Treatment for Back Pain

At Balog Regenerative we care about your pain and that’s why you’ll receive comprehensive care for the diagnosis and treatment of your back pain. Below are several treatments we offer for your spine pain.

What is Intracept?

The Intracept procedure is a minimally invasive procedure performed on the basivertebral nerve. This is a nerve located in the vertebrae. The basivertebral nerve is responsible for applying innervation to the end plates of the vertebral body. When the Intracept probe burns that nerve, pain signals are blocked from reaching the vertebral plates.

What does the procedure look like?

To perform the procedure, the physician inserts a specialized probe into the vertebrae through a small incision in the lower back. The incision is 5-6 millimeters, no larger than the Intracept probe. Once the probe is positioned at the the basivertebral nerve, the nerve is disabled with radiofrequency energy (heat). This process is known as basivertebral nerve ablation.

The basivertebral nerve is responsible for applying innervation to the end plates of the vertebral body. When the Intracept probe burns that nerve, pain signals are blocked from reaching the vertebral plates.

Intracept is a minimally invasive, outpatient procedure. This means the recovery period is rapid, the patient often recovering within days. The procedure requires no implants or augmentation to the spine’s structure. Due to the minimally invasive nature of the Intracept procedure, the patient is usually able to resume normal life with immediate pain relief.

What is a Dorsal Root Ganglion?

The DRG (dorsal root ganglion) is a bundle of nerve cells located at the side of the spine, where the spinal nerve root exits becoming a peripheral nerve.

What does the procedure look like?

Often before a permanent procedure is performed, a trial procedure is done to determine the effectiveness of the treatment with the patient. This trial typically lasts 5 to 7 days. To connect the trial stimulator, leads are temporarily implanted through the skin and using an epidural needle are placed into the epidural space. The leads are then positioned within the epidural space and the physician then stimulates the dorsal root ganglion. The physician will determine which particular DRG targets to stimulate based on the location of the patient’s pain. When the leads are properly placed, they are then connected to an external trial stimulator battery.

Throughout the trial, patients are able to control their device to alleviate pain. The patient is able to turn the device on and off as needed, and can adjust the stimulation up or down for comfort. The implant is programmed with multiple different programs they can use to help eliminate pain.

At the conclusion of the trial, the temporary leads will be removed and the patient and physician will determine if a permanent device should be implanted.

If the physician determines that the trial was successful, a permanent stimulator may be implanted.

Two small incisions are made to complete the procedure and permanent leads are implanted into the predetermined location in the epidural space. The leads are then connected to a computer/battery unit called the internal pulse generator (IPG). Once the leads are connected, the IPG unit is implanted into the upper buttock region. This takes around 30-40 minutes to complete. When the procedure is completed, the IPG is programmed with an external control unit given to the patient to control the system. The patient is then instructed on how to utilize the control unit and adjust the settings on the IPG. Once the patient is instructed they are released.

What is a Caudal Steroid Injection?

We all have nerves which run from the spinal cord down your back and legs. Back and leg pain is often caused by your nerve roots being irritated and inflamed, due to damaged disc(s).

A Caudal Steroid Injection is steroid medication injected into the epidural space, in the lowest part. Inflamed spinal nerves can be easily managed by this medication, and the procedure should only take a few minutes to complete.

What does the procedure look like?

The procedure requires little preparation. The patient will assume a prone position, face down with a pillow under the abdomen, lifting the sacrum.

The physician administers or injects a local anesthetic, desensitizing and numbing the skin and tissue above a hole at the bottom of the sacrum. This is called the sacral hiatus. 

When the location has been desensitized and is numb to touch, the doctor inserts a needle into the sacral hiatus, through the caudal epidural area and makes the injection. The injection is done in the location of the open space in the sacrum, the location of the inflamed nerves.

The physician then inserts a contrast solution with the needle. Then utilizing a fluoroscope, a kind of x-ray equipment, the doctor ensures that the end of the needle is accurately placed within the epidural space.

Following a careful examination of the needle’s exact position, the physician administers a  steroid-anesthetic medication.  The medication bathes the inflamed nerve roots,  easing the patient’s pain.

When the procedure is complete, the doctor removes the needle and dresses the injection entrance.  The patient usually experiences considerable relief after one injection.  However, this varies case to case. Some patients may require multiple injections before experiencing any form of relief.

What is a Epidural Steroid Injection ?

This procedure provides pain relief to the arms, neck and shoulders caused by a pinched nerve (or multiple nerves) in the cervical spine. Illnesses, like herniated discs and spinal stenosis, can place pressure on the nerves resulting in inflammation and pain from the cervical spine. This pain usually radiates to the neck, shoulders and arms. The injection administers a medication to assist in managing the swelling and aggravation of the nerves.

What does the procedure look like?

