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What Is Intradiscal Electrothermal Therapy And How Does It Work?

This is a fairly new technique that is slightly invasive. It is performed in cases when patients experience chronic discogenic back pain. It is believed that the discogenic back pain takes place due to the intervertebral disc degeneration. As indicated by research, discogenic pain occurs somewhere in the range of 28% and 43% of back pain cases in the United States. Moreover, additional researches have demonstrated that discogenic pain is one of the main reasons for low back pain in the United States.

Numerous patients going through discogenic back pain respond to traditional treatment alternatives including non-steroidal anti-inflammatory drugs (NSAIDs), exercise, and physical therapy. On the other hand, there are a few patients who fail to respond to these treatment strategies. Unfortunately, there are very few treatments accessible for patients amongst these traditional techniques and surgery. Nonetheless, intradiscal electrothermal therapy is a comparative traditionalist treatment strategy that can be offered to patients rather than surgical procedure.

How Does Intradiscal Electrothermal Therapy Work?

As we age or due to an injury, the tears or cracks occur in the walls of the intervertebral disc. These tears can end up filled with small nerve endings and blood vessels, however, in some cases, this turns out to be chronic pain. In principle, the intradiscal electrothermal therapy works in a way to thicken and strengthen the disc wall by applying controlled heat to the disc wall.

To begin with the procedure, a small tube known as a catheter is inserted into the disc with fluoroscopic direction. The catheter is then moved to accomplish a 360-degree entrance. Heat is brought into the disc by means of the catheter, steadily advancing around 150° F to roughly 200° F. The whole intradiscal electrothermal therapy is performed on an outpatient premise and just requires around 60 minutes, with an extra hour of recuperation time.

A few patients state quick relief from discomfort, however, all things considered, noteworthy relief and improvement in function happen as the disc heals. This procedure, for the most part, takes four to twelve weeks. Patients usually come back to a basic routine within one week of the procedure. After around six weeks, progressively strenuous physical activity, in combination with a formal spinal- strengthening program, may start.

Conclusively, intradiscal electrothermal therapy is a generally conservative treatment alternative that is accessible to patients who go through discogenic pain that has been unsuccessful to respond to customary treatment techniques. Different research studies have demonstrated the safety and adequacy of this procedure and have demonstrated positive outcomes for the usage of this technique in patients experiencing discogenic pain.

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Intercostal Nerve Block Procedure, Anatomy and Benefits

This procedure is utilized to deal with pain in the chest and upper abdomen areas. The intercostal nerve is situated between ribs all through the thoracic area. In order to ease inflammation of these nerves, the anesthetics, steroids, or other medications are injected as they inhibit the transmission of pain signals. The procedure of the intercostal nerve block may likewise be utilized to diagnose pain and distinguish the direction of the pain signal. Following conditions can be treated with this procedure:
• Neuropathic pain in the chest related to herpes zoster or shingles
• Postoperative pain of chest or upper abdominal surgery
• Chronic pain after mastectomy
• Rib fracture pain
• Pain associated with the formation of scar tissue after surgery
• Somatic pain secondary to metastatic cancer to the ribs
The intercostal nerve conveys pain signals from the muscles, bones, and skin to the brain, and a block can be successful in easing pain without the adverse effects of opioid pain medications. It is easy for the physician to access the nerve. A single intercostal nerve block may result in permanent help with discomfort.

Anatomy of Intercostal Nerve Block

The intercostal nerves begin from 12 paired thoracic nerve roots that are closely connected with the thoracic ribs. As the thoracic nerve roots emerge from the intervertebral foramen, they quickly split into the ventral rami that structure the intercostal nerves and the posterior rami. Anterior branches structure the gray and white rami communicantes of the thoracic sympathetic chain. The posterior rami innervate the zygapophyseal joints, muscles and skin of the thoracic midline and paraspinous region of the back.
The lateral cutaneous nerve splits into the back and anterior branches that innervate the skin of the chest wall from the scapular line to the midclavicular line. The intercostal nerve proceeds anteriorly inside the costal groove between the internal intercostal muscle layer and the external area of the innermost intercostal muscle, yet as it advances anteriorly, it once more emerges internally to the deepest intercostal muscle.

