Patient Information

Back pain can have a myriad of causes and it is vital that patients are correctly diagnosed. An MRI or CT scan complements the clinical examination helping identify a structural cause for symptoms which can then be managed appropriately. Once the diagnosis has been made or a serious structural cause excluded potential management options can then be explored. All MRI and CT scans are read by TheSpineGroup consultants who provide expert assessment including correlation of findings with patient symptoms.

In addition to state-of-the-art diagnostics TheSpineGroup provide a comprehensive range of interventional radiology directed minimally invasive treatment options which target the specific cause for symptoms, for example nerve root compression secondary to a disc prolapse or facet joint degenerative change. Compared with traditional pain management methods interventional therapies have demonstrated promising results. Below is an overview of the procedures we perform:


Epidural Injection

This is an injection delivered into the epidural space of the spine to provide temporary or prolonged pain relief. A combination of corticosteroids and other anti-inflammatory medications are administered in an attempt to reduce pain and swelling in and around damaged spinal nerve roots.

By delivering an injection directly into the epidural space, the medication coats the nerve roots reducing swelling and irritation. Most patients experience relief for a number of days up to several months, however, the pain may eventually return, requiring either another injection or alternative treatment options.

The Procedure

An epidural injection is performed on an outpatient basis and usually takes 20-30 minutes to administer. You will be positioned on your stomach, on a table in the fluoroscopy (x-ray) room and made to feel as comfortable as possible. Using imaging guidance in conjunction with the results of previous MRI or CT scans an appropriate injection site is selected and the skin over this area is sterilized with antiseptic solution. A small amount of local anaesthetic is then injected to help numb the area before administering the epidural injection.

Once the area is numb, imaging is used to help guide the needle to exactly the right position. When the correct position is confirmed the medication is injected slowly. When finished, you will be moved onto a bed to rest for a few minutes before being observed on a recovery ward for a few hours prior to discharge.

Benefits and risks

Benefits

  • Temporary or prolonged pain relief with improved quality of life

Risks

  • Major adverse events are rare and reported to occur in less than 1% of cases
  • Temporary headache or lower limb weakness
  • Reaction to the medication, such as hot flushes or a rash.
  • Bleeding if a blood vessel is inadvertently damaged.
  • Temporary paralysis of bladder or bowel function.
  • Minimal low-level radiation exposure – women should inform the doctor if there is any possibility that they are pregnant


Facet joint injection

This is an injection delivered into a diseased spinal facet joint to provide temporary or prolonged pain relief. A combination of corticosteroids and other anti-inflammatory medications are usually administered. By delivering an injection directly into the facet joint or on the nerve that supplies the joint, the medication aims to reduce swelling which may be irritating adjacent nerve roots.

Following the procedure, it can take up to 2 weeks to achieve maximal relief from symptoms. At this time you should be reassessed clinically with regards the need for further injections and/or a course of physiotherapy.

The Procedure

A facet joint injection is performed on an outpatient basis and usually takes 20-30 minutes to administer. You will be positioned on your stomach on a table in the fluoroscopy (x-ray) room and made to feel as comfortable as possible. Using imaging guidance in conjunction with the results of previous MRI or CT scans an appropriate injection site is selected and the skin over this area is sterilized with antiseptic solution. A small amount of local anaesthetic is then injected to help numb the area before administering the injection.

Once the area is numb, imaging is used to help guide the needle to exactly the right position. When the correct position is confirmed the medication is injected slowly. Depending upon the previous scan results it may be appropriate to inject up to 4 different facet joints in one sitting. When finished, you will be moved onto a bed to rest for a few minutes before being observed on a recovery ward for a few hours prior to discharge.

Benefits and risks

Benefits

  • Temporary or prolonged pain relief with improved quality of life

Risks

  • Major adverse events are rare and reported to occur in less than 1% of cases
  • Temporary headache or lower limb weakness
  • Reaction to the medication, such as hot flushes or a rash.
  • Bleeding if a blood vessel is inadvertently damaged.
  • Temporary paralysis of bladder or bowel function.
  • Minimal low-level radiation exposure – women should inform the doctor if there is any possibility that they are pregnant


Selective transforaminal nerve root block

This is an injection delivered around the nerve root within its exit foramen which lies at the side of the spinal canal and is indicated for sciatic symptoms that are due to single nerve root compression. A combination of corticosteroids and other anti-inflammatory medications are usually administered. By delivering an injection directly around the nerve the aim is to relief the symptoms of irritation/compression.

The Procedure

Transforaminal nerve root block is performed on an outpatient basis and usually takes 20-30 minutes to administer. You will be positioned on your stomach, on a table in the fluoroscopy (x-ray) room and made to feel as comfortable as possible. Using imaging guidance in conjunction with the results of previous MRI or CT scans an appropriate injection site is selected and the skin over this area is sterilized with antiseptic solution. A small amount of local anaesthetic is then injected to help numb the area before administering the injection.

