Lumbar Facet Joint Injections
The zygoapophyseal or facet joints are paired articular surfaces between the posterior aspects of adjacent vertebrae.Read More
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Painful treatments are over! Today we have several approved painless methods and therapies so that no one needs to worry about going to the doctor anymore. Of course, the pain treatments providing the treatment needs to have the necessary specialist knowledge and the appropriate technical equipment at hand. In our practice we offer a choice between different anaesthetic methods: apart from the most frequently applied local anaesthesia you can also decide on sedation. You will see: your treatment will be over before it even started!
The most common method of pain relief is the traditional use of 'on demand' intramuscular opioid or NSAI injections. Better pain relief can be obtained with newer techniques such as epidural, local opioids, anasthetics, steroids and patient controlled analgesia. However, some techniques such as pre-emptive analgesia have not been fully evaluated and others, such as infiltrating local anaesthetic into wounds, may not reduce the patient's analgesic requirements. Patients should be counselled before surgery because an explanation of what to expect, and other simple measures, may reduce their analgesic needs.
Radiofrequency neurotomy (also called radiofrequency ablation or lesioning) is a minimally invasive procedure that can provide lasting relief to those suffering from facet joint pain. In fact, multiple clinical studies show that radiofrequency neurotomy significantly reduces pain severity and frequency for 1 to 2 years in the majority of patients.
Flexibility is the skill that enables us to perform the movements in a big range in the joints. The maximum development of flexibility is not necessary. The most significant is the mobility of the dorsal segment of the spine, the hip and the shoulder joints. The factors that affect flexibility are; the elasticity of muscles and joint ligaments; the amount of the resting tension of the muscles; relaxation skills; technical skills; outdoor temperature, time of the day.
The zygoapophyseal or facet joints are paired articular surfaces between the posterior aspects of adjacent vertebrae.Read More
The anatomy relevant to injection of the cervical facet joints is similar to that relevant to the lumbar facet joints.Read More
The surface of the sacrum and ilium form a synovial joint the sacro-iliac joint.Read More
Intervertebral disc disease may produce inflamation of spinal nerve roots, which may be cause of radicular pain.Read More
Mecanical nerve root compression was originally thought to be the cause of pain in discogenic radiculopathy.Read More
The trigeminal ganglion gives rise to the fifth cranial nerve and divides into three branches, the ophthalmic, maxillary, and...Read More
Autonomic blockade is useful in the diagnosis and treatment of pain of autonomic origin.Read More
The cervical sympathetic trunk - the superior, middle, and stellate ganglia - supplies the sympathetic innervation ..Read More
The lumbar sympathetic chain is located in the prevertebral fascia, which lies on the anterolateral aspects of the vertebral...Read More
The celiac plexus is flat and lies against the crus of the diaphragm, surrounding the root of the celiac and mesentetric ...Read More
The superior hypogastric plexus is formed from pelvic sympathetic fibers of the aortic plexus and L2 and L3 splancnic nerves.Read More
The ganglion impar is a retroperitoneal sympathetic ganglion located at the level of the sacrococcygeal junction.Read More
Musculofascial pain occurs commonly in the muscles of the upper and lower back. It is characterized by pain associated ...Read More
The muscles most often involved in myofascial pain syndrome of the neck include the trapezius, rhomboid minor ...Read More
When buttock muscles are relaxed the quadratus femoris, gamelli and gluteus medius muscles can be palpated.Read More
The piriformis muscle inserts into the pelvic surface of the sacrum from the second to the fourth segments, lateral...Read More
The first papers about percutaneous thermic discectomy were published in 1954 and the term nucleoplasty was ...Read More
Back exercises are a common part of almost any treatment program for back pain...Read More
Neck exercises are a common part of almost any treatment program for neck pain...Read More
This is an effective complementary method for putting the patient into a state of deep ...Read More
