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Interventional Pain Management: A Practical Approach
Sanjay Bakshi, Sanjeeva Gupta, Dwarkadas K Baheti, Raghbir Singh P Gehdoo
SECTION 1: BASICS: INTERVENTIONAL PAIN MANAGEMENT
CHAPTER 1:
Understanding the Basics of Radiological Imaging
INTRODUCTION
IMAGING ANATOMY AND TECHNIQUES IN SPINAL IMAGING
Plain X-ray
Computerized Tomography Scan
Magnetic Resonance Imaging Scan
IMAGING IN SPINAL PAIN
Imaging in Degenerative Spinal Diseases
Imaging in Traumatic Vertebral Fracture Pain
Infective Spondylodiscitis
Inflammatory Spondyloarthropathies
Marrow Infiltrating and Neoplastic Disorders of Spine
Imaging in Vertebral Infarcts
Imaging in Postoperative Spinal Pain
IMAGING IN SACROILIAC JOINT PAIN
IMAGING IN HIP JOINT PAIN
IMAGING IN COCCYGODYNIA
IMAGING IN PIRIFORMIS SYNDROME
IMAGING IN BRACHIAL PLEXOPATHY
Radiological Anatomy of Brachial Plexus
IMAGING IN LUMBAR PLEXOPATHY
CONCLUSION
CHAPTER 2:
Radiological Anatomy of Spine
INTRODUCTION
THE FACET JOINTS
INTERVERTEBRAL DISKS
CERVICAL VERTEBRAE
THORACIC VERTEBRAE
LUMBAR VERTEBRAE
SACRUM AND SACROILIAC JOINT
SPINAL CORD
RADIONUCLIDE IMAGING
CONCLUSION
CHAPTER 3:
Understanding of Radiological Spinal Imaging for Pain Physicians
INTRODUCTION
IMAGING TECHNIQUES
Radiography
MAGNETIC RESONANCE IMAGING
COMPUTED TOMOGRAPHY
Other Imaging Modalities
CT Guided Injection Technique
Conventional Fluoroscopic Guided Spinal Injections Technique
COMMON SPINAL PATHOLOGIES
Disc Herniation
Facet Joints Arthropathy
Spinal Canal Stenosis
Spondylolisthesis
Infected Spondylodiscitis and Vertebral Osteomyelitis
Inflammatory Spondyloarthropathies
CONCLUSION
CHAPTER 4:
Role of Electrodiagnosis in the Management of Pain
INTRODUCTION
HOW DOES ELECTRONEUROMYOGRAPHY HELP?
WHY ELECTRONEUROMYOGRAPHY?
PROTOCOL
EQUIPMENT
ELECTRONEUROMYOGRAPHY TESTS
Nerve Conduction Studies
Sensory Nerve Action Potential
Motor Nerve Conduction (Figs 4A and B, and 5)
Sympathetic Skin Response
Needle Electromyography Examination or Electromyography (Fig. 6)
Late Responses F-waves
H Reflex Study
Somatosensory-evoked Potential Study
Neural Deficits Associated with Back or Neck Pain
Electroneuromyography in Root Lesions Correlated with Pathophysiology
Electroneuromyography in Peripheral Neuropathy
Limitations of Electroneuromyography
Electroneuromyography in Postoperative Care
Electroneuromyography versus Imaging
What Should Your Patient Expect?
How Can the Referring Doctor Help?
CONCLUSION
CHAPTER 5:
Pharmacotherapy of Drugs used in Interventional Pain Treatment Procedures
INTRODUCTION
MECHANISM OF ACTION
TYPES OF NEURODESTRUCTIVE TECHNIQUES AND NEUROLYTIC AGENTS
Chemical Neurolysis
Commonly Used Neurolytic Agents
Indications for Chemical Neurolysis
Complications of Chemical Neurolysis
Cryoablation/Cryoanalgesia
Radiofrequency Lesioning
Mechanism of Action
Technique Proper
Complications
CONCLUSION
CHAPTER 6:
Radiofrequency Lesioning in Pain Management: Principles and Clinical Applications
INTRODUCTION
OBJECTIVE
PHYSICS
TYPES OF RADIOFREQUENCY LESIONING
Continuous Radiofrequency Lesioning
Pulsed Radiofrequency Lesioning
Pulsed Radiofrequency Waveform
VARIABLES FACTORS AFFECTING LESION SIZE (FIG. 2)
ADVANTAGES OF RADIOFREQUENCY LESIONING
CLINICAL USE OF RADIOFREQUENCY LESIONING IN PAIN MANAGEMENT
ADVANCES IN RADIOFREQUENCY TECHNIQUES IN PAIN MANAGEMENT
Water-Cooled Radiofrequency28,29
