Spine Surgeries

    
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SPINE SURGERIES

SPINE SURGERIES

The spine is made of 33 individual bones stacked one on top of the other. This spinal column provides the main support for your body, allowing you to stand upright, bend, and twist, while protecting the spinal cord from injury. Strong muscles and bones, flexible tendons and ligaments, and sensitive nerves contribute to a healthy spine. Yet, any of these structures affected by strain, injury, or disease can cause pain.

Spinal curves

When viewed from the side, an adult spine has a natural S-shaped curve. The neck (cervical) and low back (lumbar) regions have a slight concave curve, and the thoracic and sacral regions have a gentle convex curve (Fig. 1). The curves work like a coiled spring to absorb shock, maintain balance, and allow range of motion throughout the spinal column.

Figure 1. The spine has three natural curves that form an S-shape; strong muscles keep our spine in alignment.

The abdominal and back muscles maintain the spine's natural curves. Good posture involves training your body to stand, walk, sit, and lie so that the least amount of strain is placed on the spine during movement or weight-bearing activities (see Posture). Excess body weight, weak muscles, and other forces can pull at the spine's alignment:

  • An abnormal curve of the lumbar spine is lordosis, also called sway back.
  • An abnormal curve of the thoracic spine is kyphosis, also called hunchback.
  • An abnormal curve from side-to-side is called scoliosis.

Figure 2. The five regions of the spinal column.

Muscles

The two main muscle groups that affect the spine are extensors and flexors. The extensor muscles enable us to stand up and lift objects. The extensors are attached to the back of the spine. The flexor muscles are in the front and include the abdominal muscles. These muscles enable us to flex, or bend forward, and are important in lifting and controlling the arch in the lower back.

The back muscles stabilize your spine. Something as common as poor muscle tone or a large belly can pull your entire body out of alignment. Misalignment puts incredible strain on the spine (see Exercise for a Healthy Back).

Vertebrae

Vertebrae

Vertebrae are the 33 individual bones that interlock with each other to form the spinal column. The vertebrae are numbered and divided into regions: cervical, thoracic, lumbar, sacrum, and coccyx (Fig. 2). Only the top 24 bones are moveable; the vertebrae of the sacrum and coccyx are fused. The vertebrae in each region have unique features that help them perform their main functions.

Cervical (neck)

The main function of the cervical spine is to support the weight of the head (about 10 pounds). The seven cervical vertebrae are numbered C1 to C7. The neck has the greatest range of motion because of two specialized vertebrae that connect to the skull. The first vertebra (C1) is the ring-shaped atlas that connects directly to the skull. This joint allows for the nodding or “yes” motion of the head. The second vertebra (C2) is the peg-shaped axis, which has a projection called the odontoid, that the atlas pivots around. This joint allows for the side-to-side or “no” motion of the head.

Thoracic (mid back) - the main function of the thoracic spine is to hold the rib cage and protect the heart and lungs. The twelve thoracic vertebrae are numbered T1 to T12. The range of motion in the thoracic spine is limited.

Lumbar (low back) - the main function of the lumbar spine is to bear the weight of the body. The five lumbar vertebrae are numbered L1 to L5. These vertebrae are much larger in size to absorb the stress of lifting and carrying heavy objects.

Sacrum - the main function of the sacrum is to connect the spine to the hip bones (iliac). There are five sacral vertebrae, which are fused together. Together with the iliac bones, they form a ring called the pelvic girdle.

Coccyx region - the four fused bones of the coccyx or tailbone provide attachment for ligaments and muscles of the pelvic floor.

While vertebrae have unique regional features, every vertebra has three functional parts

  • A drum-shaped body designed to bear weight and withstand compression (purple)
  • An arch-shaped bone that protects the spinal cord (green)
  • Star-shaped processes designed as outriggers for muscle attachment (tan)

Intervertebral discs

Each vertebra in your spine is separated and cushioned by an intervertebral disc, which keeps the bones from rubbing together. Discs are designed like a radial car tire. The outer ring, called the annulus, has crisscrossing fibrous bands, much like a tire tread. These bands attach between the bodies of each vertebra. Inside the disc is a gel-filled center called the nucleus, much like a tire tube (Fig. 4).

