Minimally Invasive Spine Procedures

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Evidence-Based Pain Treatments

Have you explored all your options for treating back pain, nerve pain, or neck pain? Did you know our pain management doctors can simultaneously diagnose and relieve spinal pain without surgery?

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If you’re experiencing debilitating spinal or nerve pain that is keeping you from doing what you want, consider what we have to offer. Our doctors have decades of experience with what you’re going through, and we utilize the most effective and minimally invasive spine procedures to help our patients.

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Discogram

A discogram is a diagnostic test in which contrast dye is injected into a disc in the patient’s spine. Discograms help to pinpoint which disc is causing back or leg pain. It is often done as a pre-surgical evaluation to consider what further treatment is needed. A post-disco CT scan will be scheduled to show where and how the disc is damaged.

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During the procedure, you may be given medication to help you relax. The area to be injected is numbed with a local anesthetic. The needle is placed into each disc being tested. Then the contrast dye is injected into one of the discs in the spine.

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Pain may increase when the contrast dye is injected. Your pain management doctor will ask if your pain is in the same place as the pain you usually feel. At least two discs will be tested for comparison.

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After the discogram, you will be given pain medication. The procedure takes approximately 30-45 minutes to complete. Following the procedure, you will recover for 15-20 minutes before going home with a driver. You should take it easy the day of the procedure and resume your normal activities the next day.

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Nucleoplasty

Nucleoplasty is a minimally invasive procedure developed to treat patients with a contained or mildly herniated disc.

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Nucleoplasty does not involve any incisions. A special access needle is placed into the disc under fluoroscopy guidance. A wand-like device is then inserted through the needle and into the disc. The device uses heat to remove disc material and seal the channel made by the needle.

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During the procedure, you may feel a sense of pressure or mild discomfort while the needle is inserted into the disc. The procedure takes about 30 to 45 minutes to complete. Following the procedure, you will be monitored for 15-20 minutes before having someone drive you home.

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Intradiscal Electrothermal Therapy

Intradiscal electrothermal therapy (IDET) is a non-surgical procedure used to treat chronic back pain.

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A catheter that uses heat modifies the protein wall of the disc and reduces the amount of disc material that causes nerve irritation. Under fluoroscopic guidance, the catheter is guided into the patient’s disc through a spinal needle and is heated for about 15-20 minutes. You may experience pressure during the procedure while the needle is placed into the disc. IDET can be done in one or multiple discs.

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Following the procedure, you will recover for 15-20 minutes before being released to go home with a designated driver. As a precaution, you should avoid strenuous activity the day of the procedure, and you can resume your normal activities the next day.

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Spinal Neurostimulation: Intrathecal Spinal Pump Implant

An intrathecal pump is offered to patients with chronic and severe pain who have not adequately responded to other treatment modalities. This computerized device delivers concentrated amounts of pain medication into the spinal cord area through a small catheter to help decrease or eliminate the need for oral medications.

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You must first be deemed eligible for an intrathecal pump implant. For patients who qualify, the pump can significantly decrease pain and improve their quality of life.

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First, you will be evaluated by a medical psychologist with experience in chronic pain management. If the psychologist concludes that you are an appropriate candidate for the intrathecal pump, you will then undergo an intraspinal medication trial.

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The trial will help determine if you have any problems with the medication that may be used in the infusion pump and to see if the medication will be effective in providing you with the desired level of pain relief. If the trial is successful, you will be referred to a surgeon to implant the pump, which is a permanent device that is placed under the skin.

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During the procedure, tubing is placed in the midline of the lower back and a local anesthetic is injected through it to confirm adequate placement and to obtain anesthesia on the entire surgical field.

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The intrathecal pump is then placed on the side of the abdomen. You should feel that your pain is under control or quite less. The pump will be adjusted electronically to deliver adequate amounts of medication.

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After the procedure, you will recover for about four hours and will be allowed to go home with a driver.

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Spinal Neurostimulation: Spinal Cord Stimulator Implant

Spinal cord stimulation is a relatively non-invasive surgical procedure that involves using electrodes to stimulate spinal cord nerves located in the space above the epidural space.

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Spinal cord stimulation (SCS) is used as a treatment for chronic pain of the trunk and/or limbs. SCS is performed after less invasive treatment options such as medications, physical therapy, epidural steroid injections or nerve blocks have been attempted.

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You will first undergo a trial period to determine your response to spinal cord stimulation. A trial spinal stimulator is inserted for 7 days, and if it works well for you, a spine surgeon will implant a permanent system. The receiver or power source is placed under the skin on your abdomen or buttocks. The power source is small and cannot be seen underneath clothing.

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After the system is in place, the settings are checked to make sure they are at the right level for you. Following the implant, you may be asked to stay in the hospital for a 24-hour observation period.

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Interventional Procedures

In our commitment to minimally invasive treatments for spine and nerve pain, the physicians at Pain Specialists of America have experience with interventional procedures. These procedures are intended for patients with severe pain that hasn’t responded to other treatments.

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Patients who are candidates for nerve blocks may also benefit from cryotherapy (which freezes nerves to destroy them) or radiofrequency thermocoagulation (which uses heats to destroy nerves).

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Cryotherapy

Cryotherapy (also called cryoablation) is a method that freezes nerves to help decrease pain. Cryotherapy is often used to treat conditions that involve an isolated nerve that is irritated, including benign nerve growths such as a neuroma and pinched nerves. At Pain Specialists of America, we frequently perform cryotherapy along the occipital nerves located at the base of the skull to treat headaches and occipital neuralgia.

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During the procedure, a probe is inserted close to the affected nerve. The probe is cooled by a gas called nitrous oxide. You may experience some pressure and discomfort during the procedure. The procedure usually takes 30 minutes to complete. After the procedure, you can expect soreness at the site where the probe was inserted.

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Cryotherapy inactivates the nerve it treats, producing variable pain relief that can last from two weeks to four months.

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Radiofrequency Thermocoagulation

Radiofrequency thermocoagulation (RFTC) uses heat to destroy the nerve near a problem joint. This procedure prevents pain signals from traveling to the brain and helps to relieve pain symptoms. RFTC is performed only when pain relief is obtained after a diagnostic block.

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RFTC is done under fluoroscopic guidance, and a contrast dye may be injected into the affected area to help get a better image. During the procedure, a needle probe is placed near the irritated nerve. Next, a micro-electrode is inserted through the probe and heated to 90°C by a small radiofrequency (RF) current for 60–90 seconds to trigger the stimulation process. The heat destroys the nerve, eliminating pain pathways in the surrounding tissues.

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RFTC will not provide a permanent cure, as the nerve fiber will regenerate usually within 12 months.