CONCLUSION
SECTION 2: DOCUMENTATION AND PROTOCOLS
CHAPTER 7:
Informed Consent Form for Interventional Pain Treatment Procedures
INTRODUCTION
CONCLUSION
CHAPTER 8:
Role of Investigations in Interventional Pain Treatment Procedures
INTRODUCTION
CLASSIFICATION OF INVESTIGATIONS
Biochemical Investigations
Diagnostic Investigations
Imaging Studies
Electromyography and Nerve Conduction Studies: Electrodiagnostic Studies (Figs 9 and 10)
Thermography (Figs 11 and 12)
CONCLUSION
CHAPTER 9:
Protocol for Interventional Pain Treatment Procedures: A Suggested Format
INTRODUCTION
PROCEDURE TIPS
CONCLUSION
CHAPTER 10:
Evaluation of the Chronic Pain Patient
INTRODUCTION
THE PAIN HISTORY
Onset
Provocation and Palliation
Quality
Region and Radiation
Severity
Temporality
Associated Symptoms
SOCIAL HISTORY
PSYCHOLOGICAL AND PSYCHIATRIC ASSESSMENT OF THE PAIN PATIENT
FUNCTIONAL ASSESSMENT
PHYSICAL EXAMINATION
General Examination
Musculoskeletal Examination
Special Maneuvers
Neurological Examination
Nonorganic Signs
DIAGNOSTIC TESTING
Laboratory
Imaging
Neurophysiologic Testing
CONCLUSION
CHAPTER 11:
Stimulation Guided Pain Mapping
INTRODUCTION
INDICATIONS
CONTRAINDICATIONS
EQUIPMENT
PROCEDURE
DISCUSSION
CONCLUSION
SECTION 3: HEAD AND NECK
CHAPTER 12:
Trigeminal Nerve Block
INTRODUCTION
ANATOMICAL PERSPECTIVE
INDICATIONS FOR RADIOFREQUENCY/BALLOON MICROCOMPRESSION/GLYCEROL INJECTION FOR TRIGEMINAL NEURALGIA
SALIENT FEATURES RELATED TO EACH INTERVENTION AS RELEVANT IN PRACTICE
Radiofrequency Thermocoagulation of the Gasserian Ganglion
Balloon Microcompression of the Gasserian Ganglion
Trigeminal Glycerol Injection
CONTRAINDICATIONS TO RADIOFREQUENCY OR BALLOON MICROCOMPRESSION OR GLYCEROL INJECTION
Radiofrequency Thermocoagulation of Gasserian Ganglion
Preparation
Technique
Important Technical Considerations
Balloon Microcompression of the Gasserian Ganglion
Important Technical Considerations
Trigeminal Glycerol Injection
Technique
Important Technical Considerations
Postprocedure Care Following Radiofrequency/Balloon/Glycerol Injection
SIDE EFFECT AND COMPLICATIONS OF RADIOFREQUENCY/BALLOON COMPRESSION/GLYCEROL INJECTION
PATIENT REPORTED OUTCOMES FROM AN AUDIT FROM AUTHOR'S UNIT
Bilateral Trigeminal Neuralgia
ALTERNATIVE OPTIONS
CONCLUSION
CHAPTER 13:
Maxillary Nerve Block
INTRODUCTION
ANATOMY OF TRIGEMINAL NERVE
Maxillary Nerve
Middle Meningeal Nerve
Pterygopalatine Nerves
Zygomatic Nerve
Posterior Superior Alveolar Nerve
Infraorbital Nerve
TECHNIQUES OF MAXILLARY BLOCK
Supraperiosteal Injection
Periodontal Ligament Injection
Posterior Superior Alveolar Nerve Block
Middle Superior Alveolar Nerve Block
Anterior Superior Alveolar Nerve Block/Infraorbital Nerve Block
Greater Palatine Nerve Block
Nasopalatine Nerve Block
Local Palatal Infiltration
Intrapulpal Injection
Maxillary Nerve Block
High-tuberosity Approach
Greater Palatine Canal Approach
Intraseptal Injection
CONCLUSION
CHAPTER 14:
Mandibular Nerve Block
INTRODUCTION
ANATOMY
INDICATIONS
CONTRAINDICATION
EQUIPMENT AND DRUGS
PREPARATION
Position
Procedure
Neurolysis
Radiofrequency Ablation
OTHER METHODS OF DOING MANDIBULAR NERVE BLOCKS
Complication
CONCLUSION
CHAPTER 15:
Sphenopalatine Ganglion Block
INTRODUCTION
ANATOMY
INDICATIONS
CONTRAINDICATIONS
EQUIPMENT AND DRUGS
PREPARATION
Position
Procedure
Neurolysis3
Radiofrequency Ablation4
OTHER WAYS OF APPROACHING SPHENOPALATINE GANGLION OR PTERYGOPALATINE GANGLION
