Pain Management
Non–Surgical Treatments
 Interventional therapy can ease chronic pain by blocking nerve conduction between specific areas of the body and the brain. Approaches range from injections of local anesthetics, steroids, or narcotics into affected soft tissues, joints, or nerve roots to more complex nerve blocks and spinal cord stimulation. When extreme pain is involved, low doses of drugs may be administered by catheter directly into the spinal cord. Although the pain management procedures look simple, extreme care should be exercised during the procedures. Specialists performing these procedures should be well-trained and experienced. At Elmhurst Orthopaedics we have board certified anesthesiologist doing these procedures on site.
- Cervical Epidural Steroid Injection: Injections that deliver strong anti-inflammatory medicine into the epidural space of the spinal cord in the neck region.
- Discography: Performed under X-ray guidance, a needle is advanced to the suspected painful discs and a dye is injected. This procedure is done to confirm or deny discogenic pain.
- Lumbar Epidural Steroid Injection: Injections that deliver strong anti-inflammatory medicine into the epidural space of the spinal cord in the lower back.
 Sacroiliac Joint Steroid Injection: Injections for pain and inflammation that originate from the sacroiliac facet joints in the lower back where the pelvis joins the spine.
- Facet Joint Injection: Injections for pain and inflammation that originate from one or more facet joints.
- Lumbar Sympathetic Blocks: Injections for pain and inflammation that are delivered to the sympathetic nerves in the lumbar region.
- Medial Branch Blocks: Injections for pain and inflammation delivered to the medial branch nerves. These injections may be indicated for facet joint pain that is unrelieved from facet joint injections.
Surgical Treatments
Surgical treatment is the last resort in serious cases, when other therapies do not relieve the pain caused by back problems. Some surgical procedures can be performed under local anaesthsia while others may require a hospital set-up. Surgical treatment is considered when there is damage to the peripheral nerves and the patient is suffering from a progressive neurologic disease.
Discectomy: It is a surgical procedure performed on the spine for the removal of the fragment of slipped disc. Slipped disc is also known as bulging disc or herniated disc.
Slipped disc occurs when the inner core of the spinal disc bulges out through the outer layer of the disc. This fragment may press the spinal cord and the nerves that surround the spinal cord. This pressure causes the symptoms of slipped disc. Here the surgeon uses the small incision to look at the actual herniated disc, to remove the disc and relieve the pressure on the nerve. It is also called as open discectomy.
Foraminotomy: is a surgery done to enlarge the foramen (bony hole through which a nerve root come out from spinal column). Bulging discs or thickening of the joints with age can cause the narrowing of the foramen. This may lead to pressure on the nerve causing pain, numbness in the arms and legs.
IntraDiscal Electrothermal Therapy (IDET): This technique uses thermal energy to relieve pain from a cracked or bulging disc. A special needle is inserted into the disc with the help of a catheter and then heated to a high temperature for 20 minutes. The heat will thicken the disc wall and thus seal it to reduce the bulging and irritation of the nerves.
Nucleoplasty: is a technique in which radiofrequency energy is used to treat low back pain which results from herniated discs. A wand like instrument is inserted through a needle into the disc under X-ray guidance, to create an opening. The material from the disc is removed through this channel. Then the wand is heated inorder to shrink the inner tissue and seal the disc wall.
Radiofrequency lesioning: is a procedure which uses electrical impulses to block the conduction of pain signals for about 6-12 months. A special needle is inserted into the affected nerve tissue under the X-ray guidance. The needle tip is heated for 90-120 seconds in order to destroy the nerves.
Spinal fusion: is a surgical procedure done for the treatment of upper and lower spine problems. The spinal disc present in between two or more vertebrae is removed and the adjacent vertebrae are joined with the help of bone grafts and/or metal devices.
It is mostly done in the lower back (lumbar region) joining two or more spinal bones to avoid the motion between them. This prevents the stretching of nerves and surrounding ligaments and muscles.
Anterior spinal fusion is a procedure where the surgeon makes an incision on the patient’s front part of the body.
Posterior spinal fusion is a procedure where the incision is made on the patient’s back exposing the spine.
Spinal Laminectomy: (to increase the size of the spinal canal and relieve pressure on the spinal cord and nerve roots.
Laminectomy is a surgical procedure to remove the portion of the lamina (roof) of the spinal bone to increase the size of the spinal column. It helps to relieve the pain caused by the pressure on spinal cord and nerves as a result of narrowing of the spinal column. The procedure removes bones and damaged discs and makes space for spinal nerves and column.
In a traditional laminectomy, the incision made is large and the overlying muscles must be cut.
In a minimal invasive technique very tiny incisions are made, the back muscles are moved aside and the lamina is removed.
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