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Usually if there has been some improvement we would recommend facet joint denervation, which involves coagulating the nerves that transmit pain signals from the joints. This is a straightforward procedure that uses highly localised radiofrequency energy at the tip of a carefully placed needle to coagulate and thus inactivate the nerves to the joints. It is extremely safe with a less than 1% complication rate. Such complications may include bleeding, nerve damage, and infection. See Important Information about Procedures.
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Facet joint denervation This is a straightforward procedure that is normally carried out if you have had a successful result from facet joint injections. Special needles are carefully placed under continuous fluoroscopy so that their tips lie exactly on the nerves that carry pain signals from the facet joints. Radiofrequency energy is then passed through the needles so that that tissue at the tip is heated to about 80°C for about a minute. This coagulates and inactivates the nerves. Although they can grow back, this can take many months or years. It provides a longer lasting and more effective solution to pain from facet syndrome. It is extremely safe with a less than 1% complication rate. Such complications may include bleeding, nerve damage, and infection. See Important Information about Procedures. |
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One of the areas where pulsed radiofrequency can particularly help is in the treatment of trigeminal neuralgia. It is extremely safe with a less than 1% complication rate. Such complications may include bleeding, nerve damage, and infection. See Important Information about Procedures.
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Discography Most disc problems can be adequately studied by MRI scans. Sometimes however patients may not be able to have an MRI scan, or it may be important to demonstrate that a patient’s pain is coming from a particular disc. Discography involves the insertion of a thin needle into one or more discs. Then either saline is injected into the disc to see if it is painful, or radio-opaque contrast dye is injected and x-rays will be taken to show the internal structure of the disc. This procedure will only be done if you are being considered for specific treatments for your disc such as dekompressor discectomy, percutaneous disc nucleoplasty, intradiscal electrothermal therapy, or total disc replacement. See Important Information about Procedures. It has a low complication rate. Such complications may include bleeding, nerve damage, disc infection.
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Cervical epidural steriod injection This is an important treatment for lumbar radiculopathy, and herniated discs. The word “epidural” simply refers to a layer of supporting tissue outside the spinal cord. In a caudal epidural a solution of long acting local anaesthetic, long acting anti-inflammatory steroid, and sometimes other pain modifying drugs is injected into the epidural space at the bottom of your spine. In this space lie the nerves that go to the back of your legs and your pelvis. In some cases it can be an alternative to lumbar epidural steroid injection. Depending on the particular reason for the procedure you can expect a very good result. In the best cases more than 90% of patients see significant, long-lasting improvement. If you do not have radicular pain the success rate is much lower but it may still help. It is a safe procedure. The most likely risk (<1.5%) is that the needle may puncture the durra. If this happens you could get a headache for a couple of days. Other risks include bleeding, nerve root damage, and infection. See Important Information about Procedures.
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Lumbar epidural steroid injection This is an important treatment for lumbar radiculopathy, and herniated discs. The word “epidural” simply refers to a layer of supporting tissue outside the spinal cord. In a lumbar epidural a solution of long acting local anaesthetic, long acting anti-inflammatory steroid, and sometimes other pain modifying drugs is injected into the epidural space in the lumbar region of your spine. In this space lie the nerves that go to your legs. This is one part of the usual treatment for “sciatica”, which simply means nerve root pain in the legs. It is generally preferable to caudal steroid injection as it is more reliable. Depending on the particular reason for the procedure you can expect a very good result. In the best cases more than 90% of patients see significant, long-lasting improvement. If you do not have radicular pain the success rate is much lower but it may still help. It is an extremely safe procedure. The most likely risk (<1%) is that the needle may puncture the dura. If this happens you could get a headache for a couple of days. Other risks that are much include bleeding, nerve root damage, and infection. See Important Information about Procedures.
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Transforaminal epidural injection This is an important adjunct to epidural steroid injection and the two are normally done together. If you have lumbar radiculopathy or cervical radiculopathy, you will probably also have one or more transforaminal epidural injections. Nerve roots are often compromised at the point they leave the spinal column so epidural injections on their own are often insufficient as the anti-inflammatory solution cannot always the point where the nerve is maximally irritated or compressed. It can greatly improve your prognosis to inject the nerve roots in the neural foramina. Depending on the particular reason for the procedure you can expect a very good result. In the best cases more than 90% of patients see significant, long-lasting improvement. It is an extremely safe procedure. The most likely risk (<1%) is that the needle may puncture the dura. If this happens you could get a headache for a couple of days. Other risks include bleeding, nerve root damage, and infection. See Important Information about Procedures.
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Sacrolliac joint steroid injection The sacroiliac joints are large fibrous joints that attach the pelvis to the spine. They can be the cause of pain, particularly either side of the bottom of the spine in the buttocks. This pain is usually worse on walking or standing. In the first instance a solution of long-acting local anaesthetic, long acting anti-inflammatory steroid, and sometimes other pain modifying drugs is injected into one or both joints. If this is successful the joint can then be denervated in a similar way to facet joint denervation. It is extremely safe with a less than 1% complication rate. Such complications may include bleeding, nerve damage, and infection. See Important Information about Procedures.
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Lumbar sympathetic block This procedure is normally carried out for pain arising from vascular problems in the legs. The block will be carried out using continuous fluoroscopy with you lying face down. The needles will be positioned and then there are three main ways to produce the block: injection of a long acting local anaesthetic to produce a diagnostic block to safely see if your pain can be treated this way; injection of a neurolytic substance such as phenol or alcohol to destroy the lumbar sympathetic nerves; and the use of radiofrequency energy to similarly destroy the nerves in a highly controlled way. The main risks are of bleeding, nerve damage, damage to bowel, or infection. These are rare. See Important Information about Procedures. |
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It is a safe procedure where the main risks are bleeding, nerve damage, and infection. You may have a drooping eyelid for a few hours after a Stellate ganglion block. See Important Information about Procedures.
