.
Common medications used in trigger point injections can include
local anesthetic, normal saline, and small doses of steroid medications.
Many studies have been done on trigger point injections and their
efficacy utilizing these different types of medications. Research
has demonstrated that just the local placement of the needle can
help with muscle spasms, similar to acupuncture. The volume of
the solution can affect the muscle spasm as well, and often times
the injections of normal saline can be helpful for pain.
Utilizing a local anesthetic to numb the region of pain can help
break the cycle of pain. A small dose of steroid medication at
the site can help decrease inflammation of muscles as well.
Your physician may choose a combination of the above medications,
depending on your symptoms and response. Trigger point injections
are sometimes repeated in a series, depending on the results of
the injections and the relief of pain that they provide. Often
times, more than one injection is performed on various sites, depending
on the physician's examination findings of trigger points.
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