COMPLICATION
TIPS
CONCLUSION
CHAPTER 16:
Glossopharyngeal Nerve Block
INTRODUCTION
ANATOMY
DIAGNOSIS
Imaging
Balloon Test Occlusion
MEDICAL TREATMENT
INTERVENTIONAL TECHNIQUES
Extra-oral (peri-styloid) Technique with Fluoroscopy
Intra-oral Technique
Anterior Tonsilar Pillar Method46
Posterior Tonsillar Pillar Method47
POTENTIAL COMPLICATIONS/SIDE EFFECTS
CONCLUSION
CHAPTER 17:
Stellate Ganglion Block
INTRODUCTION
INDICATIONS
CONTRAINDICATIONS FOR PERFORMING STELLATE GANGLION BLOCK
Absolute
Relative
APPLIED ANATOMY
TECHNIQUES FOR STELLATE GANGLION BLOCK
EQUIPMENT
DRUGS
Fluoroscopy Assisted Technique
Ultrasound-guided Technique
CT Guided Approach
Blind Landmark-based Approach
POST-PROCEDURE INSTRUCTIONS
HOW TO EVALUATE RESPONSE TO CERVICAL SYMPATHETIC OR STELLATE GANGLION BLOCK
HOW TO PRODUCE PERMANENT OR LONG-TERM BLOCKADE OF STELLATE GANGLION
Repeat Blocks
Continuous Block
Chemical Sympathectomy
Surgical Neurolysis
Radiofrequency Ablation
COMPLICATIONS AND SIDE EFFECTS
Pharmacological Complications
Technical Complications
Infectious Complications
POST-SYMPATHECTOMY SYNDROME
EFFICACY AND CURRENT EVIDENCE
CONCLUSION
CHAPTER 18:
Occipital Nerve Stimulation
INTRODUCTION
Occipital Neuralgia
Chronic Migraine
Trigeminal Autonomic Cephalgias
TREATMENT MODALITIES
APPLIED ANATOMY
MECHANISM OF ACTION
INDICATIONS
Primary Headaches:16
Secondary Headaches
EFFICACY
ASSESSMENT
SURGICAL EQUIPMENT
Midline Cervical Approach
Tunneled Trial
Retromastoid Technique
Percutaneous Trial
Parameters
SAFETY
FUTURE
CONCLUSION
SECTION 4: CHEST AND THORAX
CHAPTER 19:
Suprascapular Nerve Block
INTRODUCTION
ANATOMY
Suprascapular Nerve
Rotator Cuff
SHOULDER PAIN AMENABLE TO SUPRASCAPULAR NERVE BLOCK
Muscle Injury and Tendinopathy of the Rotator Cuff Muscles
Frozen Shoulder
Neuralgic Amyotrophy
Presentation
Symptoms
Signs
INVESTIGATIONS
TREATMENT OPTIONS
Conservative Approach
Pharmacological
Surgical
Interventional Techniques
Contraindications
Relative contraindications
Landmark Technique
Peripheral Nerve Stimulation-guided Technique
Fluoroscopy-guided Technique
Ultrasound-Guided Technique
Pulsed Radiofrequency of the Suprascapular Nerve
CONCLUSION
CHAPTER 20:
Intercostal Nerve Block
INTRODUCTION
MEDICATION CHOICE
OTHER USEFUL MODALITIES
ANATOMY
Origin of Intercostal Nerves
Branches of Intercostal Nerves
Variability in Anatomical Arrangement
T12 Ventral Ramus
PROCEDURE
Classic Technique
Ultrasound-guided Technique
CONTRAINDICATIONS
COMPLICATIONS
CONCLUSION
CHAPTER 21:
Intrapleural Block
INTRODUCTION
ANATOMY
PATHOPHYSIOLOGY OF PAIN
INDICATIONS
CONTRAINDICATIONS
Absolute
Relative
EQUIPMENT
MEDICATIONS
PRE-PROCEDURE VISIT PROTOCOL
PROCEDURE DETAILS
Complications
CONCLUSION
SECTION 5: ABDOMEN AND PELVIS
CHAPTER 22:
Celiac Plexus Block
INTRODUCTION
INDICATION FOR CELIAC PLEXUS BLOCK
CONTRAINDICATIONS
PREPARATION FOR CELIAC PLEXUS NERVE BLOCK
FLUOROSCOPICALLY-GUIDED TECHNIQUE
Computed Tomography-guided Celiac Plexus Block
Computed Tomography-guided Technique
Transaortic Technique
Celiac Plexus Block Using Single Needle Anterior Placement Technique
Intra- or Transdiscal Technique
Ultrasound-guided Technique
SIDE EFFECTS AND COMPLICATIONS OF THE CELIAC PLEXUS BLOCK
Immediate Complication
Delayed Complication
CONCLUSION
CHAPTER 23:
Splanchnic Nerve Block
INTRODUCTION
APPLIED ANATOMY OF SPLANCHNIC NERVES
INDICATIONS AND CONTRAINDICATIONS OF SPLANCHNIC NERVE BLOCK
