OIA interventional radiologists perform a variety of spine intervention procedures that are ordered for diagnosis and/or the therapeutic treatment of pain in the cervical, thoracic and lumbar areas of the spine. Fluoroscopy is normally used to guide the placement of the needle that delivers the pain medication or contrast material to the area of concern. The contrast material verifies accurate placement of the needle while the medication attempts to provide pain relief.

In some instances, the procedure may be done in conjunction with another imaging modality such as MRI or CT to provide collaborating information.

Some injections such as myelograms are purely diagnostic. They are performed to acquire additional information regarding pain symptoms so that your physician can establish the appropriate treatment.

Therapeutic procedures require the injection of a pain relief medication, often an anesthetic or steroid, into the problem area. This type of procedure provides diagnostic value as well, because if the injected medication provides pain relief, the physician gains valuable information about the origin of the patient's pain.

The injection procedures listed below are performed by skilled OIA interventional radiologists. They usually take between 30 and 60 minutes. In most cases, patients will be able to go home soon after the procedure.

Facet Joint Injection
Selective Nerve Root Blocks
Sympathetic Nerve Block
Myelograms
Epidural Steroid Injection (ESI)
Lumbar Discogram
Cervical Discogram

For information on interventional procedures that offer pain relief and stabilization of fractured or compressed vertebra of the spine, please see Vertebroplasty & Kyphoplasty.

Cervical Facet Injection, Cervical Nerve Root Block, Occipital Nerve Block and Sympathetic Block Procedures

Facet Joint Injection—Facet joints are located on each side of the spine. They join the spine vertebrae together and allow the spine to move with flexibility. A facet joint injection requires local anesthesia to be injected underneath your skin to numb it. A needle will then be placed with fluoroscopic guidance into your facet joint or along the facet joint nerves. Occasionally, CT imaging guidance may be used to help with needle placement. A small amount of contrast solution may be injected to help confirm the position of the needle. A mixture of a long-acting anesthetic (numbing medicine) and a steroid will then be injected.

Uncommonly, a nerve may be located immediately next to the injection site and may become anesthetized (numb) or irritated. If this nerve supplies a muscle, it may cause weakness in that muscle. This weakness should be transient, probably only lasting up to 15 minutes or so.

A facet joint injection normally takes 30 minutes to one hour. You will be able to go home shortly after the procedure.

Read the Spine Intervention Guidelines below for general preparatory information and to learn what to expect during and after the procedure.

Selective Nerve Root Blocks—This injection block procedure is performed to determine if a specific spinal nerve root is the source of pain and to reduce inflammation around the nerve root which will help decrease or relieve the pain.

You will be given a local anesthetic. Then, using fluoroscopy for guidance, the OIA interventional radiologist locates a specific spinal nerve root. A needle is introduced through the skin into the area adjacent to the nerve root. Medication, including an anesthetic and a steroid, is then injected into the area bathing the nerve root. Relief of the back and/or leg pain should be noted immediately. The procedure normally takes 30 minutes to one hour.

Read the Spine Intervention Guidelines below for general preparatory information and to learn what to expect during and after the procedure.

Sympathetic Injection—This injection block is performed to determine if there is damage to the sympathetic nerve chain and to determine if it is the source of a patient’s pain. This is a diagnostic test primarily, but it may provide relief far in excess of the duration of the anesthetic. A local skin anesthetic is given in the lumbar area of the back. A needle is then inserted into the back under fluoroscopy next to the vertebral body. The block may be performed on both sides of the spine. An anesthetic medication will be injected into the area. You may note redness of the lower extremities and a feeling of warmth from the block. The procedure normally takes 30 minutes, followed by evaluation and recovery for several hours.

Read the Spine Intervention Guidelines below for general preparatory information and to learn what to expect during and after the procedure.

Lumbar & Thoracic Myelograms and Epidural Steroid Injection (ESI)

Lumbar & Thoracic Myelograms—A myelogram is a minimally invasive procedure where a needle is placed with fluoroscopic (x-ray) guidance into the lumbar or thoracic area into the fibrous fluid containing sac that contains the lumbar (or thoracic) nerve roots. Fluid may be withdrawn, if necessary, for routine laboratory tests and then myelogram contrast (x-ray dye) will be injected. Radiographs will be taken and then you will have a CT scan of the area within 1-2 hours of the myelogram.

You will be returned to your room after the procedure and monitored for potential complications. You will normally be discharged about 4 hours after the procedure. You will be able to eat and drink as well as use the bathroom while in the hospital after the procedure.