Figure 4. Discs are made of a gel-filled center called the nucleus and a tough fibrous outer ring called the annulus. The annulus pulls the vertebrae bones together against the resistance of the gel-filled nucleus.

Discs function like coiled springs. The crisscrossing fibers of the annulus pull the vertebral bones together against the elastic resistance of the gel-filled nucleus. The nucleus acts like a ball bearing when you move, allowing the vertebral bodies to roll over the incompressible gel. The gel-filled nucleus contains mostly fluid. This fluid is absorbed during the night as you lie down and is pushed out during the day as you move upright.

With age, our discs increasingly lose the ability to reabsorb fluid and become brittle and flatter; this is why we get shorter as we grow older. Also diseases, such as osteoarthritis and osteoporosis, cause bone spurs (osteophytes) to grow. Injury and strain can cause discs to bulge or herniate, a condition in which the nucleus is pushed out through the annulus to compress the nerve roots causing back pain.

Vertebral arch & spinal canal

On the back of each vertebra are bony projections that form the vertebral arch. The arch is made of two supporting pedicles and two laminae (Fig. 5). The hollow spinal canal contains the spinal cord, fat, ligaments, and blood vessels. Under each pedicle, a pair of spinal nerves exits the spinal cord and pass through the intervertebral foramen to branch out to your body.

Figure 5. The vertebral arch (green) forms the spinal canal (blue) through which the spinal cord runs. Seven bony processes arise from the vertebral arch to form the facet joints and processes for muscle attachment.

Surgeons often remove the lamina of the vertebral arch (laminectomy) to access the spinal cord and nerves to treat stenosis, tumors, or herniated discs. Seven processes arise from the vertebral arch: the spinous process, two transverse processes, two superior facets, and two inferior facets.

Facet joints

The facet joints of the spine allow back motion. Each vertebra has four facet joints, one pair that connects to the vertebra above (superior facets) and one pair that connects to the vertebra below (inferior facets) (Fig. 6).

Figure 6. The superior and inferior facets connect each vertebra together. There are four facet joints associated with each vertebra.

 

Ligaments

The ligaments are strong fibrous bands that hold the vertebrae together, stabilize the spine, and protect the discs. The three major ligaments of the spine are the ligamentum flavum, anterior longitudinal ligament (ALL), and posterior longitudinal ligament (PLL) (Fig. 7). The ALL and PLL are continuous bands that run from the top to the bottom of the spinal column along the vertebral bodies. They prevent excessive movement of the vertebral bones. The ligamentum flavum attaches between the lamina of each vertebra.

Figure 7. The ligamentum flavum, anterior longitudinal ligament (ALL), and posterior longitudinal ligament (PLL) allow the flexion and extension of the spine while keeping the bones aligned.

Spinal cord

The spinal cord is about 18 inches long and is the thickness of your thumb. It runs from the brainstem to the 1st lumbar vertebra protected within the spinal canal. At the end of the spinal cord, the cord fibers separate into the cauda equina and continue down through the spinal canal to your tailbone before branching off to your legs and feet. The spinal cord serves as an information super-highway, relaying messages between the brain and the body. The brain sends motor messages to the limbs and body through the spinal cord allowing for movement. The limbs and body send sensory messages to the brain through the spinal cord about what we feel and touch. Sometimes the spinal cord can react without sending information to the brain. These special pathways, called spinal reflexes, are designed to immediately protect our body from harm.

Any damage to the spinal cord can result in a loss of sensory and motor function below the level of injury. For example, an injury to the thoracic or lumbar area may cause motor and sensory loss of the legs and trunk (called paraplegia). An injury to the cervical (neck) area may cause sensory and motor loss of the arms and legs (called tetraplegia, formerly known as quadriplegia).