Indications
Contraindications
PREPARATION FOR SPLANCHNIC NERVE BLOCK
Preprocedure Evaluation
Prerequisites
MODALITIES OF NERVE BLOCK
IMAGING GUIDANCE
Splanchnic Block under Fluoroscopic-guidance
POSTPROCEDURE CARE
COMPLICATIONS
Minor
Moderate
Severe
DISCUSSION
CONCLUSION
CHAPTER 24:
Lumbar Sympathetic Block
INTRODUCTION
INDICATIONS
CONTRAINDICATIONS
ANATOMICAL DESCRIPTION
DESCRIPTION OF PROCEDURE
Preparation
Technique
Assessment of Block
COMPLICATIONS
CONCLUSION
CHAPTER 25:
Superior Hypogastric Plexus Block
INTRODUCTION
INDICATION FOR SUPERIOR HYPOGASTRIC NERVE BLOCK
CONTRAINDICATIONS
SUPERIOR HYPOGASTRIC BLOCK UNDER FLUOROSCOPY
SUPERIOR HYPOGASTRIC BLOCK UNDER COMPUTED TOMOGRAPHY
Ultrasound-guided Technique
Postprocedure Care
COMPLICATION
CONCLUSION
CHAPTER 26:
Ganglion Impar Block
INTRODUCTION
APPLIED ANATOMY
Approaches to the Ganglion Impar
TECHNIQUES
Transsacrococcygeal Approach
Paracoccygeal Corkscrew Approach
RISKS
CONCLUSION
SECTION 6: SPINE AND BACK
CHAPTER 27:
Cervical Epidural Block: Interlaminar Approach
INTRODUCTION
ANATOMY
INDICATIONS
Chronic Pain
Acute Pain
CONTRAINDICATIONS
Systemic or Local Infection
Congenital or Acquired Anatomical Anomalies
Coagulopathy and Anticoagulation
INFORMED CONSENT
EQUIPMENT
EPIDURAL INJECTATE
TECHNIQUE (INTERLAMINAR APPROACH)
CONCLUSION
CHAPTER 28:
Cervical Transforaminal Epidural Block
INTRODUCTION
ANATOMY
INDICATIONS
CONTRAINDICATIONS
Absolute Contraindications
Relative Contraindications
STEROID INJECTATES
EQUIPMENT IN THE PROCEDURE ROOM
Kit for Transforaminal Approach:
PREPROCEDURE
TRANSFORAMINAL EPIDURAL INJECTIONS
Technique
Complications
CONCLUSION
CHAPTER 29:
Cervical Medial Branch Blocks and Radiofrequency Neurotomy
DEFINITION
ANATOMY (FIG. 1)
CLINICAL PRESENTATION
INDICATIONS
CONTRAINDICATIONS
PREPROCEDURE PREPARATION
PROCEDURE
Positioning
Block Technique
Post-Procedure Care
Complications
CONCLUSION
CHAPTER 30:
Cervical Medial Branch Block
INTRODUCTION
GENERAL PRINCIPLES OF CERVICAL SPINE INTERVENTIONS
ANATOMY
INDICATIONS
CONTRAINDICATIONS
EQUIPMENT
PATIENT POSITION, FLUOROSCOPIC ANATOMY AND PROCEDURE
ANATOMY
INDICATIONS
CONTRAINDICATIONS
PATIENT POSITION, FLUOROSCOPY AND PROCEDURE
ASSESSMENT
STEROID—TO USE OR NOT TO USE!
COMPLICATIONS
CLINICAL PEARLS
CONCLUSION
CHAPTER 31:
Lumbar and Caudal Epidural Blocks
INTRODUCTION
ANATOMY
EVALUATION
INDICATIONS
CONTRAINDICATIONS
EQUIPMENT/SUPPLIES
MEDICATIONS
TECHNIQUES
PROCEDURE
Interlaminar Approach
Transforaminal Approach
Caudal Approach
POSTPROCEDURAL CARE
COMPLICATIONS
CONCLUSION
CHAPTER 32:
Lumbar Facet Joint, Medial Branch, and Radiofrequency Procedures
INTRODUCTION
HISTORICAL BACKGROUND
CLINICAL PRESENTATION
ANATOMICAL CONSIDERATION
PRINCIPLES AND TECHNIQUES
INDICATIONS
CONTRAINDICATIONS
EQUIPMENT AND FACILITY REQUIREMENTS
Intra-articular Facet Joint Block
Lumbar Medial Branch Block
DISCHARGE INSTRUCTIONS
POTENTIAL COMPLICATIONS
RADIOFREQUENCY NEUROTOMY
Historical Background
Clinical Relevance
Principles
Patient's Selection
Procedural Considerations
Contraindications
Technical Variations
POSTPROCEDURE CARE
CONCLUSION
CHAPTER 33:
Lumbar Plexus Block
INTRODUCTION
INDICATIONS
CONTRAINDICATIONS
TECHNIQUE
Ultrasound Technique
PITFALLS
COMPLICATIONS
CONCLUSION
CHAPTER 34:
Thoracic Paravertebral Block
INTRODUCTION
ANATOMY
INDICATIONS
CONTRAINDICATIONS
Absolute Contraindications
Relative Contraindications
