Diagnostic Facet Injections

 A common diagnostic procedure in these cases is the diagnostic facet injection.  Targeted placement of anesthetic in the small "knuckle like joints of the spine" may reveal them to be the primary source of pain in many patients.  Alternatively, some patients may require a test of the intervertebral disc space, which involves stimulating the disc with fluid designed to reproduce the pain and reveal microscopic injury or disease of the disc that is frequently invisible on MRI and x-rays.
 

What Happens During the Procedure?

Spinal diagnostic tests are performed in a specialized x-ray suite, using state of the art fluoroscopic equipment.  This allows the physician to precisely steer a spinal needle toward the anatomic abnormality in question, such as a bone spur or disc.  Once accurate placement is achieved, a small amount of lidocaine is injected to temporarily remove the pain caused by that bone spur or disc.  This is the best predictor of the ultimate effect of removing the spur or disc.

The procedure is usually not painful and immediately after, the patient is typically able to move about freely.  In all cases, except the discogram, it is desired that the patient presents for the block while experiencing some of their typical pain, in order for the block to have effect upon.  Skipping a pain tablet and provoking the pain with mild activity is helpful at times.

Minimally invasive spine surgery succeeds in large part due to the skill and experience of our surgeons in identifying the primary target in the spine responsible for the pain and selectively decompressing the nerve in that spot. Once the patient is evaluated and examined and the MRI is reviewed, the need for a diagnostic test will be considered.

Spine Treatment: More Than Meets the Eye

Conventional imaging studies such as an MRI, provide the foundation of the surgical order, however, often, the MRI shows abnormalities that are in fact asymptomatic.  Careful assessment of patients' symptoms and comparing them to the imaging study usually allow the surgeon to plan the operation only on necessary areas.  However, in some patients, the MRI is inconclusive in appearance. In those cases, selective pre-operative diagnostic injections are ordered.

 For patients with primarily neck or lower back pain, the MRI may not fully identify the exact area causing pain, as some spine conditions result from microscopic injury or disease.  In those cases, diagnostic injections can locate the areas of pain and allow surgery to be performed on the correct area based upon knowledge of those unseen, but now understood abnormalities.


Selective Nerve Root Block (SNRB)

For patients with the appearance of more than one area of nerve root compression, there may be a role for a selective nerve root injection.  In this test, the suspected nerve root is identified and then "blocked" using x-ray guided placement of an anesthetic agent (lidocaine) to determine what symptoms are resulting from that area of compression.  The immediate relief is reported in a percentage of reduction in pain and those results are then used to develop the final surgical order.  In cases, the results are negative or no relief and a second area may need testing.  In other cases, it may be determined that more than one area is involved and so may require additional surgery at a later date.

In part three, we will discuss additional diagnostic tests and explain what happens during these procedures.

Dr. Robert Gruber is the Director of Spinal Diagnostics and Therapeutics at Laser Spine Institute. Click here to learn more.

As promised, below are additional tips to help you enjoy your holiday activities, while protecting your spine. The Center for Disease Control (CDC) also has excellent tips on general holiday safety, so I encourage you to visit their website. Happy Holidays!

Tip 3: Holiday Travel

Are you taking a long trip by car or plane? Consider a travel pillow to support your back or neck. An ice or heat pack can also be a helpful aid. When traveling with luggage, use suitcases with wheels to avoid the strain on muscles and joints from carrying on your shoulders.

Tip 4: Online Shopping

Many spend time at the computer shopping for holiday gifts online. To avoid lower back strain, sit back in a chair so your spine is fully supported. Thighs should be parallel with the floor with hips higher than your knees. The top of the monitor should be at eye level.

Holidays are generally filled with activities and chores. Whether you are stringing lights on the roof, wrapping Zhu Zhu pets or Tickle Me Elmos for your children or grandchildren, or affixing ornaments throughout the house, it is important to protect your spine. Many times, we tend to become wrapped up in the festivities and forget to exercise care. As such, I am reminding everyone to take care while you have fun. To help you, we will be providing tips throughout the holiday season on how to avoid injury.

