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Before the Interventional Spine Procedure

Before the Interventional Spine Procedure
By Dr. Sireen Gopal

Precision Fluoroscopic Guided Spinal Interventions
Diagnosis & Treatment to help reduce pain

Phone: 718.794.0600; Fax: 718.794.9899;

Your 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
Discs are like rubber pads that provide cushioning between the vertebrae. The discs can desiccate or get damaged leading to inflammation and pain.
A 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
The 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

Inflammation/swelling 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.

This 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

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

The procedure

The procedure is an outpatient procedure done under a X-ray camera. The actual procedure only takes minutes. Please read this important information carefully.

Getting Ready

? 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 cardiologist
? 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.

Checking in
You 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:

With 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 medications used.

During the procedure

The 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

You?ll 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 physician.

Combining Spinal Procedures with Rehabilitation
It 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.

The 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