Typically, antidepressants (Paxil, Prozak, Zoloft, Elavil, etc.) are stopped for 2 days prior and 2 days after the procedure. However, exceptions may be made depending on the antidepressant. Elavil must always be held before and after the procedure.

While most complications of myelograms are rare, a spinal headache occurs in 30 to 50% of patients having a lumbar puncture of any kind, including a myelogram.

A spinal headache may occur 2 to 3 days after the procedure if the small hole in the fibrous sac does not close after the needle puncture. In this instance, fluid can leak out. When the leakage is severe, the brain loses the cushioning effect of the fluid which causes a severe headache when you sit or stand. Being positional in nature, the headache goes away when you lie down.
 
It is important that you follow your post-operative instructions in order for the small hole in the sac to heal. These include maintaining 24 hours of bed rest (getting up only to use the bathroom), drinking plenty of fluids and taking non-aspirin pain relievers such as Tylenol. If the headache persists, contact the OIA interventional radiologist who performed the procedure or your referring physician.

Read the Spine Intervention Guidelines below for general preparatory information and to learn what to expect during and after the procedure.

Epidural Steroid Injection (ESI)—This is a minimally invasive procedure where a needle will be placed with fluoroscopic (x-ray) guidance into the lumbar or thoracic area into the fibrous fluid containing sac that contains the lumbar (or thoracic) nerve roots. A small amount of contrast (x-ray dye) will be injected to confirm correct needle placement and an injection of steroids will be made into the same location.

After the procedure, you will be monitored for potential complications in the recovery area for 30 minutes before being discharged. You will be able to eat and drink as well as use the bathroom while in the hospital after the procedure.

A spinal headache is a rare complication in ESI procedures. Small holes in the fibrous sac are only made in less than 1% of epidural injections and those usually heal on their own. If a spinal headache does occur, the treatment is the same as in the myelogram section above.

Read the Spine Intervention Guidelines below for general preparatory information and to learn what to expect during and after the procedure.

Diagnostic Lumbar Discogram

During this minimally invasive procedure, one or more discs will be studied individually by injecting contrast (x-ray dye) and then putting each targeted disc under pressure. A local anesthetic is applied to the target area. The OIA interventional radiologist will then use fluoroscopy for guidance to place needle(s) into the lumbar spine disc(s) to be studied. The appearance of the discs on the x-ray (fluoroscopic) image and your response to the injection will be monitored.

The information obtained will help determine whether one or two of your discs are potential sources of the pain. Because of this objective, we cannot give any pain or sedative medication prior to the procedure. Typically, three discs are studied, but this number varies by patient. A CT scan is often done after the procedure to obtain higher resolution images of your spine.

You can be discharged home immediately after the procedure if no IM or IV pain medications have been given.

The procedure is very safe and complications are generally limited to shooting pains/electrical shock sensation down the leg. This occurs when the needle is inserted into the disk and the nerves running adjacent to that area are irritated by it. This resolves quickly as the needle is repositioned.

Rarely, in order to access the lowest lumbar disc (L5/S1), the guiding needle needs to be placed first through the fibrous sac containing fluid and nerve roots instead of to the side of the spine. This is basically a lumbar puncture and then has a risk of spinal headache.

At OIA, this type of puncture is rare in discography. If it does occur, it is important that you follow your post-operative instructions in order for the small hole in the sac to heal. These include maintaining 24 hours of bed rest (getting up only to use the bathroom), drinking plenty of fluids and taking non-aspirin pain relievers such as Tylenol.

If the headache persists, contact the OIA Interventional radiologist who performed the procedure or your referring physician.

Read the Spine Intervention Guidelines below for general preparatory information and to learn what to expect during and after the procedure.

Diagnostic Cervical Discogram

This procedure is similar to the diagnostic lumbar discogram described above, except that it is limited to the neck so there is no risk of spinal headache.

Read the Spine Intervention Guidelines below for general preparatory information and to learn what to expect during and after the procedure.

Spine Interventional Guidelines

When Your Procedure Is Scheduled

• Our scheduler will give you a date and time for your procedure at Overlake Hospital Medical Center. You will need to arrive at the hospital two hours before the procedure to allow the admitting and nursing staffs to get you ready.
  
• Please let the scheduler know if you take Coumadin, Plavix, Insulin or Metformin. You will need to receive specialized instructions.
  