Spinal nerves

Thirty-one pairs of spinal nerves branch off the spinal cord. The spinal nerves act as “telephone lines,” carrying messages back and forth between your body and spinal cord to control sensation and movement. Each spinal nerve has two roots (Fig. 8). The ventral (front) root carries motor impulses from the brain and the dorsal (back) root carries sensory impulses to the brain. The ventral and dorsal roots fuse together to form a spinal nerve, which travels down the spinal canal, alongside the cord, until it reaches its exit hole - the intervertebral foramen (Fig. 9). Once the nerve passes through the intervertebral foramen, it branches; each branch has both motor and sensory fibers. The smaller branch (called the posterior primary ramus) turns posteriorly to supply the skin and muscles of the back of the body. The larger branch (called the anterior primary ramus) turns anteriorly to supply the skin and muscles of the front of the body and forms most of the major nerves.

Figure 8. The ventral (motor) and dorsal (sensory) roots join to form the spinal nerve. The spinal cord is covered by three layers of meninges: pia, arachnoid and dura mater.

The spinal nerves are numbered according to the vertebrae above which it exits the spinal canal. The 8 cervical spinal nerves are C1 through C8, the 12 thoracic spinal nerves are T1 through T12, the 5 lumbar spinal nerves are L1 through L5, and the 5 sacral spinal nerves are S1 through S5. There is 1 coccygeal nerve.

Figure 9. The spinal nerves exit the spinal canal through the intervertebral foramen below each pedicle.

The spinal nerves innervate specific areas and form a striped pattern across the body called dermatomes (Fig. 10). Doctors use this pattern to diagnose the location of a spinal problem based on the area of pain or muscle weakness. For example leg pain (sciatica) usually indicates a problem near the L4-S3 nerves.

Figure 10. A dermatome pattern shows which spinal nerves are responsible for sensory and motor control of specific areas of the body.

Coverings & spaces

The spinal cord is covered with the same three membranes as the brain, called meninges. The inner membrane is the pia mater, which is intimately attached to the cord. The next membrane is the arachnoid mater. The outer membrane is the tough dura mater (Fig. 8). Between these membranes are spaces used in diagnostic and treatment procedures. The space between the pia and arachnoid mater is the wide subarachnoid space, which surrounds the spinal cord and contains cerebrospinal fluid (CSF). This space is most often accessed when performing a lumbar puncture to sample and test CSF or during a myelogram to inject contrast dye. The space between the dura mater and the bone is the epidural space. This space is most often accessed to deliver anesthetic numbing agents, commonly called an epidural, and to inject steroid medication (see Epidural Steroid Injections).

ENDOSCOPIC SPINE SURGERY


How is laser back surgery different?

There are a few different types of back surgery, including the traditional, or open approach, MISS, and laser back surgery. Below, we’ll explore what makes each technique different.

Traditional

During traditional back surgery, the surgeon makes a long incision in the back. Then, they move muscles and other tissue away in order to access the affected area of the spine. This leads to a longer recovery time, and may cause tissue damage.

MISS

MISS uses a smaller incision than traditional surgery. A special tool called a tubular retractor is used to create a small tunnel in order to access the surgical site. Various specialized tools can be placed into this tunnel during the surgery.

Because it’s less invasive, MISS can lead to less pain and a faster recovery.

Laser

During laser back surgery, a laser is used to remove portions of tissue located around the spinal cord and nerves of the back. Unlike the other types of back surgery, it may only be appropriate for very specific conditions, such as when nerve compression is causing pain.

Laser back surgery and MISS are often mistaken for one another, or are assumed to be the same. Further complicating this is that MISS may sometimesTrusted Source, but not always, use lasers. Laser back surgery is relatively rare, and there are few clinical studies that have demonstrated benefits compared to other methods.

When pressure is placed on a nerve, it can lead to pain and discomfort.

In the spine, things like a herniated disc or a bone spur can often cause compression. An example of one such condition is sciatica, where the sciatic nerve becomes pinched, leading to pain in the lower back and leg.

Lasers can be used to help decompress the nerve, with the aim of relieving pain. This is done under local anesthesia, which means that the skin and surrounding muscles of your back will be numbed to pain. You may also be sedated for the procedure.

One of the more well-studied methods of laser back surgery is called percutaneous laser disc decompression (PLDD). This procedure uses a laser to remove disc tissue that may be causing nerve compression and pain.

