BACK
Back pain is a common complaint, affecting 4 out of 5 people at some point in their lives. There are many causes of back pain, and, fortunately, the majority of causes can be treated conservatively and non-surgically.

Under the direction of Dr. David Lloyd, our fellowship-trained neuroradiologist specializing in neuroimaging and percutaneous (passage through the skin) spine procedures, VISP physicians offer many pain-relieving spinal therapies. Our doctors use their expertise to pinpoint the likely cause of each patient’s back pain and select the most appropriate therapeutic procedure for that patient.

The Diagnosis

Discography

Sometimes determining the source of back pain can be difficult. Discography is used to determine whether a damaged disc between the vertebrae is the source of back pain. During discography, our interventional radiologists inject contrast, or x-ray dye, into the discs, and the patient’s response to the injection is noted. Pain during the procedure that is similar to the patient’s existing back pain suggests that the injected disc might be the source of the pain. The patient’s doctor can then more accurately tailor an appropriate treatment plan.

The Procedures

Selective Nerve Root Blocks (SNRB)

The nerves to our trunk, arms and legs exit the spine through openings called foramina. Sometimes the foramina become very small due to arthritis or disc herniation. This may cause the nerves to become compressed and inflamed, producing pain, weakness and/or uncomfortable sensations in the back and extremities. An MRI and physical examination can confirm which nerve is affected. During a SNRB procedure our doctors use a small needle to inject anti-inflammatory medication into the space where the nerve exits the spine.

Facet Injections

Facet injections target the joints between the vertebrae in the back. Arthritis, mechanical stress or back injury may make the joints inflamed and painful. The facet injections bathe the joint in an anti-inflammatory medication and numbing agent, which frequently lessen the pain.

Paraspinous Joint Injections

Back pain can sometimes be caused by arthritis of different joints near the spine. These joints include costovertebral and costotransverse (rib-to-vertebra) and sacroiliac joints (sacrum-to-pelvis). Affected joints are injected with anti-inflammatory medicine to relieve pain.

Lumbar Epidural Steroid Injections

A common procedure used to treat back pain and sciatica is the epidural steriod injection (ESI). Sciatica is pain and tingling, numbness or weakness that originates in the lower back and travels down one or both legs. If the sciatica is very specific in location, a selective nerve root block is sometimes the better procedure choice. Otherwise, an ESI can be helpful in improving pain. In an ESI, anti-inflammatory medicine is injected into a small space surrounding the spinal canal, reducing inflammation of the nerves originating from the spinal cord. Our doctors use image guidance, which ensures accurate and safe placement of the needle.

Spine Biopsy

A spine biopsy is performed by our interventional radiologists to diagnose possible bone tumors or infection, giving the patient’s doctor necessary information for treatment. Using image guidance, VISP physicians perform the biopsy by inserting a needle directly into the bone.

The Treatments

Vertebral Cement Augmentation (VCA)

VCA is a treatment that relieves pain from vertebral compression fractures caused by osteoporosis or tumor. This pain can severely impact a patient’s quality of life. VCA includes vertebroplasty and kyphoplasty, two different methods for achieving the same positive result. VISP physicians are trained in each method.

VCA is usually performed after a patient fails to respond to a 4-6 week course of conservative medical management, including pain medications, bed rest, or back bracing. VCA is performed by using a needle to inject medical grade bone cement into the fractured vertebra. The procedure requires only local anesthesia and intravenous sedation.

When properly selected, the vast majority of patients experience significant to total pain relief within hours to a couple of days.

Vertebroplasty