Spine Service

These leaks decrease the pressure in the spinal fluid and thus around the spine and head resulting in postural headaches. A postural headache is severe in the upright position and improved in the recumbent position. If conservative therapy (rest, caffeine, analgesics) fails, a blood patch can be used to treat the condition. A blood patch delivers blood to the space around the spinal sac and either primarily covers the leak and/or increases the pressure enough to stop the leak of fluid and allow the repair process to occur. This procedure, which takes 15-30 minutes, is highly effective.

A liquid anesthetic (lidocaine) is administered at the same time for immediate pain relief and diagnostic evaluation. This is the most common pain injection procedure we perform and is used for neck, midback and low back pain.

A liquid anesthetic (lidocaine) is administered at the same time for immediate pain relief and diagnostic evaluation. There are two facet joints at each vertebral level and allow for bending and twisting: they become arthritic with age, other traumatic injuries and inflammatory arthropathies such as rheumatoid arthritis. This is a common pain injection procedure and is used for focal neck, midback or low back pain felt to be directly related to a degenerated facet joint.

This technology is promising but not yet proven in clinical trials. Kyphoplasty is more involved than vertebroplasty requiring placement of 2 balloons into the fractured level and inflating them. Once deflated, liquid cement is injected into the cavities for internal casting. Kyphoplasty is 10 times more expensive than vertebroplasty, sometimes requiring general anesthesia and an overnight hospital stay. Your physician will determine if kyphoplasty is appropriate for your condition.

The condition in which that is important is a treatable cause of dementia called Normal Pressure Hydrocephalous (NPH). In patients with that diagnosis (NPH), shunting of fluid can cure their dementia. Prior to placing a permanent shunt, a trial of a lumbar drain can be used to gauge if the patient will respond to the shunt. Access to the spinal canal is easy and is performed exactly like a lumbar puncture. The drain is usually removed 3-5 days after the procedure.

Typical medical scenarios where an LP might be performed include infection, multiple sclerosis, tumor and dementia. This is the most common diagnostic spine procedure we perform. The spinal fluid is collected from the lumbar spine (low back) and rarely from the cervical region (neck).

Patients considered for this procedure have failed conservative measures including rest, physical therapy, medications and steroid injections. If successful, percutaneous discectomy could avoid an open invasive surgical procedure. Long term data are not available but the technique is promising in an appropriately selected patient population.

Osteoporosis refers to softening of the bones and loss of internal strength that results from normal aging but is exacerbated by other factors including smoking, inactivity and medications (steroids). When the sacrum fractures, pain is produced that can be debilitating. Unlike and extremity fracture we cannot provide a direct plaster or fiberglass cast. Conservative therapies such as rest and analgesics can help but many fractures do not respond to such treatment. Sacroplasty is a technique that “internally casts” a sacral fracture with liquid cement and provides significant pain relief. We performed our first sacroplasty in 2004 and have developed arguably the largest experience in the region. We have fine tuned our procedure and are experiencing excellent outcomes (significant pain relief in 95% of patients).

If the cyst compresses the spinal nerve roots, compressive symptoms (leg pain) can occur. They are most often encountered in the lumbar spine. Historically, synovial cysts have required open surgical decompression and some still do: however, percutaneous techniques have been developed to get at the cyst without open surgery. Using state-of-the art CT imaging guidance, we can localize these cysts and attempt to decompress and fenestrate them with a needle. When accessible not every cyst will drain but if it is accessible and drainable, open surgery can be avoided temporarily and in some instances completely. This is an uncommon procedure that NMH Neuroradiology has combined expertise in treating.

Osteoporosis refers to softening of the bones and loss of internal strength that results from normal aging but is exacerbated by other factors including smoking, inactivity and medications (steroids). When a vertebra fractures, pain is produced that can be debilitating. Unlike and extremity fracture we cannot provide a direct plaster or fiberglass cast. Conservative therapies such as external bracing and analgesics can help but many fractures do not respond to such treatment.

Vertebroplasty is a technique that “internally casts” a spinal fracture with liquid cement and provides significant pain relief. Developed in the 1980s by French Neuroradiologist Herve Deramond, vertebroplasty is a safe and effective treatment for osteoporosis-related spinal fractures in addition to fractures related to tumors. Up to 90% of patients have significant pain relief within 2 weeks. Many patients even report the “hallelujah effect” where their pain is essentially eliminated immediately after the procedure.

The lesions are typically identified on imaging such as CT scan or MRI. Depending upon the size and location of the lesion, image guidance will either be fluoroscopic or CT. Multiple “passes” are made to ensure adequate material for diagnosis. Because specimens need special stains and processing, a diagnosis cannot be provided the day of the procedure.

A soft tissue biopsy is performed to diagnose an unknown soft tissue lesion outside of bone. The lesions are typically identified on imaging such as CT scan or MRI. Image guidance will typically be CT. Multiple “passes” are made to ensure adequate material for diagnosis. Because specimens need special stains and processing, a diagnosis cannot be provided the day of the procedure.

Back pain is often multifactorial: that is, due to many different factors. Back pain related to the discs (discogenic) is potentially treatable if it can be determined precisely which disc or discs are responsible. If the patient’s pain is exactly reproduced at a certain level, a diagnosis of discogenic back pain can be made. This exam will help your orthopedic surgeon or neurosurgeon localize the level of disease and determine the appropriate therapeutic recommendation. The vast majority of these procedures are performed in the lumbar spine.

A liquid anesthetic (lidocaine) is administered to the pain fibers that supply the joint in question. A liquid steroid is administered as a temporizing measure. If your pain markedly improves or resolves, then the target pain generator has been identified. You may derive benefit from repeated injections or you may be a candidate for facet joint rhizotomy.