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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
Following needle placement into the center of the intervertebral disc a contrast agent is injected under fluoroscopic guidance. While observing the flow of contrast on the imaging screen, the assisting technologist will observe the patient for signs of pain or discomfort. The disc is typically injected with contrast until there is leakage of material outside the disc or until the region is filled to a capacity determined by increased resistance. Injection will continue until one of the following occurs; an endpoint is reached preventing further contrast administration, pain is manifested, or at least 4 ml of saline solution has been injected suggesting that there is leakage. A typical disc in the low back will accept approximately 1.5 to 3.5 ml of fluid depending on the health and size of the disc. If the patient does not experience any pain or distress the process injection is discontinued.
The duration of injection is recorded along with the pre-injection pressure and injection endpoint characteristics. During the procedure, the patient is asked to describe in detail what they experience. The patient may be asked to complete a pain diagram, showing the distribution of pain associated with disc assessment. If the chief complaint is reproduced at a particular disc level the pain is considered to be concordant. After evaluation of an involved disc, an anesthetic is injected into the disc prior to needle removal. This usually will relieve the associated pain within a few minutes. The most frequently requested levels of discography are at L2-L3, L3-L4, L4-L5, L5-S1, and all segments of the low back.
Indications for procedure and the use of discography: Discography can be an important tool in the evaluation of pain of spinal origin. With the development of new interventional techniques for disc problems, discography is no longer simply a procedure used to determine the site of the spine that may respond to surgical fusion.
Indications for the procedure include those individuals who have chronic low back pain, which has not responded to conservative approaches. The role of discography should be considered in cases where other procedures have failed such as joint blocks and epidural steroid injections. In summary, discography should be considered for the patient whose attending physician believes the pain is of primary discogenic origin and the pain is creating disability and/or reducing the quality of life.
Selective Nerve Blocks
Selective nerve blocks are utilized for diagnostic and/or therapeutic purposes. They are generally performed in an attempt to reduce extremity pain. Procedures should be performed by individuals who have significant experience performing selective nerve blocks as well as other spinal injection procedures. Precise needle position is critical because there are structures immediately adjacent to the nerve root sheaths that must be avoided.
The duration of injection is recorded along with the pre-injection pressure and injection endpoint characteristics. During the procedure, the patient is asked to describe in detail what they experience. The patient may be asked to complete a pain diagram, showing the distribution of pain associated with disc assessment. If the chief complaint is reproduced at a particular disc level the pain is considered to be concordant. After evaluation of an involved disc, an anesthetic is injected into the disc prior to needle removal. This usually will relieve the associated pain within a few minutes. The most frequently requested levels of discography are at L2-L3, L3-L4, L4-L5, L5-S1, and all segments of the low back.
Indications for procedure and the use of discography: Discography can be an important tool in the evaluation of pain of spinal origin. With the development of new interventional techniques for disc problems, discography is no longer simply a procedure used to determine the site of the spine that may respond to surgical fusion.
Indications for the procedure include those individuals who have chronic low back pain, which has not responded to conservative approaches. The role of discography should be considered in cases where other procedures have failed such as joint blocks and epidural steroid injections. In summary, discography should be considered for the patient whose attending physician believes the pain is of primary discogenic origin and the pain is creating disability and/or reducing the quality of life.
Selective Nerve Blocks
Selective nerve blocks are utilized for diagnostic and/or therapeutic purposes. They are generally performed in an attempt to reduce extremity pain. Procedures should be performed by individuals who have significant experience performing selective nerve blocks as well as other spinal injection procedures. Precise needle position is critical because there are structures immediately adjacent to the nerve root sheaths that must be avoided.
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