Advantages of Intercostal Nerve Block

This is a short outpatient procedure that is suitable for easing the pain of the muscles, bones, and skin in the chest and upper abdomen. Patients having hard to treat neuropathic or metastatic bone cancer pain may observe an intercostal nerve block lessens their pain or get rid of it. The intercostal nerve block is a decent alternative to opioid pain medications, which convey adverse effects the patient will most likely be unable to endure. On the off chance that the procedure is effective, the patient is a suitable candidate for repeat injections to treat repeating pain.

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Intercostal Nerve Block Procedure, Anatomy and Benefits

This procedure is utilized to deal with pain in the chest and upper abdomen areas. The intercostal nerve is situated between ribs all through the thoracic area. In order to ease inflammation of these nerves, the anesthetics, steroids, or other medications are injected as they inhibit the transmission of pain signals. The procedure of the intercostal nerve block may likewise be utilized to diagnose pain and distinguish the direction of the pain signal. Following conditions can be treated with this procedure:

  • Neuropathic pain in the chest related to herpes zoster or shingles
  • Postoperative pain of chest or upper abdominal surgery
  • Chronic pain after mastectomy
  • Rib fracture pain
  • Pain associated with the formation of scar tissue after surgery
  • Somatic pain secondary to metastatic cancer to the ribs

The intercostal nerve conveys pain signals from the muscles, bones, and skin to the brain, and a block can be successful in easing pain without the adverse effects of opioid pain medications. It is easy for the physician to access the nerve. A single intercostal nerve block may result in permanent help with discomfort.

Anatomy of Intercostal Nerve Block

The intercostal nerves begin from 12 paired thoracic nerve roots that are closely connected with the thoracic ribs. As the thoracic nerve roots emerge from the intervertebral foramen, they quickly split into the ventral rami that structure the intercostal nerves and the posterior rami. Anterior branches structure the gray and white rami communicantes of the thoracic sympathetic chain. The posterior rami innervate the zygapophyseal joints, muscles and skin of the thoracic midline and paraspinous region of the back.

The lateral cutaneous nerve splits into the back and anterior branches that innervate the skin of the chest wall from the scapular line to the midclavicular line. The intercostal nerve proceeds anteriorly inside the costal groove between the internal intercostal muscle layer and the external area of the innermost intercostal muscle, yet as it advances anteriorly, it once more emerges internally to the deepest intercostal muscle.

Advantages of Intercostal Nerve Block

This is a short outpatient procedure that is suitable for easing the pain of the muscles, bones, and skin in the chest and upper abdomen. Patients having hard to treat neuropathic or metastatic bone cancer pain may observe an intercostal nerve block lessens their pain or get rid of it.  The intercostal nerve block is a decent alternative to opioid pain medications, which convey adverse effects the patient will most likely be unable to endure. On the off chance that the procedure is effective, the patient is a suitable candidate for repeat injections to treat repeating pain.

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Intrathecal Pump Therapy Procedure and Possible Complications and Who Are the Suitable Candidates for Intrathecal Pump Therapy

This is a technique for delivering medication straight to the spinal cord. In case, all other traditional techniques have been unsuccessful to relieve long term symptoms, then a pain pump might be an alternative treatment. Based on the fact that the medication is delivered straight to the spinal cord, it can work in a way to control the symptoms with a much smaller dose than is required with oral medication. The objective of intrathecal pump therapy is to efficiently control the symptoms and to diminish oral medications.

The Anticipated Outcomes after the Procedure

The patient will wake up in the postoperative recuperation facility. Furthermore, the patient’s blood pressure, heart rate, and respirations will be observed, and the pain will be addressed. In most cases, the patient is allowed to go home the same day. The patient will be provided with the written instructions to follow. Outcomes will differ contingent upon the underlying condition being dealt with and its seriousness.