EQUIPMENT AND DRUGS
Equipment
Drugs
PATIENT POSITION
PROCEDURE
Landmark-based Technique
Loss of Resistance Technique
Nerve Stimulator Technique
Intercostal Approach
Ultrasound-guided Techniques
COMPLICATIONS
NOVEL USES FOR CHRONIC PAIN
CONCLUSION
ACKNOWLEDGMENTS
CHAPTER 35:
Sacroiliac Joint Radiofrequency Denervation
INTRODUCTION
INDICATION
CONTRAINDICATIONS
EQUIPMENT
RADIOFREQUENCY DENERVATION OF SIJ WITH SIMPLICITY 3 PROBE
RADIOFREQUENCY DENERVATION OF SIJ WITH SINERGY COOLED RADIOFREQUENCY TECHNIQUE
RADIOFREQUENCY DENERVATION OF SIJ WITH A 18G OR A 16G RADIOFREQUENCY NEEDLE WITH AT LEAST 10 MM ACTIVE TIP
CONCLUSION
CHAPTER 36:
Coccygeal Nerve Block
INTRODUCTION
ANATOMY
INDICATIONS
EQUIPMENTS
DRUGS
FLUOROANATOMY
PROCEDURE
Preparation for Procedure
Step-1
Step-2
COMPLICATIONS
OTHER TREATMENT OPTIONS
Radiofrequency Treatment of the Sacral Roots
Coccygectomy
Advanced Options
The Endoscopic Radiofrequency Ablation
Injection of Alcohol
CONCLUSION
CHAPTER 37:
Obturator Nerve Block
INTRODUCTION
INDICATIONS
ANATOMY
CONTRAINDICATIONS
TECHNIQUE USING NEUROSTIMULATION
Classic Pubic Approach (of Labat)
Accessory Obturator Nerve Blockade
Interadductor Approach
Inguinal Approach
Transvesical Block
TECHNIQUE USING ULTRASOUND
FLUOROSCOPIC RADIOFREQUENCY ABLATION
CONCLUSION
CHAPTER 38:
Piriformis Muscle Injection Instead of Piriformis Muscle and Tendon Block
INTRODUCTION
SYMPTOMS
DIAGNOSTIC CRITERIA
Physical Examination
Imaging Studies
INDICATIONS
CONTRAINDICATIONS
INVESTIGATIONS
EQUIPMENTS
DRUGS
PRE-PROCEDURE PREPARATION
PROCEDURE
Step 1
Step 2 (Needle Placement)
Step 3
Precautionary Tips
Step 4
Step 5
Complications
CONCLUSION
CHAPTER 39:
Popliteal Block of the Sciatic Nerve
INTRODUCTION
ANATOMY
INDICATIONS
CONTRAINDICATIONS
Absolute
Relative
Investigations
EQUIPMENT
DRUGS
PRE-PROCEDURE PREPARATION
PROCEDURE (REFER VIDEO)
Step 1
Step 2: Needle Placement
Step 3: Stimulation Response (Refer Video)
Step 4: Drug Injection
CONTINUOUS TECHNIQUE (REFER VIDEO)
Few Tips
COMPLICATIONS
CONCLUSION
CHAPTER 40:
Ilioinguinal Nerve Block
INTRODUCTION
INDICATIONS
CONTRAINDICATIONS
ANATOMY
MEDICATIONS
PREPARATION
LANDMARK TECHNIQUE
ULTRASOUND GUIDANCE
COMPLICATIONS
CONCLUSION
CHAPTER 41:
Genicular Nerve Block and Radiofrequency Procedure for Persistent Knee Pain
INTRODUCTION
NEUROANATOMY
DIAGNOSTIC GENICULAR NERVE BLOCK
Indications
Contraindications
Equipment
Procedure
GENICULAR NERVE RADIOFREQUENCY DENERVATION
Indications
Contraindications
Equipment
Procedure
PULSED RADIOFREQUENCY OF GENICULAR NERVES
Technique
ULTRASOUND-GUIDED GENICULAR NERVE BLOCK
MANAGING OTHER PAIN IN KNEE JOINT AREA
ASSESSMENT
DISCUSSION
CONCLUSION
SECTION 7: ADVANCED PAIN MANAGEMENT
CHAPTER 42:
Percutaneous Adhesiolysis for Failed Back Surgery Syndrome and Other Applications
INTRODUCTION
APPLIED ANATOMY
INDICATIONS AND CONTRAINDICATIONS
CLINICAL EFFICACY
TECHNICAL CONSIDERATIONS
Racz Technique
General Principles
The Caudal Approach
Interlaminar Lumbar Approach
Modified Manchikanti Technique
Facilities
Preparation
Consent
Operating Room
Recovery Room
Transforaminal Approach
SIDE EFFECTS AND COMPLICATIONS
PRECAUTIONS
CONCLUSION
ACKNOWLEDGMENT
CHAPTER 43:
Epiduroscopy for Patients with Lumbosacral Radicular Pain
INTRODUCTION
TECHNICAL REQUIREMENTS
PATHOPHYSIOLOGY OF RADICULAR PAIN
INDICATIONS (PATIENT SELECTION)
CONTRAINDICATIONS
HOW DOES SPINAL ENDOSCOPY RELIEVE BACK PAIN?
