Pain physician
-
Two major portals are available for delivery of medication into the cervical epidural space: interlaminar and transforaminal. The choice of which approach to use is commonly made by assessing the patient's structural pathology, one's skill in performing each procedure, and then weighing the advantages versus the risk associated with the particular technique. Over the past several years, a growing number of cases involving serious complications following cervical transforaminal epidural steroid injections have led some to question the safety of the procedure and to preferentially perform interlaminar epidural injections. ⋯ When performed by experienced interventionalists, major complications are probably rare and it could take years for a significant complication to occur. We must however all be aware that these complications can occur.
-
Percutaneous disc decompression using Coblation (Nucleoplasty trade mark) implements the principle of volumetric reduction to achieve disc decompression and reduce intradiscal pressure. Previous analyses have shown that Nucleoplasty achieves reduction in volume and intradiscal pressure with minimal damage to surrounding tissue in the treated disc. ⋯ Nucleoplasty for disc decompression is one of the least-invasive techniques in the minimally invasive category, thus far exhibiting a very low incidence of complications. Although no long-term data are available, these preliminary results indicate that the Nucleoplasty procedure is a safe and moderately effective procedure for reducing pain in patients presenting with predominant discogenic low back pain associated with contained disc herniation.
-
The stellate ganglion block has been utilized in a variety of painful conditions ranging from sympathetically mediated pain in the upper extremity to the pain associated with intractable angina. A number of techniques are used to block the stellate ganglion.
-
Based on responses to controlled diagnostic blocks of cervical facet joints, the prevalence of cervical facet joint pain in chronic neck pain has been shown to range from 54% to 67%, with false-positive results of 27% to 63% with a single diagnostic block. Other confounding factors claimed to influence the diagnostic validity of cervical facet joint blocks include administration of anxiolytics and narcotics prior to or during the procedure. ⋯ The administration of sedation with midazolam or fentanyl is a confounding factor in the diagnosis of cervical facet joint pain in patients with chronic neck pain. However, if > or = 80% pain relief with ability to perform prior painful movements is used as the standard for evaluating the effect of controlled local anesthetic blocks, the diagnostic validity of cervical facet joint nerve blocks may be preserved.
-
Spinal endoscopy is a useful tool for the management of intractable low back or radicular pain originating from post lumbar laminectomy syndrome, epidural scarring, or disc protrusions, and non-responsive to conservative modalities and other interventional techniques including fluoroscopically directed epidural steroid injections and percutaneous adhesiolysis. Spinal endoscopy requires that the caudal canal be entered via the sacral hiatus. ⋯ In such cases, the procedure is stopped because of the absence of an alternative approach to enter the epidural space with the spinal endoscope, resulting in non-availability of this treatment. This report describes a novel method of dealing with the problem of cartilaginous obstruction of the sacral hiatus, using a mini-surgical approach to decompress the hiatus, allowing access into the caudal canal.