Workers Compensation

Epidural injections for relief of chronic back and neck pain has been performed by physicians for generations.It has evolved the way so many procedures have to become more specific and hence diagnostic as well as still serving its therapeutic value to the patient. Current thinking dictates that epidural injections should be performed using fluoroscopic guidance to ensure correct needle placement during the procedure.

Epidural injections can be performed essentially anywhere along the spine, including cervical, thoracic, lumbar, sacral, and caudal, depending upon where the pathology dictates.

There are essentially 2 types of injections – interlaminar, and transforaminal. Interlaminar injections are the “old style” injections given directly midline and between the spinous processes. They are more effective with posterior pathology with the epidural space and with bilateral spinal pain syptomatology. Transforaminal injections (formerly known as selective nerve root blocks) are far more specific, and are targeting a single individual nerve root as it exits the spinal canal.

The decision of when to use which technique is a clinical judgement on the part of the physician when taking into account the patient’s pain and neurologic complaints and symptoms, physical examination findings, imaging studies, such as MRI or CT scan, and historically if any of these techniques have been tried already and the results they have had in controlling the patient’s pain.

Facet blocks for relief of chronic back and neck pain has been performed by physicians for many years.It has evolved the way so many procedures have to become more specific and diagnostic as well as still serving its therapeutic value to the patient.Current thinking dictates that facet blocks should be performed using fluoroscopic guidance to ensure correct needle placement during the procedure.

Facet blocks can be performed essentially anywhere along the spine, including cervical, thoracic, lumbar, sacral, and caudal, depending upon where the pathology dictates.

The facet joint is a synovial joint (which means lined by synovium – cells that secrete lubricating fluid) and represent where one vertebrae contact the vertebrae directly beneath. There is a facet joint on each side of the spine, right and left.

When these joints become enlarged (facet hypertrophy) or inflammed, they can irritate or compress spinal nerve roots that are located directly in front of each facet joint. The pain symptomatology seen typically with facet related pain is para-axial (along the side of the spine) and without significant radicular component. It is exacerbated by extension of the spine, twisting movements, and rarely radiates past the knees.

The decision of when to perform facet blocks is a clinical judgement on the part of the physician when taking into account the patient’s pain and neurologic complaints and symptoms, physical examination findings, imaging studies, such as MRI or CT scan, and historically if any of these techniques have been tried already and the results they have had in controlling the patient’s pain.

Minimally invasive spine surgery is a surgical technique with less risk of complications and shorter recovery time. It is the preferred choice for those that require spine surgery. At Dial #Pain, we are leaders in minimally invasive spine surgery, and can help address a variety of the causes of your chronic pain. Contact us today for a consultation.

Our goal is always to find the most conservative approach to relieve your chronic pain. But if physical therapy, medication, and time are unable to eliminate the pain and discomfort, it may be time to consider spine surgery.

Spine surgery has advanced considerably in the last several years. It is now more effective than ever, and when working with trained specialists, it is possible for surgery to reduce or eliminate chronic pain causes and symptoms.

But traditional spine surgery can still have a long recovery time, and may come with some risks. So when applicable, we recommend what’s called “minimally invasive spine surgery.” This is a technique for surgery that uses very tiny cuts, tiny equipment, and cameras or other technology that lets us guide the tools towards the area of concern and perform the technique without any large incisions.

Examples of these procedures include:

• Microdiscectomy
• Laminectomy (Levels 1, 2, and 3)
• Excision of Synovial Cyst

Many spine surgeries can be performed using minimally invasive techniques when appropriate, and while there are situations that may require a more traditional surgery, we will recommend minimally invasive intervention that may help to address your pain with the ability to resume normal activities at a faster rate.

Pain management is best for those that can manage pain with something with less risk and recovery, like pain medication, or when the available treatments are unlikely to treat the problem.