EPIDUROSCOPY: INSTRUMENTATION AND PROCEDURE
Epidural Access Kit (Fig. 1)
Video-guided Catheter or Steering Device (Fig. 4)
Flexible Fiberoptic Endoscope (Figs 5 to 7)
Sterilization Procedure for Fiberoptic Scope
Safety Considerations
Side Effects
Complications
OUTCOME STUDIES FOLLOWING EPIDUROSCOPY
CONCLUSION
CHAPTER 44:
Spinal Cord Stimulation
INTRODUCTION
MECHANISM OF ACTION
INDICATIONS
CONTRAINDICATIONS
TRIAL STIMULATION
SURGICAL IMPLANTATION
EQUIPMENT
PROCEDURE
Step 1: Trial Stimulation
Step 2: Permanent Implantation
Post-Procedure Care following Surgical Implantation
COMPLICATIONS
CONCLUSION
CHAPTER 45:
Diskography
INTRODUCTION
WHY DO INTERVERTEBRAL DISKS CAUSE PAIN?
CONTRAINDICATIONS
CERVICAL DISKOGRAPHY
Anatomy of Cervical Spine (Figs 1A and B)
Indications of Cervical Diskography
Technique for Cervical Diskography
Imaging Details with X-ray
THORACIC DISKOGRAM
Anatomy of Thoracic Spine (Fig. 5)
Indications for Thoracic Diskography
Technique for Thoracic Diskography
Imaging Details with X-ray
LUMBAR DISKOGRAPHY
Anatomy of Lumbar Spine
Indications for Lumbar Diskography
Technique for Lumbar Diskography (Fig. 6): Fluoroscopy of Lumbar Spine
Imaging Details of X-ray
SIDE EFFECTS AND COMPLICATIONS OF DISKOGRAPHY
CONCLUSION
CHAPTER 46:
Intradiskal Electrothermal Therapy
INTRODUCTION
INDICATIONS
TECHNIQUE
POSTOPERATIVE INSTRUCTIONS
COMPLICATIONS
STUDIES RELATED TO IDET
CONCLUSION
CHAPTER 47:
Vertebroplasty and Kyphoplasty
INTRODUCTION
INDICATIONS
CONTRAINDICATIONS
MECHANISM OF ACTION
PROCEDURE
Vertebroplasty
Kyphoplasty
POSTOPERATIVE PROTOCOL
COMPLICATIONS
RESULTS
CONCLUSION
CHAPTER 48:
Nucleoplasty
INTRODUCTION
WHAT IS NUCLEOPLASTY?
INDICATIONS
CONTRAINDICATIONS
TECHNIQUE
Preprocedure Preparation
Patient Positioning
Introducer-Needle Placement
Disk Decompression
Postprocedure Rehabilitation
COMPLICATIONS
EFFICACY OF NUCLEOPLASTY
CONCLUSION
CHAPTER 49:
Ozone Nucleolysis
INTRODUCTION
OZONE IN SPINE RELATED PAIN
PREPARATION OF OZONE
Parts of a Basic Ozone Generator
Steps to Generate Ozone
Mechanisms of Action
Methods of Injection
INDICATIONS
CONTRAINDICATIONS
Absolute Contraindications
Relative Contraindications
STEPS IN LUMBAR OZONE NUCLEOLYSIS (C-ARM GUIDED)
Preparation
Preprocedure Protocol
Requirements
Position and Monitoring
Procedure Steps
Periganglionic Ozone Injection Steps
Paravertebral Injection Steps
CERVICAL OZONE NUCLEOLYSIS
COMPLICATIONS
ADVANTAGES
CONCLUSION
CHAPTER 50:
Percutaneous Transforaminal Endoscopic Lumbar Diskectomy
INTRODUCTION
INDICATIONS
CONTRAINDICATIONS
COMPLICATIONS
PREOPERATIVE PROTOCOL
Preoperative Planning
PATIENT POSITIONING AND ANESTHETIC TECHNIQUE
INSTRUMENTATION
Identifying the Needle Entry Point on the Skin
Needle Insertion
Chromatodiskography
Placement of the Guide Wire, Dilator and the Cannula
Diskectomy
CLINICAL OUTCOMES AND DISCUSSION
CONCLUSION
CHAPTER 51:
Intrathecal Implantable Devices
INTRODUCTION
SCIENTIFIC RATIONALE
PATIENT SELECTION
Category of Patient
Spasticity due to Multiple Sclerosis, Cerebral Palsy, and Dystonia
Cancer Related Pain
Patients with Short Life Expectancy
Patients with Chronic Pain Secondary to Cancer
Chronic Nonmalignant Complex Pain
Psychological Evaluation
TYPES OF PUMPS
CHOICE OF MEDICATIONS
TRIALING PROCEDURES
IMPLANTATION TECHNIQUE
COMPLICATIONS
