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Image Guided Procedures

Properly performed interventional pain management injections utilize imaging to guide needle placement to specific areas. This allows for accurate needle placement and effective delivery of medications.

Types of Image Guidance

Fluoroscopy (X-ray) Guided Procedures

The fluoroscopy-guided method uses X-rays to allow physicians to precisely direct needles and other tools when performing procedures. The ability to see through skin ensures accuracy and improves the outcome. Fluoroscopy-guided procedures are the evidence-based recommended method for spine interventions. Fluoroscopy increases the success rate and patient satisfaction, significantly diminishes risks and complications, and reduces the number of treatments.

Ultrasound Guided Procedures

Blind injections are inaccurate. Even in the hands of experienced orthopedic surgeons, the failure rate is up to 70% for shoulder injections, and between 20% and 40% for hip injections. The benefits of ultrasonography have been reported in multiple clinical studies, including randomized control trials where ultrasound guidance (UG) was compared to the conventional palpation-guided (PG) method. The medical literature suggests that the improvement after UG is greater and lasts longer than PG. The correct injection can provide useful diagnostic information regarding the location of a pain generator. If medicine is misplaced, it may lead to complications such as skin depigmentation, subcutaneous fat atrophy, tendon rupture, neurovascular injury, increased procedural/postprocedural pain, or seizures.

Many treatments offered at our clinic use such images for accuracy.

Radiofrequency Ablation or RFA

May be recommended depending on the results of a diagnostic nerve block. This safe procedure “burns” the tiny nerves to those painful joints.

What to expect during the radiofrequency facet neurotomy?

You may be given lightly sedating medications through an intravenous during the procedure to help you relax, but you will not be asleep. You will be able to answer questions and talk with the doctor while the procedure is being performed. Local anesthetic will be used prior to the actual injection. The nerves are stimulated by a light electrical current to ensure the correct placement of the needles. You will feel a tingling sensation or a deep ache in your back. A small amount of local anesthetic +/- steroid is given and the burn is made. You should feel little to no pain. The procedure will take approximately 30-60 minutes. Risks include tenderness and/or bruising at the injection sites, very rare infection, nerve damage, allergy or seizure.

How long does it last?

The effects of the procedure can last an average of 9 months, up to 24 months for some. Complete pain relief is not to be expected. If successful, 50-80% relief is considered a good outcome. The success rate for this procedure is between 70-80% following two highly positive tests. If after this time your pain returns, the physician can repeat the neurotomy without re-testing if the pain remains unchanged. If your pain returns after only a few months, further diagnostic tests may occur in order to determine where the pain is coming from.

Epidural Steroid Injections or ESI

Is a minimally invasive procedure that can help relieve arm, back and leg pain caused by inflamed or pinched spinal nerves due to spinal stenosis or disc herniation. This leads to pain, numbness, tingling or weakness along the arm or leg. ESI procedures are performed under x-ray. A needle is inserted into the proper space using fluoroscopy. A small amount of dye is injected to verify the position of the needle and the spine’s anatomical structures. A mixture of local anesthetic and steroid is injected into the epidural space. Patients can resume activities as tolerated soon after the procedure. The local anesthetic works immediately to numb the pain and the steroid takes about 24-48 hours to take effect.