Tip 1: Home Decorating

When putting up lights or other holiday decorations, be sure to secure yourself on a stable ladder or stepstool. Try not to reach too far to avoid injury and straining back and neck muscles. Ask a friend or relative for help with heavy boxes or bulky objects.

Tip 2: Gift Wrapping

When wrapping gifts, rotate between sitting at a table and standing at a counter as needed, in order to avoid stress on your neck and lower back. Wrapping while kneeling or sitting on the floor causes you to bend and stretch your muscles causing unnecessary stiffness and pain.

I hope that everyone had a Happy Thanksgiving and that holiday plans are falling into place. For me, Thanksgiving was quite adventurous. My wife, Charlotte, had an infection, which was the result of a prior surgical procedure. As a result, she had to be hospitalized for five days and will have to undergo infusion antibiotic therapy for four to six weeks.
 
Unfortunately, infection is one of the risks of surgery and can occur despite a surgeon's best efforts. While some surgical approaches, such as minimally invasive procedures, present significantly lower risks of infection, the possibility still exists.  However, it is important that we take all necessary steps to reduce these risks.  Below, I have included a number of steps that we take at Laser Spine Institute, as well as guidelines we provide to our patients to mitigate these occurrences.  In addition, I have shared the details to a recent study on infection risk.  I will continue to keep you posted on Charlotte's recovery.

Safety Policies and Procedures

•    LSI safety policies and procedures conform to the Accreditation Association of
     Ambulatory Health Care (AAAHC) standards and is fully accredited by this organization.

•    LSI voluntarily follows the safety guidelines of the Association of Perioperative Registered
     Nurses (AORN) standards in our facilities.
.
Complication Mitigation

One of the most common fears regarding surgery is the possibility of infection.  To minimize the risk of infection, LSI strictly adheres to the following preventative measures:

•    Sanitization - operating rooms are sanitized and maintained according to AORN, AAMI
     and AAAHC standards.
    
•    Sterilization of surgical instruments conforms to infection control practices as
     mandated by AHCA, AAAHC and AAMI.

•    Antibiotics are administered to each patient prior to surgery and for 7-10 days after
     surgery.

Patient Guidelines
 
•    Patients must follow all pre and post-surgical instructions, including antibiotic usage
     guidelines and incision site care instructions.

•    In the event that a patient experiences unexpected symptoms, you MUST contact your
     physician immediately.
 
Patient safety is an important aspect of medical operations in any facility.  Laser Spine Institute has been able to maintain an excellent safety record at our facilities by adopting and conforming to high standards and implementing extensive procedures to mitigate the risks commonly associated with surgery.
 
Click here to read infection risk study.

Q: I spend much of my time working at the computer and my neck has become stiff and what's worse - I feel a pinching sensation down my left arm. For six months, I have gone to a chiropractor. Can you help me understand where my pain is coming from and other options I might consider?

A: We often joke about our jobs or bosses being a "pain in the neck." But, some of our on-the-job habits can trigger the kind of neck pain that's no laughing matter. If you want to avoid developing neck problems, there are several things to keep in mind. Of course, if you are currently experiencing neck pain or stiffness, your doctor should rule out any serious medical causes.

Your physician should conduct a thorough clinical evaluation. Depending on your medical history, your doctor may order an MRI, which will reveal any anatomical abnormalities, such as nerve impingement or spinal stenosis.

The National Institute of Occupational Safety and Health (NIOSH) reports neck pain can develop for a number of reasons. For example, sitting at our desks, we put extra strain on the neck muscles when we:

• look down for extended periods without breaks
• cradle the phone between our neck and shoulder
• tense the muscles as we work

According to the American Association of Neurological Surgeons (AANS), there are two serious types of neck pain that require immediate medical attention. The first is dull pain in the neck that radiates down the shoulders and arms usually caused by a herniated disc in the neck pressing on the nerve root. The second sometimes isn't felt in the neck at all, that's because the pressure is on the spinal cord, causing imbalance or weakness in other parts of the body, such as the hands and arms.

