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YOU are here : Home > Spinecare Topics > Intervention - Spinal Disorders > Minimally Invasive Intervention for Spine Pain
Spinecare Topics
Intervention - Spinal Disorders
Minimally Invasive Intervention for Spine Pain
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Minimally Invasive Intervention for Spine Pain
Indications for procedure: Candidates include those patients who have unremitting signs and/or symptoms due to disc herniation, which have not responded favorably to an appropriate course of conservative care. The use of neuroimaging techniques such as MRI is particularly helpful determining whether patients meet this criterion. Individuals who have herniations that involve extrusion of the gel-like center of the disc beyond the outer boundaries of the disc are not good candidates. Another procedure that is proven to be very sensitive for the selection of patients with APLDs is computed tomography and the CT discogram. This procedure helps to confirm the presence of complete tears of the outer fibers within the disc. It can also be used to evaluate the relationship of a disc herniation with the pain sensitive posterior longitudinal ligament. A CT discogram can be used to evaluate the size of a tear within the intervertebral disc. Patients who are selected for this procedure should have undergone a differential pain workup including diagnostic facet blocks/injections to help exclude non-discogenic sources of pain at the involved spinal level.
Procedure: The procedure is generally carried out under local anesthesia. This helps reduce the risk for neurological complications. The patient can provide feedback during the procedure. The attending clinician must choose the optimum entry point for the instruments to be used. Patients are generally placed in a lateral position with a towel rolled up under their hip. Prior to placement of the probe into the disc, a local anesthetic is used followed by placement of a steroidal compound into the disc. This approach helps to increase the fluid content of the disc thus making the procedure simpler. Under fluoroscopic image guidance a probe is incrementally positioned into the center of the disc. A special probe is then placed into the disc, which is used to aspirate some of the fluid or gel-like material from the center of disc. This portion of the procedure can take up to 20 minutes. The instrument can be moved back and forth at different angles to help obtain greater amount of disc material.
Goals of the procedure: The primary goal of the procedure is to lower central disc pressure and to reduce disc volume in order to reduce pressure upon adjacent pain sensitive structures within the spine. This includes taking pressure off of spinal nerves and other pain sensitive tissues, which lie next to the disc. The procedure may result in some reduction of vertical disc height.
Discography
Background: Advancements in technology has lead to improved imaging, which has resulted in an increased understanding of the origin of spinal pain. For example, magnetic resonance imaging (MRI) provides detailed imaging of the soft tissues such as the intervertebral disc as well as the spinal cord and nerve roots. It can be used to assess small regions of structural compromise. This has become particularly important in evaluating the intervertebral disc. Research has shown that disc problems can be the primary source of back pain. Sometimes MRI imaging findings correlate well with discogenic pain. The primary challenge for the physician is determining whether changes detected by imaging procedures such as MRI are clinically significant. A specialized imaging procedure referred to as discography can be used in the cervical, neck, mid back, and low back regions to help determine whether pain is primarily arising from an intervertebral disc. It can also be used to help determine which form of therapeutic intervention may be most appropriate. The study is used to determine the exact or primary level of disc involvement.
Procedures: Discography must be performed by an experienced and qualified professional. The procedure may be performed by a surgeon, an interventional neuroradiologist, and/or a pain management specialist. The procedure is performed via imaging guidance usually in the form of a fluoroscopic C-arm unit. Conscious sedation or anesthesia is used as needed. The patient is usually placed prone or face down on a tilting table next to a fluoroscopic imaging unit. The tabletop is movable and can be rotated or tilted. Pads are used to position the patient. Fluoroscopy is performed to identify the best route of access for needle placement into each disc and to identify the disc to be evaluated. Under image guidance a specialized needle is slowly and precisely placed into the intervertebral disc to be evaluated. The needle is advanced incrementally with periodic radiographic checks lasting a few milliseconds. The needle tip is progressed to as near to the center of the disc as possible. Multiple X-ray perspectives are used to guide the needle into position.
Procedure: The procedure is generally carried out under local anesthesia. This helps reduce the risk for neurological complications. The patient can provide feedback during the procedure. The attending clinician must choose the optimum entry point for the instruments to be used. Patients are generally placed in a lateral position with a towel rolled up under their hip. Prior to placement of the probe into the disc, a local anesthetic is used followed by placement of a steroidal compound into the disc. This approach helps to increase the fluid content of the disc thus making the procedure simpler. Under fluoroscopic image guidance a probe is incrementally positioned into the center of the disc. A special probe is then placed into the disc, which is used to aspirate some of the fluid or gel-like material from the center of disc. This portion of the procedure can take up to 20 minutes. The instrument can be moved back and forth at different angles to help obtain greater amount of disc material.
Goals of the procedure: The primary goal of the procedure is to lower central disc pressure and to reduce disc volume in order to reduce pressure upon adjacent pain sensitive structures within the spine. This includes taking pressure off of spinal nerves and other pain sensitive tissues, which lie next to the disc. The procedure may result in some reduction of vertical disc height.
Discography
Background: Advancements in technology has lead to improved imaging, which has resulted in an increased understanding of the origin of spinal pain. For example, magnetic resonance imaging (MRI) provides detailed imaging of the soft tissues such as the intervertebral disc as well as the spinal cord and nerve roots. It can be used to assess small regions of structural compromise. This has become particularly important in evaluating the intervertebral disc. Research has shown that disc problems can be the primary source of back pain. Sometimes MRI imaging findings correlate well with discogenic pain. The primary challenge for the physician is determining whether changes detected by imaging procedures such as MRI are clinically significant. A specialized imaging procedure referred to as discography can be used in the cervical, neck, mid back, and low back regions to help determine whether pain is primarily arising from an intervertebral disc. It can also be used to help determine which form of therapeutic intervention may be most appropriate. The study is used to determine the exact or primary level of disc involvement.
Procedures: Discography must be performed by an experienced and qualified professional. The procedure may be performed by a surgeon, an interventional neuroradiologist, and/or a pain management specialist. The procedure is performed via imaging guidance usually in the form of a fluoroscopic C-arm unit. Conscious sedation or anesthesia is used as needed. The patient is usually placed prone or face down on a tilting table next to a fluoroscopic imaging unit. The tabletop is movable and can be rotated or tilted. Pads are used to position the patient. Fluoroscopy is performed to identify the best route of access for needle placement into each disc and to identify the disc to be evaluated. Under image guidance a specialized needle is slowly and precisely placed into the intervertebral disc to be evaluated. The needle is advanced incrementally with periodic radiographic checks lasting a few milliseconds. The needle tip is progressed to as near to the center of the disc as possible. Multiple X-ray perspectives are used to guide the needle into position.
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