Delayed Complications
Complications Related to the Intrathecal Pump
Medication Related Complications
MANAGEMENT OF INTRATHECAL PUMPS
Use of Compounded Medications
COST EFFECTIVENESS OF INTRATHECAL THERAPY
CONCLUSION
CHAPTER 52:
Subarachnoid or Intrathecal Neurolysis
INTRODUCTION
PATIENT SELECTION
AGENTS USED AS NEUROLYTIC DRUGS
Phenol
Ethyl alcohol
EQUIPMENTS
DRUGS
PATIENT PREPARATION
Position
Position for Alcohol Neurolysis
POSITION FOR PHENOL NEUROLYSIS
PROCEDURE
Neurolysis with Alcohol
Neurolysis with Phenol
SUCCESS OF BLOCK
CONTRAINDICATIONS
COMPLICATIONS
CONCLUSION
CHAPTER 53:
Percutaneous Cervical Cordotomy for Cancer Pain
INTRODUCTION
HISTORICAL PERSPECTIVE
CONCEPT
INDICATIONS AND PATIENT SELECTION
Technique
Patient Preparation
EQUIPMENT
PATIENT POSITION
IMAGING
Needle Insertion
Myelogram
Inserting Cordotomy Probe into Spinal Cord
Radiofrequency Lesioning Technique
Points to Ensure Safety and Efficacy
PRE- AND POST-PROCEDURE CARE
SIDE-EFFECTS AND COMPLICATIONS
OUTCOME FROM PROSPECTIVE AUDIT FROM AUTHOR'S UNIT
BILATERAL CORDOTOMY
FUTURE DIRECTIONS
CONCLUSION
CHAPTER 54:
Radiofrequency Ablation of Spinal Metastasis
INTRODUCTION
SCIENTIFIC RATIONALE FOR TARGETED RADIO-FREQUENCY ABLATION
FOCAL PALLIATIVE TREATMENT OF BONE METASTASES
Local Bone Pain
PATIENT SELECTION
MECHANICAL DETAILS OF TARGETED RADIO-FREQUENCY ABLATION
Technique of t-RFA
Suitable Practitioners
COMPLICATIONS
Early Complications
Fracture of Pedicle
Extension of Cement into the Posterior Spinal Space
Late Complications
RESULTS
CONCLUSION
SECTION 8: ULTRASOUND-GUIDED PROCEDURES
CHAPTER 55:
Ultrasound versus Fluoroscopic Guidance in Interventional Pain Management
INTRODUCTION
ULTRASOUND
Advantages
Disadvantages/Limitations
Required Equipment for Ultrasound
FLUOROSCOPY
Indications
Contraindications
Equipment
Advantages
Disadvantages
CONCLUSION
CHAPTER 56:
Introduction to Ultrasound-guided Blocks
INTRODUCTION
PHYSICS
Transducers
Echogenicity
SPINE INTERVENTIONS
UNIVERSAL PRECAUTIONS
CONTRAINDICATIONS
Absolute Contraindications
Relative Contraindications
MEDICATION
CONCLUSION
CHAPTER 57:
Ultrasound-guided Greater Occipital and Third Occipital Nerve Block
INTRODUCTION
GREATER OCCIPITAL NERVE BLOCK
Anatomy
INDICATIONS
Sonoanatomy and Technique
THIRD OCCIPITAL NERVE BLOCK
Anatomy
Indications
Sonoanatomy and Techniques
CONCLUSION
CHAPTER 58:
Cervical Medial Branch Block
INTRODUCTION
ANATOMY
DIAGNOSTIC CRITERIA
EQUIPMENT
ULTRASOUND EXAMINATION
Lateral Approach
Posterior Approach
INJECTION TECHNIQUE
COMPLICATIONS
CONCLUSION
CHAPTER 59:
Ultrasound-guided Shoulder Injections
INTRODUCTION
ANATOMY
Glenohumeral Joint
Acromioclavicular Joint
Scapulothoracic Joint
Long Head of the Biceps Tendon
INDICATIONS
Glenohumeral Joint
Acromioclavicular Joint
Subacromial Space
CONTRAINDICATIONS
PRECAUTIONS
EQUIPMENT AND DRUGS
Glenohumeral Joint
Acromioclavicular Joint
Subacromial Space
PROCEDURE AND TECHNIQUE
Glenohumeral Joint
Acromioclavicular Joint
Subacromial Bursa
CONCLUSION
CHAPTER 60:
Ultrasound-guided Thoracic Interventions: Paravertebral Blocks
INTRODUCTION
ANATOMY
INDICATIONS
TECHNIQUES
Ultrasound-guided Thoracic Paravertebral Block
Equipment
Drug
Transverse (Horizontal Probe Orientation) Scanning: In-Plane Approach
Technique
Parasagittal (Vertical Probe Orientation) Scanning