During PLDD, a small probe containing a laser is passed into the core of the affected disc. This is accomplished with the help of imaging technology. Then, the energy from the laser is used to carefully remove tissue that may be pressing on the nerve.

The benefits of laser back surgery are that it’s less invasive than the traditional approach to back surgery. Additionally, it can be performed in an outpatient setting under local anesthesia. In many ways, it’s very similar to MISS.

There’s a limited amount of information regarding the overall effectiveness of laser back surgery in comparison to other methods.

One 2017 studyTrusted Source compared PLDD to another surgical approach called microdiscectomy. Investigators found that both procedures had a similar outcome over a two-year recovery period.

However, it should be noted that when discussing PLDD, the researchers included additional follow-up surgery after PLDD as part of a normal outcome.

Laser back surgery isn’t recommended for some conditions, such as degenerative spine diseases. Additionally, more complex or complicated conditions will often require a more traditional surgical approach.

One of the drawbacks to laser back surgery is that you could need an additional surgery for your condition. A 2015 studyTrusted Source found that microdiscectomy had a lower number of reoperations required compared to PLDD.

Additionally, a 2017 meta-analysis of seven different surgeries for herniated discs in the lumbar region found that PLDD ranked among the worst based off of success rate, and it was in the middle for reoperation rate.

Every procedure can have potential side effects or complications. This is also true for laser back surgery.

One of the main potential complications from laser back surgery is damage to the surrounding tissue. Because a laser is used for the procedure, heat damage can occur to surrounding nerves, bone, and cartilage.

Another possible complication is infection. This can occur during the placement of the probe if proper sanitization procedures aren’t followed. In some cases, you may be provided with prophylactic antibiotics to help prevent an infection.

Recovery time can vary by individual and the specific procedure performed. Some people may be able to return to normal activities relatively quickly, while others may require more time. How does laser back surgery compare to other types of back surgery?

Having a traditional back surgery requires a hospital stay after the procedure, and recovery may take many weeks. According to the Johns Hopkins Spine Service, people undergoing traditional spine surgery should expect to miss 8 to 12 weeks of work.

In contrast, MISS is often performed as an outpatient procedure, meaning that you can go home the same day. Generally speaking, people who’ve undergone MISS may return to work in around six weeks.

You may have read that laser back surgery has a faster recovery than other procedures. However, there’s actually been very little research into how the recovery time compares.

In fact, the 2015 studyTrusted Source discussed above found that recovery from microdiscectomy was faster than for PLDD.

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Cost

There’s not a lot of information regarding the cost or cost effectivenessTrusted Source of laser back surgery versus other types of back surgery.

The cost will vary from state to state. Insurance coverage can vary by insurance provider and insurance plan. Before undergoing any sort of procedure, you should always check with your insurance provider to see if it’s covered by your plan.

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Alternative treatments

Not everyone that has back pain requires back surgery. In fact, if you’re experiencing back pain, your doctor will likely recommend that you try more conservative treatments first, unless you have a progressive neurologic loss or loss of bowel or bladder function.

There are a variety of things that you can try to help relieve pain due to conditions like sciatica. Examples include:

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Medications

Your doctor can prescribe several different types of drugs to help with pain. These can include things like

  • nonsteroidal anti-inflammatory drugs (NSAIDs)
  • muscle relaxants
  • opioid pain relievers (for a very short period of time only)
  • tricyclic antidepressants
  • anti-seizure drugs
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Steroid injections

Getting an injection of corticosteroids near the affected area can help to relieve inflammation around the nerve. However, the injection’s effects typically go away after a few months, and you can only receive so many due to the risk of side effects.

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Physical therapy

Physical therapy can help with strength and flexibility and to prevent future problems. It can involve various exercises, stretches, and corrections to posture.

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At-home care

Using things like hot or cold packs can help to ease pain. Additionally, some over-the-counter NSAIDs like ibuprofen may also help.

The bottom line

Laser back surgery is a type of back surgery that uses a laser to remove tissue that may be pressing on or pinching a nerve. The procedure is less invasive than other back surgery methods, but it may require additional follow-up surgeries.

So far, little concrete information is available on if laser back surgery is more beneficial than other types of back surgery. Additionally, comparisons of cost effectiveness compared to other methods have yet to be made.