While you can alleviate some of these problems through good posture and regular breaks, neck pain can also result from other factors including injury or underlying conditions. Consulting with your doctor as soon as possible is especially important if neck pain does any of the following:

• lasts for more than a week
• if it's accompanied by headache and fever
• if other symptoms are present such as numbness or tingling

It is important that the results of your treatment be directed to those levels causing your symptoms, not your MRI. Treatment can range from a conservative approach, i.e. medication, physical therapy and exercises, to spine surgery.


Dr. John Spallino is a Medical Information Specialist at LSI. In this capacity, he facilitates patient education by conducting nationwide informational seminars, in addition to interpreting and analyzing radiographic imaging. To learn more about Dr. Spallino, click here.

LSI's Ask the doctor column is also featured in our monthly newsletter, The Spinal Column. To subscribe, click here.

Tuesday, October 20th marked the 5th anniversary of one of the most important days of my life. It was exactly 5 years ago that Dr. Jim St. Louis and his incredible team performed a minimally invasive spine surgery on me that has forever changed my life. I thank God for Dr. St. Louis, Dr. Michael Perry, Dr. Glen Hamburg, Jim Stafford, and my angel, Stacy Danahy. Stacy wiped my nose, rubbed my feet, and at one point, got down and lay on the floor facing up at me to talk me through a terrible claustrophobic moment.  

Five years ago, I was a miserable human being. I had no quality of life. I was in such pain and could not imagine how I was going to make it through the rest of my life. Today, I am pain free and I feel it is my duty to continue to PAY IT FORWARD and tell the world about the great things we do at Laser Spine Institute! Since that fateful day five years ago, we have helped over 12,000 patients "get their lives back." And, thanks to our patients and dedicated staff, we should help 40,000 to 50,000 more over the next five years. We are making a huge difference every day. It is an honor and a privilege to be a part of this great company.
 
So, thank you Dr. St. Louis, Dr. Perry, Dr. Hamburg, Jim Stafford, and Stacy Danahy for changing my life and the lives of 12,000 others. It has been an incredible ride. As Tim McGraw would say, "I can't wait til the next 30 years!"

I am pleased to announce that we have partnered with United Healthcare. This new development will allow many more persons suffering from back and neck pain to access some of the most innovative spine procedures available.  Over the past year, I have communicated with many of you about the state of our current healthcare system and the challenges we face.  However, most of us can agree that our focus must be on creating solutions, though sometimes difficult to attain and often isn't achieved quickly. Today marks an exciting milestone in Laser Spine Institute's history and symbolizes a new horizon for those of you who are seeking relief through minimally invasive surgical options.

LSI's surgical team is committed to providing the most effective treatment to our patients. In order to do so, we conduct an extremely thorough evaluation process before performing surgery. One important aspect of our evaluation process is our diagnostic testing. The purpose of diagnostic testing is to identify and isolate the specific source of pain in a particular area, allowing our surgeons to provide the most appropriate and effective treatment for each patient's spine condition.

Examples of diagnostic tests performed at Laser Spine Institute include: selective nerve root block (SNRB), discogram and diagnostic facet injections. In part two of this post, our surgeons will provide detailed information about each procedure. Among the topics that will be discussed are as follows:
 
•    Instances in which each test is ordered and performed
•    How is each test performed?
•    What can patients expect during and after the procedure?

Please feel free to submit questions, whether specifically related to diagnostic testing or general spine procedures that you would like our surgeons to address in part two of this post.  While all questions will be addressed, we learn from each other, so it would be beneficial to click the Submit Questions link above to make your question visible to everyone, rather than clicking the Contact Bill Horne tab, which defaults to my personal email.