Epidural block- Epidural injections are recommended to provide pain relief and enable patients to progress with their rehabilitation. Epidural injections may be an effective nonsurgical option for common conditions such as lumbar disc herniation, degenerative disc disease, and lumbar spinal stenosis.
There are basically three types of epidural blocks
Caudal epidural injection: Caudal is the Latin word signifying the tail, or tail end of the spine. Thus, a caudal injection is the location where the epidural steroid is placed. The spinal needle is introduced through a portion of the sacrum. A small bony opening, called the sacral hiatus, is entered with the spinal needle under X-ray guidance. This technique is often preferred in patients who have had previous surgeries causing scar formation that would interfere with injection at other locations. It is also sometimes the preferred place of injection for patients with spinal stenosis. This is a relatively safe, easy procedure to perform and can provide significant anatomical coverage of the injected medications. It is not one of the more specific, localizable procedures.
- Transforaminal epidural injection: A transforaminal epidural steroid injection (selective nerve root block) is a procedure performed for both diagnostic and therapeutic purposes for neck/back pain and limb pain, numbness, tingling or weakness. In this procedure, a needle is directed under fluoroscopic (X-ray) guidance through the foramen or opening where the spinal nerve exits at the level where the disc and nerve injury has occurred. The medication – anaesthetic and steroid – is delivered specifically between the disc and nerve interface and along the course of the nerve which is causing the majority of the symptoms.
- Interlaminar (translaminar) injection: An interlaminar epidural steroid injection is an approach in which a needle is advanced to a site specific to the injury. The level of injury is viewed under fluoroscopy, and the needle is advanced between two vertebrae to a depth that puts it in the epidural space. The epidural space is a space overlying the spinal cord. As the needle advances, it goes past the bony shelves of the back portion of the vertebrae and stops before entering the spinal cord or spinal space. The injected material is placed over this region to then bathe the areas of interest
Radiofrequency neurotomy (also called radiofrequency ablation or lesioning) is a minimally invasive procedure that can provide lasting relief to those suffering from facet joint pain. In fact, multiple clinical studies show that radiofrequency neurotomy significantly reduces pain severity and frequency for 1 to 2 years in the majority of patients.
Radiofrequency neurotomy involves applying heat to certain nerve pathways to "shut off" the transmission of pain signals to the brain. It is performed on an outpatient basis and requires only local anaesthetic and mild sedation, alleviating the possible complications of open surgery and general anaesthesia. It has a high success rate [ low complication rate.
- Benefits of radiofrequency ablation include: Pain relief for up to 2 years
Significant and longer lasting pain relief compared to steroid injections
Low complication and morbidity rates
Appreciable pain relief compared to surgery: Nearly half of back pain sufferers are not helped by surgery
Greater range of motion
Lower use of analgesics
Improved quality of life
Short recovery time
PROCEDURE-Radiofrequency neurotomy is performed in an awake patient under local anaesthesia.. Using x-ray guidance, a needle and electrode is inserted at the designated site. Once the correct placement is confirmed after sensory and motor stimulation, a high-frequency electrical current is passed through the electrode, heating up and lesioning the sensory nerve. Once the procedure is complete, the needle and electrode are removed.
OZONE NUCLEOLYSIS-Ozone nucleolysis or ozone discectomy is a non-operative intervention for slipped disc / disc prolapse & discogenic pain.
It is done usually under local anaesthesia. The patient is put in prone position i.e. lies on his stomach. A needle is introduced into the diseased disc under fluoroscopic guidance after local anaesthesia has been given. The position of needle tip may be confirmed by injecting some small amount of radio-opaque dye. Then some 7-8 cc of oxygen-ozone mixture (at a concentration of 29 microgram/ml.) is injected into the disc. Ozone at this concentration is not all harmful for the surrounded tissue. So if ozone spreads to the surrounded tissues including spinal cord causes no harm. . For injection it is always freshly prepared on site (from an ozone generator) for immediate administration. . While needle with the syringe is taken out some amount of oxygen-ozone mixture is also injected into the paraspinal muscle and para-radicular soft tissue to reduce nerve root inflammation and increased oxygenation of the para-spinal muscles. Some 15 to 30 minutes is required to perform the total procedure depending on the experience of the interventionist.