Technique
COMPLICATIONS
CONCLUSION
CHAPTER 61:
Ultrasound-guided Lumbar Medial Branch Block
INTRODUCTION
ANATOMY
DIAGNOSTIC CRITERIA
ULTRASOUND-GUIDED LUMBAR FACET JOINT INJECTION
Position
Ultrasound Transducer
Sonoanatomy
Injection
Complications
L5 DORSAL RAMUS BLOCK
Applied Anatomy
Sonoanatomy
Technique
Limitations
Complications
CONCLUSION
CHAPTER 62:
Ultrasound-guided Sacroiliac Joint Injection
INTRODUCTION
ANATOMY
INDICATIONS
POSITION
SONOANATOMY
TECHNIQUE
COMPLICATIONS
CONCLUSION
CHAPTER 63:
Ultrasound-guided Hip Injections
INTRODUCTION
ANATOMY
INDICATIONS
CONTRAINDICATIONS
EQUIPMENT
PROCEDURE
Intra-articular Hip injection/Aspiration
Greater Trochanteric Bursa Injection
POST-PROCEDURAL CARE AND EVALUATION
CONCLUSION
CHAPTER 64:
Ultrasound-guided Knee Injections
INTRODUCTION
ANATOMY
INDICATIONS
CONTRAINDICATIONS
EQUIPMENT
PROCEDURE
POSTPROCEDURAL CARE
CONCLUSION
SECTION 9: ALTERNATE THERAPIES
CHAPTER 65:
Intramuscular Stimulation or Dry Needling
INTRODUCTION
TARGETS OF DRY NEEDLING IN MYOFASCIAL PAIN SYNDROME: WHERE, WHEN, AND WHY?
CLASSIFICATION OF TRIGGER POINTS3,6,8,11
Associated Trigger Point
Attachment Trigger Point
Satellite Trigger Point
CLINICAL ASPECTS OF TRIGGER POINTS
Sensory Aspects1,4,6,8,14
Motor Aspects1,6,8
Autonomic Changes
INDICATIONS OF DN
CLINICAL APPROACH TO DRY NEEDLING
History
General History
Pain History
Personal History
Psychological Factors
PHYSICAL EXAMINATION
Inspection
Palpation
Methods of Palpation1,4,6,8
REPRODUCTION OF THE PERSON'S SYMPTOMATIC PAIN
LOCAL TWITCH RESPONSE (LTR)
Objective Methods
EQUIPMENT FOR DRY NEEDLING
Acupuncture Needles (Fig. 6)
Procedure
Techniques of Dry Needling
Superficial Dry Needling
Deep Dry Needling
PARASPINAL NEEDLING (FIGS 9A AND B)
DRY NEEDLING FOR COMPLEX REGIONAL PAIN SYNDROME
GRADING OF MUSCLE SPASM47
EFFECTS OF DRY NEEDLING
CONTRAINDICATIONS
Relative Contraindications
Absolute Contraindications
Complications and Side Effects
DRY NEEDLING VS. BOTOX55
DRY NEEDLING AND ACUPUNCTURE
Common Misconceptions
Role of Dry Needling in Pain Management
Advantages of Dry Needling
Safe
Effective
Easy
Economical
The Future of DN: Ultrasound-guided Dry Needling (USGDN) (Figs 11A and B)
CONCLUSION
ACKNOWLEDGEMENTS
CHAPTER 66:
Myofascial Pain Syndrome and Trigger Point Injections
INTRODUCTION
NORMAL ANATOMY/PHYSIOLOGY
Muscle Structure and Function
PATHOPHYSIOLOGY OF MYOFASCIAL TRIGGER POINTS
Clinical Characteristics
Musculoskeletal History
Physical Examination Findings
General Approach to Management
Trigger Point Injections
Mechanism of Action
Goal of Trigger Point Injections
Injection Approach
Head and Neck
Upper Trapezius
Middle and Lower Trapezius
Sternocleidomastoid
Splenius Capitis/Splenius Cervicis
Temporalis
Scalenes
Levator Scapulae
Upper Back and Torso
Rhomboid Major/Minor
Pectoralis Major
Supraspinatus
Infraspinatus
Lower Torso and Lower Limb
Lumbar Paraspinal Muscles: Iliocostalis, Longissimus, Multifidi
Quadratus Lumborum
Gluteus Maximus
Gluteus Medius, Minimus
Tensor Fascia Latae
Adductor Longus, Brevis, Magnus
Quadriceps (rectus femoris, vastus lateralis, intermedius, medialis)
Hamstrings (biceps femoris, semitendinosus, semimembranosus)
CONCLUSION
APPENDICES
INDEX
TOC
Index
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