Possible Complications after Intrathecal Pump Therapy

In this case, the adverse effects are minimal, in spite of the fact that they do exist. Similarly, as with all surgeries, complications may incorporate infection and bleeding. The catheter could move or end up blocked, or the pump could quit working (however, rare). The fluid can gather around the pump resulting in a clear watery discharge from incisions or result in a headache. However, these normally vanish on their own but may require a drain.

Adverse effects from the medications may incorporate:

  • Respiratory Depression
  • Twitching
  • Muscle Spasm
  • Urinary Retention
  • Constipation
  • Nausea
  • Vomiting
  • Dizziness
  • Anxiety
  • Depression
  • Edema

Contingent upon how much medication the pump delivers, the battery will eventually be required to replace.

Possible Limitations after Intrathecal Pump Therapy

The patient will be advised to stay away from particular activities for around six to eight weeks in order to avoid movement of the catheter. Moreover, no bending, twisting, stretching, raising the arms over the head or lifting heavy objects. Prevent sleeping on stomach. No climbing stairs or sitting for extensive periods.

The patient will be advised to avoid driving for 2 to 4 weeks after surgery or until examined with their surgeon. Furthermore, housework and yard-work are not allowed until the first follow-up office visit. This incorporates gardening, mowing, vacuuming, ironing, and loading/unloading dishwasher, or dryer.

Who Are The Suitable Candidates?

This procedure incorporates individuals for whom traditional treatments have been unsuccessful. The decision of treatment relies upon the sort of pain, how serious it is, and how you react to pain treatment. In the event that the doctor thinks you are a decent candidate for intrathecal pump therapy, you can go through a trial screening test so you can go through the treatment to check whether you are a decent candidate.

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What Is Kyphoplasty And How The Procedure Is Performed?

This is a slightly invasive procedure for the treatment of painful vertebral compression fractures, which are fractures relating the vertebral bodies that make up the spinal column. At the point when a vertebral body fractures, the typical rectangular shape of the bone ends up compressed, as a result, triggers the pain.

These compression fractures may include the breakdown of one or more vertebrae in the spine and are a common aftereffect of osteoporosis. Osteoporosis is a disorder that outcomes in a loss of normal bone density, mass and strength, driving towards a condition in which bones turn out to be more and more porous, and helpless against breaking easily.

In order to perform kyphoplasty treatment, doctors utilize image guidance, in most cases fluoroscopy, in order to inject a blend of cement into the cracked bone through a hollow needle.

Kyphoplasty Treatment Before and During the Procedure

Preparation for the Procedure:

Based on the fact that kyphoplasty treatment is a surgical procedure, the doctor will most likely require some blood tests prior to the day of the procedure. Furthermore, X-Ray or MRI will enable the doctor to see the area or areas that need repair.

In the process of preparation, an intravenous line will be set in a vein in order to deliver anesthesia. You may likewise get pain and anti-nausea medications, as well as antibiotics,  to avoid infection. The patient most likely additionally be connected to the heart, pulse, and blood pressure monitors.

Kyphoplasty Treatment Procedure:

In these sort of procedures, patients are required to lie down on the stomach. The area in which the needle will be inserted is shaved on the off chance that obligatory and afterwards cleaned and sterilized.

Following Are The Steps Performed By The Surgeon:

  • A hollow needle is inserted into the skin with the guidance of fluoroscopy, this is a kind of X-Ray. They guide the needle through the muscles and into the right position in the bone.
  • In the next step, an inflatable balloon is inserted into the trocar.
  • After that, the balloon is inflated in order to make the space required for the bone cement.
  • As soon as space has opened up, the blend is injected in order to fill it. In this case, imaging tests work in a way to assist the surgeon to confirm that the blend is distributed appropriately.
  • As soon as the mixture is set up, the needle is taken out.
  • After that, the area is bandaged. In this case, stitches won’t be required.
  • IV and monitoring equipment are removed.

