Answer: Interventional spinal procedures are minimally invasive injection techniques performed with needles to relieve pain caused by degenerative changes in or near the neck and back.

Most spinal procedures are performed with you positioned on your stomach.  You may experience a brief prick and some temporary burning that usually lasts only a few seconds while the skin over the injection site is being numbed.

Fluoroscopy (low-dose x-ray) is then used to guide needle placement onto specific locations in your spine.  Some procedures require the placement of only one needle while others require the use of multiple needles.  Medications (usually a combination of steroid and numbing medication) are then deposited in an effort to decrease pain, inflammation, and swelling that often results from arthritis, herniated disks, pinched nerves, and/or compression of the spinal cord.  The injections will likely help to relieve your pain but will not reverse the degenerative changes in your spine.

Answer: If you are going to be sedated or having an anesthetic, other than your regular medications with sips of water you should not eat for 6 (six) hours, or drink other than sips of water for 4 (four) hours prior to the procedure. Diabetic patients should consult their primary care physician to see if they need to adjust their diabetes medications prior to injections.

Answer: Medications that thin the blood must be temporarily discontinued prior to each spinal procedure because they can cause internal bleeding and serious complications. Do not stop these medications without permission and specific instructions from our nursing staff, in conjunction with scheduling your procedure. Blood-thinning medications should be temporarily stopped only with written authorization from the outside physician who prescribed them.  Injections will not be performed without authorization to stop blood thinning medications. Baby aspirin (81 mg) taken once daily does not have to be stopped before injections.

Blood thinning medications should be stopped before each procedure for the appropriate length of time as follows:

• Coumadin (warfarin): 5 days
• Plavix (clopidogrel): 7 days
• Pletal, Trental, Aggrenox: 5 days
• Ticlid (ticlopidine):14 days
• Aspirin (325 mg): Must be decreased to 81 mg daily for 10 days
• Non Steroidal Anti Inflammatory Drugs (NSAIDS): 48 hours

We perform on-site fingerstick INR testing immediately prior to the procedure, to make sure your blood is clotting adequately.  Your injection will be cancelled if this test shows that your blood is still too thin.

All blood-thinning medications should be restarted on the day after each procedure.  You may continue taking your other medications that do not thin the blood with a small sip of water prior to procedures.

Answer: Please arrive at the clinic 30 minutes before your scheduled procedure to allow ample time for you to complete your paperwork, change into a gown, have your vital signs taken, and ask our staff any question that you may have.

Answer: Yes. We insist that you do not drive for the remainder of the day in order to ensure the safety of yourself and others. Your procedure will likely be cancelled if you do not bring a driving escort with you to the clinic.  Numbing medications can occasionally cause temporary numbness and weakness in the arms or legs.  These symptoms usually last less than a few hours.  When this occurs, patients are closely monitored in the clinic until these symptoms resolve completely.

Answer: Yes, although you may be sedated or offered an anesthetic if you wish.  Communication between you and our staff ensures that the procedure is performed in the safest manner possible.

Answer: Every attempt will be made to maximize your comfort.  The skin and soft tissues overlying each injection site will be numbed.  Most patients report that numbing medication causes temporary stinging and burning that lasts for only a few seconds.  Patients usually report only minor discomfort during procedures after their skin is numbed.

Answer: Steroids decrease pain by reducing inflammation and swelling of the joints, muscles, nerves, and spinal cord.

Answer: Large doses of steroids can have undesirable effects on your body.  For this reason, we make every effort to use the lowest effective dosage of steroid.  We also monitor the cumulative amount of steroid you receive annually.  Only a limited number of steroid injections can be performed each year based on the total amount of steroid you receive during each injection.

Steroids can temporarily increase blood sugar levels in diabetic patients.  We recommend that diabetic patients monitor their blood sugar closely for 48 hours following each procedure to ensure that the level remains within normal range.  Diabetic patients should consult their primary care physician for instructions on how to treat elevated blood sugar.

Steroids can occasionally cause weight gain and water retention, although this is uncommon.  High cumulative doses of steroids can potentially decrease bone density and worsen osteoporosis.

Answer: No. Please call our office within 24 hours of your scheduled procedure if you are ill or being treated for an infection with antibiotics.  Your procedure will need to be rescheduled once your illness resolves.

Answer: No. Interventional spinal procedures require the use of fluoroscopy (low-dose x-ray) and medications that may have adverse effects on a developing child.  Please notify our staff immediately if you ever suspect that you may be pregnant and we will obtain a pregnancy test prior to your procedure. Women of childbearing potential are routinely given on-site urine pregnancy testing prior to procedures.

Answer: Interventional spinal procedures are minimally invasive.  Complications such as allergic reaction, infection, internal bleeding, nerve damage, and spinal cord damage are rare.  Patients occasionally experience a spinal headache after procedures that increases with sitting and standing.  Please inform our office immediately if you develop a spinal headache as there is a simple procedure we can perform to alleviate the symptoms.

All procedures are performed by experienced physicians under sterile conditions with the use of fluoroscopy.  Our staff will take every precaution to ensure that your procedure is performed as safely as possible.  Your physician will review the potential benefits, risks, and alternatives associated with your scheduled procedure.  Please notify our staff if you have any additional questions prior to your treatment.  A copy of the informed consent form that you sign prior to the procedure will be available to you upon request.

Procedures may include the injection of numbing medication, steroid, x-ray contrast dye containing iodine, and other medications.  Please notify your physician immediately if you are allergic to iodine, shellfish, x-ray contrast dye, or any other medications.

Answer: We recommend that you “take it easy” for the remainder of the day.  You may resume your usual pain medications following the procedure.  We recommend that you apply a cold compress to the injection sites for 10 minutes up to six times daily to help reduce post-procedure tenderness.  Do not apply heat to the injection sites.  A small adhesive band-aid will be applied to the injection sites and should be left in place for 48 hours.

You may shower the morning after the procedure.   We recommend that you do not bathe, swim, or use a whirlpool for 24 hours after the injection.

Answer: Patients often report decreased pain before leaving the clinic due to the rapid onset of the numbing medication.  The effects of steroids usually become noticeable within 48 hours.  Most patients experience pain relief with injection therapies.  Some patients require several injections before achieving noticeable results.

Answer: The onset, duration, and degree of pain relief varies from patient to patient.  Some patients experience significant pain relief for several months or longer while others respond for only a short time.  Your response will likely depend on the severity of your pain and the effects of the injected medications on your body.