If you need to have back surgery, you should discuss all the possible options with your doctor. That way, you’ll be able to receive the treatment that’s best for you.

Kyphoplasty

What is kyphoplasty?

A compression fracture or a break in one of your vertebra can be painful. It can also make it difficult to move freely. That’s because a break can result in bone fragments rubbing against each other. Surgery can help treat such fractures. For example, kyphoplasty and vertebroplasty are minimally invasive procedures that are often performed together. Usually, they can be done without a hospital stay.

In vertebroplasty, a doctor injects a cement mixture into the bone to give it strength.

Kyphoplasty makes room for the mixture. In this procedure, a doctor inserts and inflates a balloon to create an opening for the mixture. The balloon is removed after the cement is injected. Kyphoplasty is sometimes referred to as balloon vertebroplasty.

Both of these procedures are more likely to be successful if done within two months of a fracture diagnosis. They can help relieve pain and improve mobility when other measures fail to provide relief.

Candidates for kyphoplasty or vertebroplasty

These procedures can be effective in treating people whose bones are weakened by cancer or whose vertebrae collapse due to osteoporosis, a disease that causes loss of bone density.

Kyphoplasty and vertebroplasty are used to mend recent fractures. However, they aren’t used as a preventive technique, even for osteoporosis. As well, they’re usually not advised for herniated disks, back arthritis, or curvature of the spine due to scoliosis.

These two procedures haven’t been extensively tested in younger, otherwise healthy people. The long-term effects of the bone cement aren’t known, so these procedures are generally reserved for older people.

What happens before and during the procedures

Preparation

Because kyphoplasty and vertebroplasty are surgical procedures, your doctor will probably order some blood tests before the day of your surgery. Imaging tests such as an X-ray or MRI scan will help your surgeon see the area or areas that need repair.

In preparation, an intravenous line (IV) will be placed in a vein in your arm to deliver anesthesia. You may also receive pain and anti-nausea medications, as well as antibiotics to prevent infection. You’ll probably also be connected to heart, pulse, and blood pressure monitors.

If only one vertebra is being treated, kyphoplasty usually takes less than an hour.

Procedures

For these procedures, you need to lie down on your stomach. The area in which the needle will be inserted is shaved if necessary, and then cleaned and sterilized. A local anesthetic may be injected in the same place.

Your surgeon then performs these steps:

  • The surgeon inserts a hollow needle (trocar) into your skin. With the aid of fluoroscopy, a type of X-ray, they guide the needle through your muscles and into the correct position in your bone.
  • They next insert an inflatable balloon into the trocar.
  • The balloon is then inflated to create the space needed for the bone cement.
  • OOnce the space has opened up, the mixture is injected to fill it up. Imaging tests will help the surgeon confirm that the mixture is distributed properly.
  • Once the cement is in place, the needle is removed.
  • The area is bandaged. Stitches won’t be necessary.
  • Your IV and monitoring equipment are removed.

Recovery after the procedure

Following the procedure, you’ll probably stay in a recovery room for a short time. You may be encouraged to get up and walk within an hour of the procedure. Some soreness is to be expected.

You may be able to go home later that day. However, you might need to stay in the hospital overnight for monitoring if:

  • your procedure involves more than one vertebra
  • there were any complications
  • your general health isn’t good

Your doctor will advise you when you can resume normal activities and if you should take any bone-strengthening supplements or medications. You’ll probably be asked to schedule a follow-up visit to check your progress. An ice pack can help relieve immediate soreness or pain, but you should be feeling better within 48 hours.

Complications and risks

All medical procedures have some level of risk. There’s a chance of infection or bleeding where the needle penetrated your skin. In some cases, nerve damage can lead to numbness, weakness, or tingling. It’s possible to have an allergic reaction to the materials used in the procedure.

After kyphoplasty or vertebroplasty, about 10 percent of people end up with more compression fractures.

Microdiscectomy

What Is Microdiscectomy?

Spinal surgery once meant large incisions, long recovery periods, and painful rehab. Fortunately, surgical advances like the microdiscectomy procedure have improved the process.