 

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Microdiscectomy Spine Surgery’s Purpose of Procedure and Success Rate

In the case of microdiscectomy spine surgery, an exceptionally specialized procedure is performed on the spine, yet it is essentially utilized to decrease pain in another part of the body altogether. It is a fact that the spine is consists of a chain of bones each cushioned by an elastic disc that supports in both shock absorption and flexibility. On the off chance that a disc in the lower back turns out to be herniated and as a result, pushes on a spinal nerve, consequently, pain can radiate down a patient’s leg.

The procedure of microdiscectomy spine surgery is slightly invasive executed on the spine that works in a way to help most individuals feel prompt relief and return home the same or next day. The procedure is executed through a small incision, generally, one to one and-a-half – inches length, the objective of the procedure is to relieve the pressure on the affected spinal nerve by taking out a part of the bone or disc resulting in the pressure and pain.

During the microdiscectomy spine surgery, the spine’s structure remains intact, in light of the fact that this phenomenal surgery doesn’t require the cutting of joints, ligaments, or muscles. Patients who go through the procedure return to their normal life earlier, without leg pain, offering improved comfort and quality of life.

The Purpose of Microdiscectomy Spine Surgery

The key motive of this procedure is to surgically take out a part of the disc that is pushing on the nerve and hence, causing the pain. The objective is to take the pressure off the nerve yet at the same time retain as much of the disc as could be possible. The whole disc isn’t taken out, only the herniated part. The process usually takes on an average l around 60 minutes.

A timely return to normal routine is depicted with three exceptions. Heavy lifting, bending from the waist and delayed sitting are discouraged for the initial six weeks after surgery. Most patients can go up and down stairs when they return home from the hospital.

Success Rate of Microdiscectomy Spine Surgery

As per the statistics, the success rate of the procedure is commonly high, one extensive medical study presenting good or astounding outcomes generally for 84% of individuals who have gone through the strategy.

The report additionally indicates a few advantages for surgery, when contrasted with nonsurgical treatment, however, the distinction diminishes after some time in specific cases. One vast examination found that individuals who had surgery for a lumbar herniated disc had more noteworthy improvement in symptoms for as long as two years than the individuals who did not have surgery.

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Racz Epidural Neurolysis Benefits and Suitable Candidate

In the case of RACZ epidural neurolysis, a series of injections or an injection utilized in the area of the spine. This method is utilized as a treatment for chronic back pain. The repeated injections are utilized four times during the two days in house treatment. It is a fact that the back pain most of the times is complex and has numerous causes. Going through interventional pain treatment for chronic back pain has demonstrated that the pain frequently takes place because of scar tissue that is either from injury, disc herniation, or past back surgical procedure.

In most cases, RACZ epidural neurolysis can work in a way to avoid the requirement for spinal surgery with chronic back pain and sciatic pain. Based on the fact that the treatment can possibly give prompt and vital long term ease from chronic pain and uneasiness in the lumbar spine, without the requirement for spinal surgery. Furthermore, this treatment is also successful in easing lower back pain and transmitting sciatic pain.

How Can The Doctor Determine, In Case, The Racz Epidural Neurolysis Treatment Is Feasible For You?

The treatment is only suggested in conditions of extreme, chronic pain. Patients are required to have somewhere around three months history of unsuccessful, conventional treatment, for back or sciatic pain in order to be a suitable candidate for RACZ epidural neurolysis. In most conditions, RACZ epidural neurolysis can likewise turn out to be effective after a successful micro-surgical nerve decompression, as this surgical procedure can leave the spine with agonizing surgical scarring, or annoyance in the region of the spinal cord.

Nerve root irritation can be determined through MRI-imaging. Around six weeks ought to be allowed in the middle of the recent epidural injection and the RACZ catheter for security reasons.