The procedure is done with the patient lying on their back. Intravenous sedation is administered and an area of the neck is desensitized using a local anesthesia through an injection.

Using an x-ray device known as a flouroscope, the physician navigates a larger needle to the affected area of the neck.  The needle is then guided into the epidural space, the area where the spinal nerves traverse.

The contrast dye needle is injected through the epidural space and securely positioned near the inflamed nerve roots.

The fusion of both anesthetic and cortisone steroid solution is infused into the epidural space.  This steroid solution is an anti-inflammatory drug that relieves swelling and inflammation in the affected area. The nerves absorb the solution to combat the swelling and relieve nerve pressure.
 

Once the procedure is complete, the patient is provided food and drink in the recovery room to restore strength. They are then given take-home medications and post-treatment care instructions. While some of the patients that undergo this procedure requires only one injection, some require two or three procedures (usually done weeks apart) for significant pain relief.

What are Intrathecal Pump Implants?

We all have nerves which run from the spinal cord down your back and legs. Back and leg pain is often caused by your nerve roots being irritated and inflamed, due to damaged disc(s).

A Caudal Steroid Injection is steroid medication injected into the epidural space, in the lowest part. Inflamed spinal nerves can be easily managed by this medication, and the procedure should only take a few minutes to complete.

What does the procedure look like?

The procedure requires little preparation. The patient will assume a prone position, face down with a pillow under the abdomen, lifting the sacrum.

The physician administers or injects a local anesthetic, desensitizing and numbing the skin and tissue above a hole at the bottom of the sacrum. This is called the sacral hiatus. 

When the location has been desensitized and is numb to touch, the doctor inserts a needle into the sacral hiatus, through the caudal epidural area and makes the injection. The injection is done in the location of the open space in the sacrum, the location of the inflamed nerves.

The physician then inserts a contrast solution with the needle. Then utilizing a fluoroscope, a kind of x-ray equipment, the doctor ensures that the end of the needle is accurately placed within the epidural space.

Following a careful examination of the needle’s exact position, the physician administers a  steroid-anesthetic medication.  The medication bathes the inflamed nerve roots,  easing the patient’s pain.

When the procedure is complete, the doctor removes the needle and dresses the injection entrance.  The patient usually experiences considerable relief after one injection.  However, this varies case to case. Some patients may require multiple injections before experiencing any form of relief.

What is Radiofrequency ablation?

Radiofrequency ablation (or RFA) is a treatment which utilizes radiofrequency waves to kill problem nerves or tissue to relieve pain or ailment. While this treatment is often used to treat growths or tumors, it is also effective in treating chronic pain including low back pain

What does the procedure look like?

In this procedure the physician uses an ultrasound, fluoroscope, or another imaging technique to locate the problem nerve. Once the nerve has been located, one or a series of needle-like probe devices are inserted into the affected area.
 
Radiofrequency waves are then administered, killing ablating the affected nerve. This procedure is almost strictly outpatient and rarely requires any medication. A patient may receive medication to relax for the procedure. Some patients may experience numbness, swelling, or bruising at the procedure site.

What are adhesions?

Adhesions are growths of scar tissue that form between organs and structures, fusing normally separate organs and structures. These adhesions vary in thickness, from web-like structures to thicker structures acting more like glue. They may result from disease (such as endometriosis), infection (such as pelvic inflammatory disease), injury (as a result of surgery) or may have no known cause.

What is Adhesiolysis?

The first step of adhesion surgery is a process called adhesiolysis. This is the process of dissection (to cut apart or separate) structures that have been fused by adhesions. In order to carefully remove all adhesions and scarring without causing damage to the pelvic structures, advanced laparoscopic surgical skills and an extensive knowledge of the pelvic anatomy are required. Once all adhesions have been carefully separated the patient will typically be left with multiple areas of raw tissue. If these areas are left as they are, adjacent structures may stick to these raw areas resulting in new adhesions. This process typically occurs during the first hours and days following surgery, and these newly formed adhesions may then go on to thicken and tighten during the months thereafter. This is the body’s natural healing response to “injury,” although some people have a greater tendency to form scar tissue and adhesions than others

What does the procedure look like?

Adhesiolysis can be performed in two ways: The first operation is open adhesiolysis, in which one large incision is made through the midline of the patients body and is then extended to remove the abdominal adhesions. The other is laparoscopic adhesiolysis, when a tube-like camera is inserted through a small incision made into your abdomen. The physician uses this camera to locate and remove the abdominal adhesions with an accurate visualization. The physician evaluates the patient’s complete physical state using a series of tests including blood tests, X-ray and CT scans to determine which form of adhesiolysis is best suited. The patient will be administered a general anesthesia so they sleep through the procedure. Local anesthesia may also be injected into the abdomen so that the area of operation is more specifically numbed.

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