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Dekompressor discectomy The Stryker Dekompressor is a relatively new technique for the decompression of contained lumbar herniated discs. A special device the size of a needle is inserted into the affected disc. This then rotates like a drill removing some of the nucleus of the damaged disc, thus decompressing it and allowing the bulge to reduce. This in turn reduces the pain from both the disc and the nerve root. In appropriate patients it can be very effective, relieving pain in up to 80% of patients. The main risks are of bleeding, nerve damage, damage to bowel, or infection of the disc or other structures. These are rare. See Important Information about Procedures.
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Percutaneous disc nucleoplasty This is a relatively new technique for the decompression of contained lumbar herniated discs. A special device the size of a needle is inserted into the affected disc. This probe has radiofrequency electrodes at its tip and is slightly angled. It is moved around inside the disc vapourising a very controlled amount of disc nucleus, typically 1 – 2 ml. This is enough to decompress the disc, allowing the bulge to reduce. This in turn reduces the pain from both the disc and the nerve root. In appropriate patients it can be very effective, relieving pain in up to 80% of patients. The main risks are of bleeding, nerve damage, damage to bowel, or infection of the disc or other structures. These are rare. See Important Information about Procedures.
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Lumbar radiofrequency neurotomy This can be an effective treatment for otherwise difficult to treat nerve root pain. Before you have this treatment you will be likely to have undergone one or more lumbar epidural injections, or transforaminal injections. It is not frequently performed. It is safe and you will be given more details if it is considered suitable for you. See Important Information about Procedures.
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Intradiscal electrothermal therapy This can be an effective treatment for degenerative disc disease, and is sometimes considered before resorting to surgery such as interbody fusion, or total disc replacement. It will not normally be performed until you have had discography to determine if the disc in question is the source of your pain. You will be given more details if it is considered suitable for you. See Important Information about Procedures.
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Kyphoplasty Kyphoplasty is a relatively new procedure for the treatment of vertebral body compression fractures (VCFs). It is an alternative to vertebroplasty, and differs from that procedure in that Kyphoplasty is the only procedure that can correct the deformity from a VCF. It involves the insertion of needles into the damaged vertebral body, through which balloons are passed. These are inflated under high pressure, which expands the VCF and corrects the deformity. Once corrected, liquid bone cement is injected into the vertebra to permanently fix the restored shape. It is newer than vertebroplasty but has less risk of cement leakage and therefore of emergency surgery. Other risks are of bleeding, nerve damage, damage to bowel, or infection. This can usually be performed as a day case but you may require one overnight stay. See Important Information about Procedures.
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Spinal cord stimulation Spinal cord stimulation can be very effective at treating nerve pain (neuropathic pain) and dysfunction from a number of different conditions. It has been shown to be particularly effective at relieving resistant nerve pain such as lumbar radiculopathy following spinal surgery. Other conditions for which it is useful include limb ischaemia, refractory angina, bladder and bowel control problems, and direct nerve injury pain. It is an advanced treatment and should only be carried out after trying all other non-destructive treatment options. It involves the implantation of a wire and a device the size of a matchbox. Usually patients will have a trial system for a couple of weeks that will not be fully implanted. If they get good symptom relief a full system will then be implanted. The main risk is infection, which can occur in up to 5% of patients. If the system becomes infected it will have to be removed. Other risks include bleeding, nerve damage, damage to bowel, or infection. It can usually be performed as a day case but patients may require one overnight stay. See Important Information about Procedures.
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Sacral nerve root stimulation This is a new and effective treatment for a number of loosely related bladder and bowel control problems. The other main treatment alternative is spinal cord stimulation. The main risk is infection, which can occur in up to 5% of patients. If the system becomes infected it will have to be removed. Other risks include bleeding, nerve damage, damage to bowel, or infection. It can usually be performed as a day case but patients may require one overnight stay. See Important Information about Procedures. |
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Intrathecal pump implant Intrathecal drug delivery devices are advanced pain management systems for patients whose pain cannot be adequately be controlled by conventional oral or systemic analgesics. They may be useful for palliative care. Delivery strong painkillers such as morphine directly into the cerebrospinal fluid can avoid many of the unpleasant side effects of conventional drug delivery. It is an advanced pain management system and if you think you or a patient might be suitable please contact the practice for further information. This animation gives a demonstration of the implantation procedure.
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Botox injections Botox has a number of surprising uses. Of most interest to readers of this site will be its ability to inactivate sweat glands. Botox injections can be very useful for patients who suffer from excessive sweating. Prior to this discovery patients who suffered from this condition would have to undergo destructive surgery (thoracic sympathectomy) under general anaesthesia to destroy the nerves inside the chest that control sweating in the arms and hands. This could often cause unwanted side effects as well as being associated with risks from the surgery itself. Instead it is much simpler and safer to inject Botox in a grid like pattern in the area of skin affected. It works by blocking the release of acetyl choline from overactive autonomic nerve fibres supplying sweat glands. The effects of injection last around 6 months on average, which is the time it generally takes for new nerve endings to grow. Some patients may only need one treatment. It is extremely safe. Botox can also be useful in treating painful trigger points or muscle spasms, where it is presumed to work by relaxing the muscles whose tonic contraction is believed to be the cause of the pain. |
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