Advantages of Racz Epidural Neurolysis

The procedure totally maintains a strategic distance from tissue injury. The procedure utilizes the natural openings in the spine so as to get to the epidural space. Thus it turns out to be the least invasive type of surgical pain therapy accessible. The treatment is mainly useful after unsatisfactory outcomes from micro-surgical treatment (open spine surgery). Contingent upon conditions, up to 50% of patients feel no adequate relief from pain following micro-surgery, despite the fact that the essential issue ought to have been addressed.

The zone around the spine is especially weak for surgical procedures because of its high density of nerve tissue. Scar formation after open spinal surgery can potentially drive towards chronic irritation and loss of function, in this way making a secondary issue.

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The Radiofrequency Lesioning Procedure and Benefits

Briefly, the procedure of radiofrequency lesioning is a slightly invasive, outpatient method that utilizes radiofrequency energy with an objective to terminate damaged nerves or nervous tissue that work in a way to send pain signals to the mind. In most cases, the specialists recommend radiofrequency lesioning treatment for individuals who have not reacted well to other interventional pain management treatments, for example:

  • Epidural Steroid Injections
  • Or Nerve Blocks

Prior to performing radiofrequency lesioning, patients usually go through a process of a diagnostic nerve block with an objective to decide whether the treatment will be fruitful.

Who Gets Advantages From Radiofrequency Lesioning Treatment?

In most cases, the experts perform the procedure on individuals with chronic pain resulted from damaged peripheral nerves (sensory nerves) or nervous tissue surrounding the central nervous system (brain and spinal cord). Particular conditions that come under this type for the most part include:

  • Trigeminal neuralgia (chronic facial pain)
  • Occipital nerve neuralgia
  • Degenerative disc disorder
  • Post-herpetic neuralgia
  • Complex Regional Pain Disorder
  • Peripheral neuropathies
  • Coccydynia
  • Neck or back pain because of facet joint arthropathy

Who Is The Candidate For Radiofrequency Lesioning Treatment?

Radiofrequency lesioning treatment is recommended to individuals with specific sorts of low back or neck pain. To begin with the procedure, you are required to respond well to diagnostic local anesthetic blocks to be a suitable candidate for radiofrequency lesioning treatment. The effectiveness of the treatment will be dependent upon how well you react to the “temporary” or diagnostic block.

How Radiofrequency Lesioning Performed?

Based on the fact that nerves can’t be seen on x-ray, the needles are situated utilizing bony landmarks that work in a way to show where the nerves typically are. Fluoroscopy is utilized to distinguish those bony landmarks. After needle placement, very low voltages are applied to the needle in order to test for appropriate placement. Once it is confirmed that the needle is in the correct place, a little measure of local anesthetic is injected. Once the nerve is appropriately numbed, higher voltages of radiofrequency are applied and the nerve, as a result, nerve heats to the required temperature.

How Painful Is The Radiofrequency Lesioning Treatment?

The majority of the procedures start by injecting a little measure of local anesthetic through an extremely small needle. It senses similar to a pinch and after that, a slight burning as the local anesthetic begins numbing the skin. Once the skin is numb, the needle feels like a touch of weight at the injection area. A great number of individuals decide to be drowsy or more vigorously sedated for these procedures.

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Spinal Cord Stimulation Patient Criteria and Potential Benefits

Chronic pain is termed as long-lasting pain that keeps going than the standard recuperation time frame or that goes with a chronic health condition. Since this pain isn’t protective and isn’t an aftereffect of current injury, it is indicated to as “pathological” and is consequently treated as a condition, not as a symptom. Chronic pain may keep individuals away from working, eating appropriately, taking part in physical activity or enjoying life.

In the procedure of spinal cord stimulation, the technique is utilized to relieve pain that delivers a low-voltage electrical current constantly to the spinal cord in order to block the sensation of pain. Spinal cord stimulation is the most generally utilized implantable neurostimulation innovation for management of pain syndromes.