The analgesic effect of cold was first recorded by Hippocrates.1 Early physicians such as Avicenna used cold for preoperative analgesia. Robert Boyle published a classic monograph nearly three hundred years ago entitled "New Experiments and Observations Touching Cold". In 1851, Arnott reported the application of cold in relieving cancer pain. Smith and Fay in 1939 reported finding regression of tumor following localized freezing. The first cryoprobe was developed by Cooper and colleagues in 1961. Subsequently, Amoils developed a more practical enclosed gas expansion cryoprobe that operated based on the Joule-Thompson principle. In the early 1970's, the concept of therapeutic peripheral nerve freezing was reintroduced by Nelson, Brain, Lloyd and others. Lloyd and coworkers in 1976 used this method for pain relief and coined the term "cryoanalgesia". Additionally the technological advances which have caused renewed interest in cryosurgery are the development of intraoperative ultrasound to monitor the therapeutic process and the development of new cryosurgical equipment designed to use supercooled liquid nitrogen. The thin, highly efficient probes, available in several sizes, can be placed in diseased sites via endoscopy or percutaneously in minimally invasive procedures. The manner of use is to place the probe in the desired location in the diseased tissue with ultrasound guidance. If required by the size or location of the tumor, as many as five probes can be inserted and cooled to -195 degrees C simultaneously. The process of freezing is monitored by ultrasound which displays a hypoechoic (dark) image when the tissue if frozen. Rapid freezing, slow thawing, and repetition of the freeze/thaw cycle are standard features of technique. Clinical applications which have become common in the past 4 years include the treatment of prostatic cancer and liver tumors. The cases selected for cryosurgery are generally those for which no conventional treatment is possible.
C ell death starts at -20°C. Holding the temperature below -20°C for some duration,depending on the cell type, allows intracellular changes to occur and cell destruction to adequately take place. Effective Cryosurgery • Tissue temperature changes must be extremely fast (50-100°C/min). • Final temperature of tissue cells must be colder than -20°C. However, especially in prostatic cancer, the operative morbidity is so low and the results of therapy are sufficiently good in the short term to merit consideration of use in earlier stages of the disease. Diverse tumors in other sites, such as the brain, bronchus, bone, pancreas, kidney, and uterus, have also been treated in small numbers by cryosurgery. Judging from this experience, further expansion in the use of cryosurgical techniques seems certain.
Prolotherapy (growth factor or growth factor stimulation injection) raises growth factor levels or effectiveness to promote tissue repair or growth. Growth factors are complex proteins (polypeptides), and their beneficial effects on human ligament, tendon, cartilage, and bone are under intense investigation. Prolotherapy may utilize inflammatory or noninflammatory mechanisms. The treatment of sports injuries to the point of restoration of full sports performance is an obvious goal in sports medicine. However, healing is the preferred goal because returning connective tissue to normal strength allows for a durable return to full sports performance. Regenerative injection therapy (prolotherapy) is the injection of growth factors or growth factor production stimulants to promote the regeneration of normal cells and tissue. Inflammation is not required, and scarring is not the result. Open-label clinical trials have been uniformly positive in outcome,but double-blindclinical trials havebeen hampered by a needling control that does not appear to be a placebo.Recent studies aremaking use of a noninjection control. Making use of consecutive patient data from athletes with career-threatening injuries (i.e., chronic groin strain in soccer or rugby players) that are not responsive to other treatments is a recommended study approach to assess regenerative injection therapy's ability to reverse otherwise permanent conditions.
This is an avenue for the critical assessment of regenerative injection therapy's potential. Serial high-resolution ultrasound images are limited somewhat by uniformity of technique, but they offer a way to follow healing from regenerative injections.
There are other solutions that stimulate the AA type of inflammation, such as phenol, and they are also called prolotherapy. However, when cells are removed from the human body and then reinjected, that is "biologic repair injection." The primary goal is still repair but it is by use of tissue from living (biologic) sources. This includes injection of whole blood, stem cell injection and platelet rich plasma injection.