• If you take BLOOD THINNERS OR ANTIPLATELET medications, such as Coumadin, Heparin. Plavix or Lovenox, please contact the prescribing physician to discuss your risk of stopping these medications in advance of your test/procedure. We require that Coumadin is stopped for 5 days prior to your test/procedure, and that Plavix is stopped for 7 days prior to your test/procedure. Please call and speak with an interventional nurse at 425-688-5005 for further instructions or if you have questions about your medications. Your procedure will be canceled if these medications have not been stopped.
  
• Please notify us if you’ve had a previous reaction to contrast dye.
  
• The admitting department will attempt to call you the night before your procedure to confirm your arrival time.
  
• Please plan to leave any jewelry or valuables at home.
  
• Make sure to arrange for someone to drive you home after the procedure. If a driver is unavailable, the procedure will be canceled per hospital policy. We must be able to contact your driver before, during and after your procedure either by phone or pager. *You must be healthy on the day of the exam. You cannot have a fever, infection, sore throat or cough. If you have concerns regarding your current health, please call and speak with an interventional nurse at 425-688-5005.
  
• If you have any questions regarding your procedure, please call us at 425-688-5005 anytime Monday thru Friday from 8AM to 4PM.

Preparation

• You will need to be at the hospital’s admitting area two hours before you procedure’s scheduled start time. This is located at the large desk at the hospital’s main entrance (across from Stanza’s Café).
  
• Wear loose comfortable clothing. A sweat suit is optional.
  
• Please withhold pain medication for at least 2 hours prior to the exam time. If you are receiving pain medication by skin patch, you must call and speak with an interventional nurse at 425-688-5005 for further instructions.
  
• You may bring pain medication with you to take after the procedure, if desired.
  
• Do not eat or drink for 4 hours before your exam.
  
• You may bring a snack with you to eat after the procedure; a drink will be provided.
  
• Please take your normal heart and blood pressure medications with a sip of water.
  
• Insulin-dependent diabetics, please note:
  
  • If your exam is before 12 noon, do not eat or take any diabetic medication
    before the procedure. Bring your medication with you.
    
  • If your exam is at 12 noon or after, please eat breakfast before 7AM. and take your pill or your morning dose of insulin. Bring your medication with you.
    
• You will be taken down to your room where you will meet your nurse and be asked to change into a patient gown.
  
• An IV will be started and blood drawn for lab tests. The nurse will ask you for your medical history. If possible, bring a list of all the medications you take and when you take them.
  
• The nurse will also ask you about allergies. If you are allergic to radiology/contrast dye please let them know.
  
• If there is a possibility that you’re pregnant, please let the nurse know. You will be asked to sign a form if you are a female of childbearing age (12-57).
  
• The nurse or tech will clean and shave, as necessary, an area around the needle’s point of entry.
  
• Before the procedure, the interventional nurse will meet with you and your family to review the procedure and answer any questions you might have.

What to Expect During the Procedure

• The procedure takes approximately 1 hour. You will meet the interventional radiologist who will go over the consent form and answer any questions you might still have.
  
• You will receive sedation medication during the procedure to help you relax.
  
• During the procedure you might feel warmth, tingling or flushing when you are given the contrast dye. This usually lasts about 10 seconds.
  
• During the procedure the nurse will be monitoring your heart, blood pressure and the oxygen level in your blood.
  
• Once the procedure is over you will be transferred back to your room.

What to Expect After the Procedure

• Your blood pressure, pulse and puncture site will be monitored very frequently by the nurse.
  
• You will be encouraged to drink a lot of fluids to help wash the contrast out of your system. You will need to continue to drink fluids for the first 24 hours after your procedure, unless your physician has limited your fluid intake.
  
• Most patients will be discharged about 6 hours after their procedure.
  
• You will be given written instructions and a phone number to call if you have any questions or concerns.
  
• One of the interventional nurses will do a follow-up call the next week-day after your discharge. Write down any questions you might have for them.
  
• To speak to an interventional nurse, please call 425-688-5005. It is best to call between 8AM and 4PM Monday thru Friday. You can leave a message on the voicemail, and a nurse will return your call as soon as possible.
  
• If you are on Coumadin and have been told not to take it before your procedure, you need to check with your physician, and/or the Anti-Coagulation Clinic for instructions.
  
• If you are on Metformin/Glucophage, withhold taking it for 48 hours post procedure. Check with the physician who ordered the medication on when to restart it. Additional blood work may be required.
  
• If you an insulin-dependent diabetic, restart your regular dosing when you get home. Check your sugar regularly and if you have a concern, contact your diabetic doctor.
  
• You may resume taking all of your normal medications once you are home.
  
• If you are in physical therapy, check with your physician before resuming treatment. We recommend delaying any physical therapy for 48 to 72 hours post procedure.