Microdiscectomy, also sometimes called microdecompression or microdiskectomy, is a minimally invasive surgical procedure performed on patients with a herniated lumbar disc. During this surgery, a surgeon will remove portions of the herniated disc to relieve pressure on the spinal nerve column.

 

Who Benefits from Microdiscectomy?

According to the Spine Institute of San Diego, a microdiscectomy procedure is up to 95 percent effective at eliminating sciatica pain caused by disc herniation. Sciatica is a pain condition caused by compression of the spinal nerve. This compression is most often the result of a herniated lumbar disc.

As the hernia develops and the damaged tissue extends into the spinal column, it pushes on the nerves. This causes the nerves to send pain signals to the brain. The pain is interpreted to be coming from the legs.

Most cases of sciatica will heal naturally without surgery in a few weeks. If the pain from sciatica lasts more than 12 weeks, you may benefit from a microdiscectomy. A microdiscectomy is not effective in relieving back pain.

How Is the Surgery Performed?

The goal of a microdiscectomy is to remove the disc material placing pressure on the nerves. The procedure is done under general anesthesia. You will be unconscious during the entire procedure and unable to feel anything. The procedure is performed with the patient lying face down. The process goes as follows:

  • A 1- to 1 1/2-inch incision will be made directly over the affected disc.
  • A lighted microscope is used to help your surgeon see the affected area.
  • The surgeon may remove a small portion of bone that protects the root nerve.
  • With a scissor-like tool, your surgeon will remove the damaged herniated tissue, relieving the pressure on the nerve.
  • The incision is closed with sutures.
  • The patient is usually discharged the same day or the next morning.

The spinal nerve now has the space it needs inside the spinal column, so any pain caused by pinching on the nerve should stop.

Recovery Time

The recovery time is shorter than other, more invasive procedures. Most people can expect to leave the hospital that same day, or within 24 hours. You’ll likely meet with a physical therapist and occupational therapist before leaving the hospital. These therapists will give you instructions on how to reduce the bending, lifting, and twisting you do with your back. The therapist may tell you what exercises you can do to improve the strength and flexibility of the muscles around your spine.

You should avoid driving, sitting for a prolonged period, lifting anything heavy, and bending over immediately after the surgery. Although you won’t be able to resume normal activities immediately, your lifestyle shouldn’t be greatly impacted. For the first week or two, you may need to reduce your workload or be absent from work while you recover. You’ll also need to avoid lifting heavy objects for two to four weeks after the surgery. This generally includes anything more than 5 pounds. You may also need to slowly progress your way back to normal physical activity. For example, you may not be able to resume exercise or physical hobbies for two to four weeks after the procedure. The typical time to a full recovery is about six weeks.

What Are the Risks?

Microdiscectomy is a safe procedure and complications are rare. However, like any surgery, there are some risks. These include:

  • dural tear (cerebrospinal fluid leak) in 1 to 2 percent of surgeries
  • nerve root damage
  • recurrent disc herniation (5 percent of cases)
  • bowel/bladder incontinence (very rare)
  • bleeding
  • infection

What Is the Cost?

A microdiscectomy is a specialized surgery that requires a surgeon with special training. Because of this, it can be more expensive than other back surgeries. Prices for the surgery vary and can range anywhere from $15,000 to $50,000. This price may not include any follow-up visits or care.

Your health insurance may cover a large portion of this expense once you pay your deductible and coinsurance. If you don’t have insurance, be sure to talk with your hospital, surgeon, and all other medical professionals before receiving the procedure. Ask if you can negotiate a lowered rate because you are paying from your own pocket.

Spinal Intervention Treatment

After evaluation of your symptoms, x-rays and scans, surgeon may decide to offer you a course of spinal injections. The aim of the injections is to reduce the pain and inflammation, which in certain types of spinal problems, can be long lasting and may obviate the need for spinal surgery.

Blocks are injections of medication onto or near nerves. The medications that are injected include local anesthetics, steroids, and opioids. In some cases of severe pain it is even necessary to destroy a nerve with injections of phenol, pure ethanol, or by using needles that freeze or heat the nerves. Injections into joints are also referred to as blocks. Although not technically correct, such shorthand is commonly used.