Once the area is numb, imaging is used to help guide the needle to exactly the right position. Correct positioning is confirmed using a small injection of x-ray dye to outline the nerve root and then the medication is injected. When finished, you will be moved onto a bed to rest for a few minutes before being allowed to leave.

Benefits and risks

Benefits

  • Temporary or prolonged pain relief with improved quality of life
  • To confirm the initial diagnosis
  • Also a prognostic indicator prior to surgery

Risks

  • Major adverse events are rare and reported to occur in less than 1% of cases
  • Reaction to the medication, such as hot flushes or a rash.
  • Bleeding if a blood vessel is inadvertently damaged.
  • Minimal low-level radiation exposure – women should inform the doctor if there is any possibility that they are pregnant


Vertebroplasty


Vertebral Fracture CT
Vertebral Fracture MRI
Vertebroplasty Prodecure

This is the injection of bone cement through a small hole in the skin into a fractured vertebra with the aim of relieving the pain of osteoporotic or malignant compression fractures. The acrylic cement quickly dries and forms a support structure within the vertebra which provides stabilization and strength.

The Procedure

Vertebroplasty is performed under light sedation on an inpatient basis and usually takes around 30 -40 minutes. You will be positioned on a table in the fluoroscopy (x-ray) room and made to feel as comfortable as possible. Using imaging guidance in conjunction with the results of previous MRI and CT scans an appropriate injection site is selected and the skin over this area is sterilized with antiseptic solution. A small amount of local anaesthetic is then injected to help numb the area before administering the injection.

Once the area is numb, imaging is used to help guide cement injection into the centre of the fractured vertebra. When finished, you will be moved onto a bed to rest for a few hours. As it is a minimally invasive procedure patients usually go home the day of treatment.

As it is a minimally invasive procedure patients usually go home in the evening or the following day.

Benefits and risks

Benefits

  • Pain relief with improved quality of life

Risks

  • Major adverse events are rare and reported to occur in less than 3% of cases
  • Bleeding if a blood vessel is inadvertently damaged.
  • Numbness, tingling and paralysis if cement leaks outside the vertebra
  • Minimal low-level radiation exposure – women should inform the doctor if there is any possibility that they are pregnant


Coccyx injection

This is an injection delivered around the coccyx to provide temporary or prolonged pain relief from coccydynia. A combination of corticosteroids and other anti-inflammatory medications are administered in an attempt to reduce pain and swelling in and around the damaged joint.

The Procedure

Coccyx injection is performed on an outpatient basis and usually takes 20-30 minutes to administer. You will be positioned on your stomach on a table in the fluoroscopy (x-ray) room and made to feel as comfortable as possible. Using imaging guidance in conjunction with the results of previous MRI or CT scans an appropriate injection site is selected and the skin over this area is sterilized with antiseptic solution. A small amount of local anaesthetic is then injected to help numb the area before administering the injection.

Once the area is numb, imaging is used to help guide the needle to exactly the right position. When the correct position is confirmed the medication is injected slowly. When finished, you will be moved onto a bed to rest for a few minutes before being observed on a recovery ward for a few hours prior to discharge.

Benefits and risks

Benefits

  • Temporary or prolonged pain relief with improved quality of life

Risks

  • Major adverse events are rare and reported to occur in less than 1% of cases
  • Reaction to the medication, such as hot flushes or a rash.
  • Bleeding if a blood vessel is inadvertently damaged.
  • Minimal low-level radiation exposure – women should inform the doctor if there is any possibility that they are pregnant

MRI

MRI of the lumbar spine

Magnetic Resonance Imaging (MRI) is the technique of choice for investigating most spinal disorders as it provides unparalleled soft tissue resolution enabling a complete assessment of the spinal cord, nerve roots, facet joints and surrounding structures including ligaments and muscles. MRI is the best technique to assess for a prolapsed disc and for nerve entrapment. A typical MRI scan of the lumbar spine takes around 20 minutes to acquire.

“Open” MRI

Conventional MRI scanners require the patient to lie within an enclosed tunnel and some patients can find this uncomfortable due to claustrophobia. Thespinegroup are able to provide MRI scans using the latest state-of-the-art “open” MRI scanners which do not have a traditional tunnel design but are instead open on both sides which effectively eliminates the sensation of claustrophobia. If you would prefer to have your scan performed on an “open” MRI system simply let us know and we can arrange this on your behalf. Most private health insurance companies will fund scanning on an “open” MRI scanner if there is a specific reason, such as claustrophobia that precludes use of a conventional scanner.


CT

CT of lumbar spine

Computed tomography (CT) is an alternative technique for imaging the spine and is principally reserved for patients with a contraindication to MRI such as a pacemaker, although in some circumstances CT is superior to MRI e.g. for assessment of certain types of vertebral fracture.

One of the main advantages of CT scanning is the speed at which the images are acquired with a typical lumbar spine scan taking just a few seconds on the latest generation CT systems. Thespinegroup are able to provide CT scans using the latest state-of-the-art multi-slice CT technology which provides a comfortable scan experience and exquisite image quality.