Spine Services

Management of back pain, nerve pain, vertebral tumors, and spinal vascular malformations and fistulas.

Additional information is available by clicking on the links below.

 

Spine Services

Vertebral Compression Fractures

Pain Management Injections

Vertebral Compression Fractures

Spinal Vascular Malformation Embolizations

Spinal cord vascular malformations represent a heterogenous group of blood vessel disorders that affect the spinal cord parenchyma either directly or indirectly. This group consists of spinal arteriovenous malformations (AVMs) and spinal duralarteriovenous fistulas (AVF). An accurate diagnosis is critical because these lesions may represent a reversible cause of myelopathy. In the setting of spinal cord vascular malformations, myelopathy means a stepwise progression of lower extremity weakness, spasticity, clumsiness, pathological hyperreflexia and inverted Plantar reflex (positive Babinski sign), sensory deficits, bowel/bladder symptoms, and sexual dysfunction.

Lumbar Punctures & Drains

A lumbar puncture (or LP, and colloquially known as a spinal tap) is a diagnostic and at times therapeutic procedure that is performed to collect a sample of cerebrospinal fluid (CSF) for biochemical, microbiological, and cytologicalanalysis, or very rarely as a treatment (“therapeutic lumbar puncture”) to relieve increased intracranial pressure.

A lumbar drain is a small, flexible, soft plastic tube placed in the lower back to remove spinal fluid. The tube is attached to a drainage bag. A lumbar drain is often needed to collect CSF leaking from the brain or spine after surgery or to reduce pressure in the spinal cord or brain due to too much CSF on the brain.

Vertebral Augmentation (Vertebroplasty & Kyphoplasty)

Vertebroplasty and kyphoplasty are similar medical spinal procedures in which bone cement is injected through a small hole in the skin (percutaneously) into a fractured vertebra with the goal of relieving back pain caused by vertebralcompression fractures.

 

Sacralplasty

Sacralplasty evolved from the treatment of insufficiency fractures in the thoracic and lumbar vertebrae with vertebroplasty. The procedure, essentially identical, entails guided injection of bone cement through a needle or trocar inserted into the fracture zone.

Pain Management Injections

Translaminar Epidural Steroid Injections

Epidural steroid injection (ESI) is a technique for relieving pain from spinal stenosis and spinal disc herniation. Using a needle, relatively small amounts of corticosteroids together with a local anesthetic are injected into the epidural space around the spinal cord and spinal nerves. This injection can be performed from a translaminar or a transforaminal approach. The anti-inflammatory effect of the corticosteroid is responsible for providing pain relief when radiculopathy exists.

Medial Nerve Branch Blocks

A nerve block is the interruption of signals traveling along a nerve, in this case for the purpose of pain relief. The procedure results in the block of nerve signals, usually lasting hours or days, by the injection of an anesthetic and other drugs such as steroids onto or near a nerve. The medial branch nerve supplies pain and other sensory input to the facet joints of the spine. By selectively blocking the medial branch nerve of the spine, pain that is referable to the spinal facet joint at the selected level can be temporarily eliminated. This procuedure is both diagnostic and therapeutic and may assist the spinal surgeon in determining the best operative approach for treatment of back pain.

Dorsal Rhizotomy

Radiofrequency ablation of the medial branch of the posterior ramus can be performed for long term relief of pain referable to the facet joints of the spine. This procedure uses similar imaging guidance and anatomic principles of medial nerve branch blocks with the addition of a radiofrequency pulse that ablates the function of the small nerves that provide pain sensation in the spine.

Facet Joint Injection

A zygapophysial joint or facet joint is a synovial joint between the superiorarticular process of one vertebra and the inferior articular process of the vertebra directly above it. There are two facet joints at each spinal motion level. The biomechanical function of each pair of facet joints is to guide and limit movement of that spinal motion level.

Facet syndrome is a syndrome in which the facet joints cause back and/or neck pain. Facet syndrome can progress to spinal osteoarthritis, which is known as spondylosis.

Facet joint injection is the injection of anesthetic and/or anti-inflammatory medication into the facet joint under imaging guidance for the diagnosis and treatment of facet syndrome.

Synovial Cyst Injection and Rupture

A synovial cyst of the facet joint is a non-neoplastic cystic lesion that develops as a response to the biomechanical stressors that are placed upon the synovial lined joints of the spine, the facet joints. When cysts arise from these joints, they may press upon critical neurologic structures, including the ventral nerve roots and the spinal cord. These benign yet painful cysts may be treated by performing synovial cyst injection and rupture. The procedure involves cyst puncture under CT or fluoroscopic guidance followed by the high pressure injection of fluids, including injection of long acting local analgesics and corticosteroid suspensions.