As per the research, around 50,000 neurostimulators are implanted worldwide every year. Furthermore, the procedure of spinal cord stimulation is broadly recognized, and also FDA- approved medical treatment in order to treat chronic pain of the trunk and limbs, that include:

  • Back
  • Legs
  • Arms

Moreover, there are three spinal cord stimulation devices types:

  • In the case of conventional systems, this needs minor effort on the patient’s end for maintenance. Yet, a slight surgery is needed to replace the power source when it runs out.
  • The second one is the radiofrequency. In this procedure, the system is intended to support therapy over long periods at the highest output level. On account of its powerful abilities, this system is appropriate for the most difficult cases in which there is complex, multi-extremity pain. With the radiofrequency system, the patient is required to wear an outer power source to trigger stimulation.
  • The recent advancement in the spinal cord stimulation is the rechargeable system. In this case, the patient is required for recharging the power source in case it runs low. As per the fact, a rechargeable system commonly keeps going longer than a customary system.

The Criteria of Patient Selection for Spinal Cord Stimulation:

  • Pain isn’t related with malignancy
  • Unsatisfactory reaction to conventional treatment for at least six months
  • Revision surgical procedure is impossible or would have a low possibility of success
  • No pacemaker or other medical contraindications
  • No critical psychiatric complications, including somatization
  • Readiness to stop unsuitable medication use before implantation
  • No related litigation
  • Capability to give informed consent for the technique

What Are the Potential Advantages of Spinal Cord Stimulation?

This technique is a type of neuromodulation that works in a way of blocking pain signals in nerves from getting the brain. Furthermore lessening pain, and other vital advantages are as follows:

  • Enhanced functioning
  • Better activity and mobility
  • Lessened opioid [narcotic] use
  • Less requirement for other pain medications
  • Less reliance on bracing
  • Better sleep

The results differ from individual to individual, and it is critical to comprehend that spinal cord stimulation may work in a way to help decrease pain, yet not dispose of it.

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What Is Selective Nerve Root Block And What Are The Risks And Complications?

Selective nerve root block is another standard injection is fundamentally utilized to analyze the particular source of nerve root pain and, secondarily, for therapeutic help of low back pain and additionally leg pain.

At the point when a nerve root ends up compressed and inflamed, as a result, it can create back or leg pain. At times, an imaging study may not obviously demonstrate which nerve is triggering the pain and selective nerve root block is performed with an objective to help with disconnecting the cause of pain. Additional to its analytic function, this sort of injection for pain management can likewise be utilized as a treatment for a far lateral disc herniation.

The Experience during Selective Nerve Root Block 

The procedure is carried out by a specialist with the patient requiring lying on the stomach on an X-Ray table. The doctor utilizes fluoroscopy with an objective to find the particular nerve root. Moving forward with the procedure, the doctor inserts a needle into the area, then the medication and an anesthetic are inserted. This step requires only a couple of minutes.

After the injection, the patient is observed for around 15-20 minutes and after that discharged. Most individuals begin observing relief after the third to seventh day, which can endure weeks or months. On the off chance that the initial injection does not produce fruitful results within one to two weeks, the specialist may prescribe another injection. In most cases, specialists limit in injections to three in a year time.

Selective Nerve Root Block Outcomes

Instantly after the injection, the patient may feel legs or arms, along with that particular nerve root, getting slightly heavy or numb. The patient may observe that the pain might be gone or significantly less. This is because of the impact of the local anesthetic and keeps going just for a couple of hours. The pain may return and the patient may have some soreness at the injection site for a day or so.

The patients are usually advised to relax for a day or so after the selective nerve root block. Execute the activities as endured by them. The recuperation room nurse will recommend applying ice to the site.

Risks and Complications after Selective Nerve Root Block 

Comparatively, the selective nerve root block does not have many risks. Though, similarly as with any procedure, there are a few risks and complications. Most observed adverse effects are enhanced pain from the injection (normally short term), hardly ever inadvertent puncture of the “sack” containing spinal fluid (may result in headaches). Further complications include:

  • Infection
  • Bleeding
  • Nerve damage
  • Or no easiness from usual pain
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