A lumbar RFA is a procedure that uses radio waves to stop the lumbar medial branch nerve from transmitting pain signals from the injured facet joint to the brain. The procedure calls for a needle to be inserted through the skin and guided with X-ray to the correct site overlying the medial branch nerve. Additionally Radiofrequency ablation (RFA) is a technique used to treat benign and malignant liver tumors, often without the long incisions traditionally used in liver tumor ablation. Your doctors have found a tumor (or tumors) in an organ in your body (usually the liver, kidney, or lung). There are many treatments for tumors, but certain ones work best for certain people. Our team of experts believes that ablation (destruction) of the tumor with a heat probe is the perfect option for you at this time. In some cases, this treatment will destroy the tumor. After this, other options (such as chemotherapy, chemoembolization, or surgery) may also be advised for you. Also RFA is a procedure that uses radio waves to stop the lumbar medial branch nerve from transmitting pain signals from the injured facet joint to the brain. The procedure calls for a needle to be inserted through the skin and guided with X-ray to the correct site overlying the medial branch nerve. Before the procedure: You will meet with a doctor who will explain the risks and benefits of the procedure and answer any questions you may have. The potential risks include, but are not limited to:
Radiofrequency ablation uses alternating current (electricity) delivered through a specially designed probe that is directed into the brain tumor using CT scan guidance. The probe allows the electric current to pass into the tumor, while the surrounding tissues (skin, muscle and blood vessels) are not affected. The electric current generates heat which causes death of tumor cells. After the tumor cells are destroyed, the tumor will eventually be replaced by scar tissue.
How is RFA Performed? Radiofrequency ablation can be performed using many different approaches, but usually requires surgery and general anesthesia to be done safely.
Infusion of DC cells into ablated tumor
Danger Signals TLR ligands.
Potential synergy with systemic vaccines
Synergy in chemotherapy with BBB modulation
Many experimental and clinical studies have shown analgesic and anti-inflammatory potential of low-level laser therapy (LLLT) in a dose-dependent manner. It has been shown to be a low risk and safe treatment, but its true efficacy is controversial. LLLT was demonstrated to modulate the inflammatory, proliferative, and remodeling phases of the healing process. Important additional effects appear to include a direct influence on neural structures that are damaged by compression or inflammation, and this significantly improves nerve recovery. Laser's effectiveness in pain management, combined with a lack of serious side effects has been proved. Laboratory studies, for example, showed that infrared light from LLLT can stimulate healing, alter cellular metabolism, improve enzyme production, and stimulate tissue proliferation at intensities that do not produce significant heating. One of the problems in studying laser therapy is dose. For example, when the dose is too low, which is common in the older, very low-power lasers, treatment is ineffective. On the other hand, very hot, high-powered lasers risk eye damage and skin burns, and could potentially aggravate symptoms. In fact, a recent study found that LLLT irradiation should be avoided over melanomas because the combination of hotter lasers and high doses significantly increased melanoma tumor growth in vivo.11 An intriguing study from the Mayo Clinic provided 2 main insights. First, 50% of patients with CRPS I noted a sensation of warmth in their symptomatic limb after treatment, but control subjects did not. More importantly, one-third of the treated subjects had a reduction in pain of more than 50%, which lasted for over 2 weeks. This is a dramatic finding considering the recalcitrant nature of CRPS pain. Even though the study size was small, the fact that it was well controlled and double blinded makes the results more interesting. In contrast to some previous studies, this research documented no measurable alteration in sympathovagal balance, vasomotor tone, or sudomotor function. Thus, the author concluded that irradiation must act through a somatic rather than an autonomic mechanism.
Low-level laser therapy LLLT) is also known as photobiomodulation, cold laser therapy, and laser biostimulation. It is a medical treatment that uses low-level lasers (LLL) or light-emitting diodes to stimulate or inhibit cellular function. A large number of studies suggest that light, whether in the form of LLL radiation or from other light sources, benefits a variety of painful musculoskeletal and neurologic conditions. In addition, a number of studies have reported that infrared light is exceptionally effective in reducing pain associated with CRPS. One study using laser acupuncture demonstrated an increase in vagal activity and suppression of cardiac sympathetic nerves. Another study found that LLLT created an effect that appeared to normalize the autonomic nervous system.
The effects on sympathetic tone were thought to result from normalization of the SNS.