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Inside
the spine:
The spinal column is made up of five sections
and consists of 33 bones known as the vertebrae.
Get an inside look of the spine you won't
find anywhere else!
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Introduction
Our physicians have special
training in the diagnosis and treatment of musculoskeletal
problems with an emphasis on spinal disorders. While most
patients do not require surgery, they may benefit from some
form of non-operative management of their spinal problems.
The Institute provides a wide array of these services for
the benefit of our patients. A large number of patients are
managed with education, medications, activity modification,
and physical therapy. In addition, we offer non-surgical diagnostic
and therapeutic procedures.
Spine Interventional Procedures
A variety of procedures may be helpful in identifying the
source of pain and alleviating symptoms. The physician bases
the type of injection offered on the individual's specific
symptoms, the physical examination, and the imaging studies
reviewed. A procedure may be used by itself or in conjunction
with other measures as part of a comprehensive rehabilitation
program. These injections, with the exception of trigger point
injections, are performed as an outpatient procedure at a
hospital or surgery center. They may provide pain relief for
several months or longer and may be repeated to some extent
depending on one's clinical progress. The goal of the injection
is to decrease pain to facilitate rehabilitation activities.
For the procedure itself, the individual will
lie on an exam table, either on the back or stomach. A sedating
medication may be administered intravenously. The physician
will cleanse the injection site before injecting a local anesthetic.
Using x-ray guidance (fluoroscopy), a spinal needle will be
advanced toward the target area. In general, small gauge needles
are used. Radiographic dye is used to confirm adequate and
safe needle placement before injecting the medications themselves.
The medications may include a mixture of anesthetics and steroids.
More than one injection may be performed on the same day,
as most procedures can be performed within thirty minutes.
The patient will then be transported to the recovery area
for a short while before being discharged. Typically, one
can resume usual activities by the following day. However,
we recommend avoiding physical work or exercise for five to
seven days.
These injections are generally considered safe.
However, serious side effects can rarely occur. You will see
a physician in the office to discuss risks and benefits of
the procedure.
How do I prepare for an interventional (non-surgical)
spine procedure?
- Advise your physician if you are currently being treated
for any infection, taking blood thinners (Coumadin, Plavix,
or Heparin), have a history of bleeding disorder, or have
a history of iodine dye allergy.
- Arrive at the specified "Check-In" time for your appointment.
- Procedure time generally ranges from 20 to 45 minutes,
but plan on being at the hospital or surgery center for
2 to 3 hours for admitting and observation after the procedure.
- You will be kept on a gurney for observation for approximately
30 minutes to 1 hour after the procedure. Ask your physician
when you can return to work.
- An IV will be started to permit access for medication
should sedation be necessary for comfort (this may vary).
PLEASE arrange for someone to drive you home. Do not drive
for 12 hours after the procedure (even if sedation is not
administered).
- Do not take any Aspirin or Aspirin-containing medications
for 7 days before the injection - NO Motrin, Feldene, Naprosyn,
Advil, Voltaren, Disalcid, Anaprox, Relafen, Ansaid, Lodine,
Aleve, Nuprin or other "anti-inflammatory" medication 3
days before the injection. It is OK to take Tylenol, Norco,
Vicodin, Darvocet or Codeine.
- Advise the nurse at the hospital of any drug allergies
you may have.
- DO NOT EAT OR DRINK ANYTHING PAST MIDNIGHT JUST PRIOR
TO THE PROCEDURE. YOU MAY TAKE YOUR REGULAR MEDICATIONS
WITH A SIP OF WATER.
- If there is any possibility that you might be pregnant,
you should NOT have this procedure due to x-ray procedure.
After the Procedure
- Do not drive, operate machinery or sign any legal documents
for 12 hours after the procedure (especially if sedation
was administered)
- Icing the area of injection 20 minutes at a time, 4 times
a day for 1-2 days following the procedure will reduce local
muscle soreness. You may experience injection area achiness
and stiffness for 2-3 days.
- Improvement in your baseline condition may be noted as
early as 2-3 days, but may take 2 weeks for significant
effects to be noted.
- Avoid excessive exercise even if you are feeling great,
for at least one week.
- If you are currently in physical therapy, resume 5 days
following the injection. If your Physical Therapist is unsure
of what to do following the injection, have him/her call
your physician.
- You may resume regular medications immediately.
- We will call you after the procedure to check on you and
arrange your follow-up visit.
- Call your physician if you have any problems related to
the injection procedure.
Potential Adverse Effects
- Possible side effects of steroids: These usually last
only a few days and include flushing of the face, fluid
retention, stomach irritation, mood changes, insomnia, headache,
increased heart rate, elevation in blood sugar levels, menstrual
cycle changes, and facial flushing.
- Bleeding and infection tend to be the leading factors
yet only occur with very little frequency (<1%)
- Allergic reactions to the mediations, i.e., local anesthetic,
steroid and radiographic dye.
- Although serious complications are extremely rare, they
may include nerve damage, seizures, stroke, paralysis, collapsed
lung and death.
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