There are many different strategies that our pain doctors and neurosurgical associates may use to approach pain management with our patients. These techniques include:

• Injections
• Stem Cell Therapy
• Regenerative Medicine
• Spinal Cord Stimulator

You may also benefit from a combination of different treatments, many of which let you avoid surgery or treat pain that did not respond well to prior procedures.

We will always explore pain management techniques first, before we recommend surgical treatment. That is why it is so important to contact us for a consultation, even if you’ve had treatments before. We will listen to your concerns and struggles, complete our testing, and see what the best possible treatment is for you. Contact us today to get started.

Radiofrequency technology has been around for approximately 30 years. The science involves the transmission of electric energy applied to nerves that are transmitting painful signals towards the brain and spinal cord where they are perceived. The result is a disruption in the nerve’s ability to transmit painful stimuli.

RF (for short) can be done either in a destructive (lesioning) manner, in which heat is actually destroying the affected nerves, or in a non-destructive fashion, called “pulsed” RF.

The recent advancement of pulsed RF makes RF an excellent modality to treat painful conditions that were otherwise intractable without surgery.

Common pain syndromes that can be effectively treated with RF include:

• Low back and neck pain from facet related pain, and/or sciatica.
• Reflex Sympathetic Dystrophy
• Occipital neuralgia
• Intercostal neuralgia
• Shingles related pain
• Frozen shoulder syndrome
• Trigeminal neuralgia (facial pain involving the 5th cranial nerve)

RF is usually performed in a monitored setting under light sedation and with fluoroscopic guidance to verify correct needle placement. It may be considered after temporary local/steroid injections have resulted in significant improvement, albeit temporary. Patients may experience prolonged relief lastinga few months or longer. It may sometimes need to be repeated for various reasons.

Nerve block is a generic term for when a procedure is done that reduces or halts the transmission of impulses along a particular nerve. It can encompass individual nerve or extend to involve entire groups of nerve, such as the brachial plexus the controls function to the entire upper extremity.

Blocking a nerve serves a valuable diagnostic purpose in that if the nerve is blocked and pain diminishes, the source of the pain can very often be isolated. Nerve blocks can be therapeutic as well and when longer pain relief is desired, steroids are often combined with long acting local anesthetics to provide this effect.

Nerve blocks can also be accomplished by using alcohol or phenol when permanent nerve block is indicated. Often times, depending on the location, fluoroscopy will be used to locate and identify the nerve being blocked.

X-rays are a type of radiation, and when they pass through the body, dense objects such as bone block the radiation and appear white on the x-ray film, while less dense tissues appear gray and are difficult to see. X-rays are typically used to diagnose and assess bone degeneration or disease, fractures and dislocations, infections, or tumors.

Organs and tissues within the body contain magnetic properties. MRI, or magnetic resonance imaging, combines a powerful magnet with radio waves (instead of x-rays) and a computer to manipulate these magnetic elements and create highly detailed images of structures in the body. Images are viewed as cross sections or “slices” of the body part being scanned. There is no radiation involved as with x-rays. MRI scans are frequently used to diagnose bone and joint problems.

A computed tomography (CT) scan (also known as CAT scan) is similar to an MRI in the detail and quality of image it produces, yet the CT scan is actually a sophisticated, powerful x-ray that takes 360-degree pictures of internal organs, the spine, and vertebrae. By combining x-rays and a computer, a CT scan, like an MRI, produces cross-sectional views of the body part being scanned. In many cases, a contrast dye is injected into the blood to make the structures more visible. CT scans show the bones of the spine much better than MRI, so they are more useful in diagnosing conditions affecting the vertebrae and other bones of the spine.

Physical therapy is the treatment of musculoskeletal and neurological injuries to promote a return to function and independent living. Physical therapy incorporates both exercise and functional training. Exercise restores motion and strength while functional training facilitates a return to daily activities, work, or sport.

After an injury patients often experience severe muscle spasms. We have massage therapists, especially trained in personal injury that can work with you to alleviate and relax these spasms.