Procedures

TCPC provides a full range of therapeutic pain management injections in all areas of the spine (lumbar, thoracic and cervical) as well as joints (shoulders, hips, knees, etc.). Some of these procedures are performed in the office, such as joint, tendon and muscle injections.

Dr. Will and Dr. Kokayeff perform other precision spinal procedures under guided X-ray imagery, at the Twin Cities Pain Clinic Edina location. The doctors both have advanced training in the image-guided approach to ensure that your therapeutic injection is accurate and safe.

Dr. Will is a member of the International Spine

Intervention Society (ISIS), American Society of Interventional Pain Physicians (ASIPP),and Physiatric Association of Spine, Sports and Occupational Rehabilitation (PASSOR).

The procedures described in the following list may cure your pain or may reduce your pain in order to enable you to participate in other treatments such as physical therapy.

Epidural Steroid Injections

Epidural steroid injections provide pain relief by delivering local anesthetic (numbing medication) and steroid medications (anti-inflammatory medication) into the spinal area on the surface of the spinal column.

An epidural steroid injection may reduce inflammation, resulting in long-term pain relief. It can also provide valuable information on the source of your pain. While the effects of an epidural steroid injection may be temporary (lasting anywhere from a week up to a year), it can deliver substantial benefits for many patients experiencing back pain, including improved mental health, minimizing the daily need for pain medications and potentially delaying or avoiding surgery.

An injection delivers steroids directly to the painful area to help decrease the inflammation that may be causing the pain. Dr. Will performs the procedure in the hospital under guided fluoroscopy to ensure accurate placement of the steroid. The injection may also remove or “flush out” inflammatory proteins from around the structures that may cause pain. In addition to relieving pain, the process of natural healing can occur more quickly once the inflammation is reduced.

The steroid medication can reduce the swelling and inflammation caused by spinal conditions including spinal stenosis, radiculopathy, sciatica, and herniated discs. In some cases, it may be necessary to repeat the procedure as many as three times to get the full benefit of the medication.

However, many patients get significant relief from only one or two injections.

Epidural steroid injections are done from one of three approaches: Interlaminar, Transforaminal and Caudal. A Selective Nerve Root Injection can also be done.

Interlaminar Epidural Steroid Injection

In an Interlaminar Epidural Steroid Injection, the needle tip is inserted into the back side of the spine between two vertebrae. This placement allows delivery of the medication to a broader area.

Watch Educational Video

Transforaminal Epidural Steroid Injection

In a Transforaminal Epidural Steroid Injection, the needle tip is placed up next to a particular foramen. A foramen is an opening on the side of the spine where a nerve root would come out. Placing the needle here focuses the medication closer to the problem area.

Watch Cervical Transforaminal Epidural Steroid Injection Video
Watch Lumbar Transforaminal Epidural Steroid Injection Video

Caudal Epidural Steroid Injection

A Caudal Epidural Steroid Injection is placed through the sacral hiatus (an opening at the base of the tailbone). This type of injection usually affects the spinal nerves at the end of the spinal canal near the sacrum or tailbone. This collection of nerves is called the cauda equina.

Selective Nerve Root Injection

Selective Nerve Root Injections are done for diagnostic purposes only. In these cases, only a small amount of anesthetic (ie. Lidocaine) is injected next to a specific spinal nerve root. If this relieves the patient’s pain temporarily, then it helps confirm that the patient’s pain is coming from that specific spinal nerve.

Watch Educational Video

Facet Joint Injections

A facet joint injection is a procedure that treats the source of irritation in the small joints at each segment of the spine. These joints provide stability and help guide motion. A cervical (neck), thoracic (upper back) or lumbar (lower back) facet joint injection involves injecting a steroid and local anesthetic into the small facet joint.

If multiple levels of pain exist, several facet joints may need to be injected to treat the pain. By placing numbing medicine into the joint, the amount of immediate pain relief you experience may help confirm or deny the joint as a source of your pain. This pain relief will enable you to undergo necessary conventional treatment, such as physical therapy, to rehabilitate your back.

