Fluoroscopy Guided Spine Procedures

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Spine pain (Neck or Back pain) is a very common painful condition, seen in young active adults or elderly. After diagnosing the root cause of back pain, following Interventional Pain procedures can be done under fluoroscopy guidance in OT for treating the disease and relieving pain.

Epidural injections: This spine injection procedures targets inflammation/swelling around nerves in spine, due to disc prolapse or spinal stenosis (narrowing of spinal canal). They are extremely useful for Back pain with Sciatica (Radicular pain in lower limb or upper limb) cases, where it causes immediate & long lasting relief of sciatica pain/symptoms. In this procedure, anti-inflammatory medicine (combination of Glucocorticoids with local anaesthetics) is injected in epidural space, just near to the inflammed nerve roots, which relieves inflammation and compression over nerve roots and consequent pain relief.

Facet joint injections: Patients suffering from back or neck only (without pain in upper or lower limb) are having facet joint disease or injury, which is causing constant discomfort in spine. These patients get good amount of relief with Facet joint injection (with anti-inflammatory medicine) or Medial branch block (a type of injection which stops pain sensation of sensory nerve supplying facet joints). The effect is immediate and lasts for at-least 1-3 months, which can be followed by RFA (Radiofrequency Ablation) treatment of affected nerve, which lasts 1-5 years.

Disc procedures e.g. Provocative Discography, Biaculoplasty, DiscFx, Coablation, ozone injection, transforaminal discectomy, etc.: Patients who have documented disc prolapse with discogenic pain in back, need these disc interventional procedures, which specifically targets affected discs and relieves pain. These procedures can be tried before surgical disc removal or discectomy which is a major surgery.

Sacro-iliac joint injection/ Sacral nerves RFA: Patients who have buttock pain/thigh pain that increases in taking turns in bed or getting up from sitting position are suffering from sacro-iliac joint pain, which is quite resistant to medicine treatment. In these resistant pain cases, sacro-iliac joint injection under fluoroscopy guidance with anti-inflammatory medicine or nerve RFA can be given, with significant pain relief.

Percutaneous epidural adhesiolysis (PEA): In patients with long-standing back pain or following any spine surgery, scar/adhesions formation occurs in spine which entraps nerves exiting from spine to lower limbs, resulting in severe pain resistant to all known treatment modalities. In such cases, this scar tissue in spine is removed either by catheter or epidural scar dissolving medicine, resulting in removal of compression over nerves and healing of nerve tissue, with pain relief.

Myofascial trigger point injections: Some patients develop muscle spasm following injury to spine, with resultant spine pain & deformity. These patients benefit a lot by trigger point injections, which relieve muscle spasm and pain.

These pain medicine procedures are followed by home exercise regimen and posture correction. These procedures give significant (>50%) but variable amount of relief as per disease status of patient.

Side-effects: Mild soreness or pain at the site of needle insertion may occur which is relieved by ice packs. Some patients may develop allergic reaction to medications, which are managed easily. Rarely, like any other procedure, these procedures can cause bleeding or infection. You should discuss the risks and benefits -- and other options -- with your doctor.

To summarize, patients with spinal pain which is not relieved by medicine or physiotherapy, should go for pain medicine procedures as they are target specific, efficient, safe & cost-effective

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