Fluoroscopic Guided Injections
Epidural Pain Management: Using local anesthetics
Patients with known diagnoses of herniated discs or pinched nerves in their neck have complaints that include numbness and tingling, as well as weakness in the arms or hands. Patient may feel weakness in the grip, holding or squeezing objects.
What is the epidural space?
The membrane that covers the spine and nerve roots in the neck is called the dura membrane. The space surrounding the dura is the epidural space. Nerves travel through the epidural space to the neck, shoulder and arms. Inflammation of these nerve roots may cause pain in these regions due to irritation from a damaged disc or from contact with the bony structure of the spine in some way.
What is an epidural and why is it helpful?
An epidural injection places anti-inflammatory medicine into the epidural space to decrease inflammation of the nerve roots, reducing the pain in the neck, shoulders and arms, as well as numbness and tingling into the arms. The epidural injection may help the injury to heal by reducing inflammation. It may provide permanent relief or a period of pain relief for several months while the injury or cause of pain is healing.
Will I be “put out” for this procedure?
No. This procedure is done under local anesthesia. This makes the visit quick and convenient where patients are able to pick up and go right after their visit.
What happens during the procedure?
The patient is placed on the injection table with stomach facing downward.The injected area is cleaned and sterilized and a local anesthetic is administered to numb the area of the injection site. After the numbing medicine has been given time to be effective, we direct a small needle, using x-ray guidance called fluoroscopy into the epidural space. A small amount of contrast (dye) is injected to insure the needle is properly positioned in the epidural space. Then, a small mixture of numbing medicine (anesthetic) and anti-inflammatory (cortisone/steroid) is injected.
Patients are able to get up and drive home after the procedure, as we do not use any general anesthesia. The procedure is performed in the office and takes approximately 30 minutes.
Facet Joint Pain Management
The small joints in your neck that guide movement back and forth, up and down and around arecalled facet joints. They are small circular joints that are surrounded by a joint capsule. Facet joints are commonly affected by arthritis and inflammation of the capsule called capsulitis. This type of condition results in stiffness and pain with ranges of motion and physical activity, in addition to the constant need to change sleep positions.
When the facet joints and capsules are the primary problem, pain is most often localized to the neck on either side, and usually does not include numbness or tingling into the arms or hands.
What is a Facet Joint Injection?
Facet Joint Injection is an injection of long lasting steroid (“cortisone”) in the facet joints, which are those that guide movement in your neck. These are actual joints with joint capsule that contains lubricating fluids.
What is the purpose of a Facet Joint Injection?
The injected steroid reduces the inflammation and/or swelling of tissue in the joint space. This may in turn reduce pain, and other symptoms caused by inflammation and irritation of the joint and surrounding structures.
How long does the injection take?
The actual injection takes only a few minutes.
What is actually injected?
The injection consists of a mixture of local anesthetic (like Lidocaine or bupivacaine) and the steroid medication (methylprednisolone – Depomedrol).
Will I be “put out” for this procedure?
No. This procedure is done under local anesthesia. This makes the visit quick and convenient, allowing patients to get up and go right after.
How is the injection performed?
It is done lying on the stomach. The skin on the back of the neck is cleaned and sterilized, and local anesthetics injected to numb the injection site. Using x-ray guidance (called fluoroscopy) a small needle is guided to the facet joint. A small amount of contrast (dye) is injected to insure the needle is properly positioned in the facet joint capsule. Then, a small mixture of numbing medicine (anesthetic) and anti-inflammatory (cortisone/steroid) is injected. In some cases where the arthritis covers several locations, more than one joint can be injected during the same visit.
Patients are able to get up and drive home after the procedure, as we do not use any general anesthesia. The procedure is performed in the office and takes approximately 30 minutes.
New Treatment Using LIPOGEMS® Could Be the Answer for Arthritis Pain
LIPOGEMS® is a new treatment option for arthritis pain now offered by Dr. Norma Bilbool, M.D., a double board certified physician specializing in Physical Medicine and Rehabilitation and Pain Medicine and Richard D. Striano D.C., RMSK Registered in Diagnostic Medical Musculoskeletal Sonography. The combination of advanced imaging techniques with ultrasound to diagnose and precisely guide treatment, and physician experience with treating all joints with minimally invasiveLIPOGEMS® has led to the majority of patients treated having significant improvement with less pan, improved function and quality of life.
LIPOGEMS® could be the solution to those who suffer from pain in the shoulder, lower back, hip, knee, ankle and other joints including the rotator. Optimum Joint, is equipped and has been performing ongoing clinical studies on the shoulder, rotator cuff, lower back, hip and ankle pain where a patient’s own fat is used to alleviate arthritis related conditions many of which have failed to respond to other treatment methods including bone-on-bone joints. Optimum was among the first practices in the USA trained in the state-of-the-art treatment through LIPOGEMS® technology that is a minimally invasive same day procedure, performed in about an hour, using local anesthetic with no sedation required and no down time. This could be the answer for many of those looking to avoid surgery.
The Autologous (fat from you and put back into you) Micro-Fragmented Adipose Tissue (LIPOGEMS®) is a NEW technology where fat is taken from the patient, using a local anesthetic, washed, and micro-fragmented, using the LIPOGEMS® system. Micro-fragmented fat using the LIPOGEMS® system mechanically supports and cushions joints, and holds regenerative capabilities and when re-injected can decrease inflammation, cushion, repair or replace defects in damaged tendons and cartilage, or other tissue.
The fat is injected using continuous ultrasound guidance to ensure pin point accuracy in treating the joint and surrounding damaged tendons to repair and restructure damaged tissue with pin-point accuracy. Research has shown non-guided “blind” injections are accurate 36% – 60% of the time while ultrasound guided injections are 100% accurate. Accuracy in delivering regenerative treatments is essential. We are evaluating the LIPOGEMS®, made with an FDA cleared device, for their ability to cushion, repair, or replace damaged tissue and the regenerative effects of the fat it contains, to jump-start repair and decrease inflammation.
“This is an extraordinary study because of its use of micro-fragmented fat tissue, which makes it more bioavailable to the area we inject, and by using the precision of ultrasound guidance the treatment is visualized being delivered to each area of the joint and tissues in need of repair. This combination of support and regenerative regenerative elements with the precision of advanced ultrasound guidance is contributing to the long term impressive results.
NEW STUDY: Adipose tissue contains Adipose Derived Stem Cells “ADSC’s” and more than 600 secreted proteins and included key molecules involved in tissue regeneration. Stem Cell Res Ther. 2015; 6: 221.
NEW STUDY: Lipogems Product Treatment Increases the Proliferation Rate of Human Tendon Stem Cells without Affecting Their Stemness and Differentiation Capability. Results showed that the Lipogems product significantly increases the proliferation rate of hTSCs (human tendon stem cells). Moreover, treated cells increase the expression of VEGF, which is crucial for tissue healing. Stem Cells International Volume 2016 (2016), Article ID 4373410, 11 pages
Dr’s Bilbool and Striano are among few doctors in the country offering IRB- approved regenerative treatment options, with a focus on minimally invasive alternatives to surgery. Their work has been recognized and new studies are being published this year.
Can an OptimumJoint traditional or regenerative medical procedure help me? To find out if you might be a candidate for an OptimumJoint medical treatment procedure, complete our Optimum Joint Procedure Candidate Form online.