Before the Interventional Spine Procedure
|By Dr. Sireen Gopal|
Precision Fluoroscopic Guided Spinal Interventions
Diagnosis & Treatment to help reduce pain
NEW YORK SPINE & SPORT REHABILITATION MEDICINE P.C.
2008 EASTCHESTER ROAD, 2ND LEVEL, BRONX, NY 10461
Phone: 718.794.0600; Fax: 718.794.9899; www.nyssrm.yourmd.com
Doctor has recommended that you have a spinal procedure for pain
management. This procedure can help relieve low back, leg, neck or arm
pain that originates from the spine by reducing inflammation and
swelling. This procedure can also help in diagnosing the source of your
spine pain. It can speed up your recovery and facilitate rehabilitation.
Learn about your back anatomy to know how the spinal procedure can help relieve or locate pain.
Vertebrae are spine bones that stack up to from the spine
are like rubber pads that provide cushioning between the vertebrae. The
discs can desiccate or get damaged leading to inflammation and pain.
nerve root is the part of the nerve that leaves the spinal canal.
Inflammed and swollen nerve roots can lead to back/neck and leg/arm pain
sciatic nerve is a large nerve that extends down to the leg. When its
nerve roots are inflammed, buttock, leg or foot pain can often result.
A procedure for Pain relief and Diagnosis
of one or more nerve roots or joints or their covering in the spine may
cause pain. This procedure is done under a Xray-camera called a
fluoroscope with the latest and advanced techniques. This allows for
pinpointing the source of pain. It makes the procedure more safe and
effective, thereby limiting the number of procedures needed. It also
allows much less use of steroid (anti-inflammatory) and/or other
medications, thereby limiting its general side effects in the body.
injection in most cases will not stop all low back, neck, leg or arm
pain. It may however reduce pain significantly and break the pain
cycle, enabling you to remain physically active and do therapeutic
exercise. The procedure can therefore speed your recovery. Some people
may feel more relief from an injection than others, while some people
may need more than one injection to get relief. The injection can also
help locate the source of pain.
Different procedures and types of pain
PROCEDURE TYPES OF PAIN
Transforaminal Selective Epidural
Persistent radiating back, leg, neck or arm pain from the spine, one or two level
Interlaminar/Caudal Epidural Persistent radiating back, leg, neck or arm pain, multiple level
Facet Injection/Nerve Blocks Persistent central back or neck pain
Discogram/ Intradiscal thermal therapy Persistent central back pain of disc origin
Sacroiliac joint injection Persistent lower back/buttock pain from sacroiliac joint
Hip joint injection Persistent hip pain
procedure is an outpatient procedure done under a X-ray camera. The
actual procedure only takes minutes. Please read this important
? You must arrange for a responsible adult to drive you home after your procedure.
? Wear loose, comfortable two piece clothing e.g. sweat top/pant
? You can have light breakfast or your regular snack/meal
? Plan to spend up to 1-1.5 hours at the facility
? Please DO NOT stop taking your blood pressure, insulin or cardiac medication
? If you are a diabetic, steroids may temporarily affect your blood sugar, please contact your physician
Stop taking anti-inflammatory medications 7 days prior to the procedure
such as: Aspirin, Advil, Aleve, Motrin, Ibuprofen, Naprosyn, Naproxen,
Voltaren, Relafen, Cataflam, Feldene, Lodine, Mobic, Arthrotec,
Vicoprofen, can resume the next day of the procedure
? Advise your
doctor if you are taking ?blood thinners? such as Coumadin, Persantine,
Fragmin, Lovenox, Aggrenox, Normiflo, Plavix or Orgaran. These will
need to be stopped, only after consultation with your medical doctor or
? Continue taking pain medication like: Celebrex,
Nortriptyline, Pamelor, Elavil, Amytriptyline, Neurontin, Ultram,
Ultracet, Tylenol No 3, Codeine, Percocet, Oxycodone, Hydrocodone,
Vicodin, Morphine, Oxycontin
? Bring any requested X-ray, CT or MRI images on the day of the procedure
If you are pregnant or if there is a possibility that you may be, let
the physician know immediately, as the X-ray camera cannot be used.
will need to sign a consent form before the procedure. Please advise
the medical staff if you have any allergies, especially to shellfish,
iodine or contrast dyes.
Risks & Complications:
any procedure there are risks. In the case of fluoroscopic (x-ray
camera) guided procedures these risks are very small. The x-ray camera
allows for safe, effective and much less use of medication use, thereby
minimizing complications. Possible side effects may include temporary
increase in pain or soreness, numbness or weakness. We advise you not
to operate a vehicle or perform any activities that require
coordination of the first twelve hours. One percent of patients may
develop a headache. Other rare complications include bleeding and
infection. In many years of our practice with use of new and advanced
techniques, we have successfully treated thousands of patients and
reported no serious complications secondary to the procedure or the
During the procedure
injection takes just a few minutes. The x-ray image lets the doctor
locate the nerve root or joint. Routine monitors will be used. You will
lie on your stomach or side, depending on where the injection will be
given. Your back is cleaned and may be covered with sterile towels.
Medicine is given to numb the skin near the injection site. You may be
given medicine before the procedure to help you relax. With use of
fluoroscopy (x-ray imaging) a contrast dye may be injected to get a
better image and target the source of pain. A local anesthetic (for
numbing) or cortisone (for reducing inflammation), or both are injected
into the epidural space.
After the procedure
spend from 15-30 minutes in the facility after the procedure. We advise
you not to operate a vehicle or perform any activities that require
coordination of the first twelve hours. You may notice some side
effects. They should go away in the first few days. They may include
briefly increased pain, soreness or trouble sleeping. When you get home
you don?t need to stay in bed. In fact, it?s best to walk around if you
feel up to it. Even if you feel better, avoid activities that are very
strenuous or that may strain your back. Discuss your pain medications
and whether you can resume or start physical therapy with your
Combining Spinal Procedures with Rehabilitation
is critical to understand that these injections work best with an
appropriate exercise program and good body mechanics (how you move).
The timing of this procedure therefore should be such that you are able
to participate in a structured rehabilitation program. The time you
spend in rehabilitation (physical therapy) may depend on how effective
the injections are in controlling your pain and on how soon you can
learn the exercise program to then continue to do it independently.
focus of spine rehabilitation is to improve function and quality of
life instead of simply treating pain. A structured exercise designed by
your physician and demonstrated by a qualified physical therapist can
protect your spine and may help keep the pain from returning or
worsening. It will help improve flexibility, strength and endurance in
specific spine and extremity muscles in your body. The focused program
is designed to help you recover and prevent related problems