Purpose of Nerve Block :

  • Blocks with local anesthetic can be used to control acute pain. (Hence, the shot at the dentist or the epidural block for a surgery or a delivery.)
  • Pain and injury often makes nerves more sensitive, so that they signal pain with less provocation. Think about lightly brushing against your skin when you have a sunburn. Blocks can provide periods of dramatic pain relief, which promotes the desensitization of sensory pathways.
  • Steroids can help reduce nerve and joint inflammation and can reduce the abnormal triggering of signals from injured nerves.
  • Blocks often provide diagnostic information, helping to determine the source of the pain.

How Are Nerve Blocks Used?

There are different kinds of nerve blocks used for various purposes.

  • Therapeutic nerve blocks are used to treat painful conditions. Such nerve blocks contain local anesthetic that can be used to control acute pain.
  • Diagnostic nerve blocks are used to determine sources of pain. These blocks typically contain an anesthetic with a known duration of relief.
  • Prognostic nerve blocks predict the outcomes of given treatments. For example, a nerve block may be performed to determine if more permanent treatments (such as surgery) would be successful in treating pain.
  • Preemptive nerve blocks are meant to prevent subsequent pain from a procedure that can cause problems including phantom limb pain.
  • Nerve blocks can be used, in some cases, to avoid surgery.

Types of Nerve Blocks :

Various areas of pain require different nerve block types. Below are a few of the available nerve blocks and some parts of the body where they are used.

  • Trigeminal nerve blocks (face)
  • Ophthalmic nerve block (eyelids and scalp)
  • Brachial plexus block, elbow block, and wrist block (shoulder/arm/hand, elbow, and wrist)
  • Maxillary nerve block (upper jaw)
  • Sphenopalatine nerve block (nose and palate)
  • Cervical epidural, thoracic epidural, and lumbar epidural block (neck and back)
  • Cervical plexus block and cervical paravertebral block (shoulder and upper neck)
  • Supraorbital nerve block (forehead)
  • Subarachnoid block and celiac plexus block (abdomen and pelvis)

Spinal Injections Spinal Injections After evaluation of your symptoms, x-rays and scans, your surgeon may decide to offer you a course of spinal injections. The aim of the injections is to reduce the pain and inflammation, which in certain types of spinal problems, can be long lasting and may obviate the need for spinal surgery.

Your surgeon will decide which of the two types of spinal injections will benefit you:

Facet Injection or Facet Block

Transforaminal Epidural Steroid Injection or A Nerve Root Block.

Facet Injection :The facet joints are paired joints in the back that have apposing surfaces of cartilage (cushioning tissue between the bones) and a surrounding capsule. Twisting injuries can cause damage to one or both facet joints, and cartilage degeneration associated with aging may also cause pain.

In cases where the facet joint itself is the pain generator, a facet block injection can be performed to alleviate the pain. Similar to Selective Nerve Root Blocks(SNRBs), facet block injections are a diagnostic tool used to isolate and confirm the specific source of back pain for the patient. Additionally, facet blocks have a therapeutic effect as they numb the source of pain and soothe the inflammation for the patient.

Epidural Injections :

The Epidural means “around the spinal cord.” Typically, epidural injections are performed in a doctor’s office or the hospital. They’re usually given by anesthesiologists, physiatrists, or interventional radiologists with special training. Before receiving an epidural injection, you will probably undergo an imaging test. This may involve a CT scan or an MRI of the back. The test allows the doctor to identify possible causes of back pain.

The epidural injection takes place in several steps :

  • The skin will be cleaned and injected with an anesthetic to numb it.
  • The doctor will insert a needle through the skin toward the spine.
  • The doctor will use a machine that produces live X-ray video called fluoroscopy. With it, the doctor will maneuver the needle between the bones of the spine.
  • Using a contrast dye, the doctor will confirm the needle is placed in the epidural space. That’s the space between the spine and the spinal cord inside it.
  • When the needle is in position, the doctor will inject a solution into the epidural space. The solution contains a steroid medicine, also called corticosteroid, and usually an anesthetic medicine, too.