Watch Facet Radiofrequency Neurotomy Video
Watch Facet Joint Injections Video

Facet Nerve Blocks (Medial Branch Blocks)

In this procedure, a small amount of local anesthetic (ie. Lidocaine) is injected next to the nerves that supply a particular facet joint. The injection temporarily blocks the pain coming from this joint. The procedure is usually done as a trial to see if the patient is a candidate for a radiofrequency neurotomy procedure.

Sympathetic Nerve Blocks

A sympathetic nerve block is an injection to anesthetize the sympathetic nerves along the front of the spine to decrease your pain temporarily and to define it more precisely. Often a series of sympathetic nerve blocks are done on a weekly basis until the pain is under control. If the pain relief is only short term with each injection, a neurostimulator may be considered.

Radiofrequency Neurotomy

Radiofrequency Neurotomy treatment in MN by Dr. Will Radiofrequency neurotomy is intended to identify and interrupt the nerves that contribute to chronic pain. The procedure has proven to be a valuable asset in the treatment of spinal pain that originates from the facet joints. The process of radiofrequency neurotomy begins by identifying which facet joint or joints are causing the pain. A series of two test injections are performed on separate days. Individual facet nerves are numbed to see if the pain can be temporarily stopped. If the two test injections are both successful at alleviating the pain temporarily, then the painful joint has likely been identified. Statistics show that a patient who has passed both test injections has about an 80% chance of getting pain relief with the final step, which is called radiofrequency neurotomy.

October 2011 – Read Dr. Will's article in MD News for more information on how Radiofrequency neurotomy is a new advanced alternative solution to chronic pain.

Watch Educational Video

Neurostimulation Therapy

A neurostimulator is a small system that would be placed in your body like a pacemaker. They are sometimes referred to as “pacemakers for pain.” A neurostimulator generates mild electrical pulses and sends them to your spinal cord. These electrical pulses replace the feeling of pain with a tingling or massaging sensation. A variety of neurostimulators are available to relieve a patient’s specific region of pain, such as the spinal cord or the peripheral nerves.

Three major medical manufacturing companies make neurostimulators: Medtronic, ANS: A St. Jude Medical Company, and Boston Scientific.

Watch Educational Video

Intrathecal Pain Pump

The Intrathecal Pain Pump drug delivery system is made up of two implantable components: an infusion pump and an intraspinal catheter. The pump is placed in a subcutaneous pocket while the catheter is inserted into the intrathecal space of the spine, tunneled under the skin and connected to the pump. Medication can be delivered at constant or variable flow rates.

Because there are no external parts, the system usually does not interfere with daily activities. A programmable pump allows clinicians to adjust doses non-invasively, minimizing patient discomfort. In addition, the pump can be programmed to deliver different doses at various times of the day depending on the patient's needs. Medtronic is the only medical manufacture of a programmable intrathecal pain pump.

Watch Educational Video

Vertebroplasty

A proven treatment for vertebral compression fractures with a 20-year clinical history.

Watch Short Patient Education Video

Fragility fractures are a serious and growing problem for older adults and the healthcare system. In fact, 50% of women and 25% of men will have an osteoporotic fracture in their lifetime. Vertebral compression fractures (VCFs) are the most common type of osteoporotic fracture, with an estimated 700,000 reported nationally each year.

Vertebroplasty offers a proven and safe treatment that assures the best quality results.

This minimally invasive, image-guided treatment, in which bone cement is injected into the vertebral body, significantly decreases pain and increases mobility in more than 90% of patients.

Here are the steps involved in a vertebroplasty:

Performed in our Edina clinic; 90% success rate

The procedure is performed on an outpatient basis at our Edina clinic under local anesthesia and mild sedation. The patient is generally ready to go home one hour post-procedure.

The overall success rate for vertebroplasty in treating osteoporotic fractures is approximately 90%. Patients experience a dramatic reduction in pain, increased mobility, and improved overall quality of life.