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Interventional approach to back pain Management
1. Dr (Maj) Pankaj N Surange
MBBS, MD (Anesthesiology), FIPP (Hungary)
Director, Interventional Pain and Spine Centre, New Delhi
Chairman, World Institute of Pain, India Chapter
Founder Member and Treasurer, MSK Ultrasound Society
2. Interventional Pain management
Interventions are Minimally Invasive, Non
Surgical and Target Specific procedures to
Diagnose and to treat Various painful conditions
It fills the gap between
pharmacologic management of
pain & more invasive
operative procedure
3. • 36 Years, Executive
• Back pain with radiation
to Left leg for 4 months.
• Lost his job.
• Progressively increasing and
association with paraesthesia.
6. .
Management : Disc Herniation
Under fluoroscopic Guidance
Correct level of the prolapsed
disc is identified
Needle is inserted into the centre
of the Disc and ozone is Injected.
Pain relief starts usually within
one week and ozone takes 3-4
weeks for its complete effect
Percutaneous Ozonucleolysis + Transforaminal L5 and S1
7. Minimally invasive procedure using small needle and probe to remove disc
material of prolapsed disc ,releasing pressure on nerves and relieving pain in
most of the patients of prolapsed/ bulging / slipped disc
Management : Disc Herniation
Percutaneous disc decompression
8. Rotating tip removes
small portion of disc
material.
Because only enough of
the disc is removed to
reduce pressure inside
the disc, the spine
remains stable.
Insertion site covered with bandage.
Recovery is fast as unlike surgical
decompression no bone or muscle is cut.
2-3 days of bed rest and may return to normal
activity within one week.
Management :
Case 1
Percutaneous disc decompression
29. Facet Arthropathy
• Low back pain- unilateral or
bilateral
• Tenderness over facet joints
• Pain is deep, dull aching,
difficult to localize
• Referred to the buttocks, groin,
hip, or posterior and lateral
thigh.
• Pain is more prominent in the
morning and with inactivity
• May aggravate on extension after
forward flexion
30. Facet Arthropathy secondary to
Disc degeneration
• Disc bears 80% of weight
• Facet joints bears 20 % of weight
A change in the intervertebral disc produces
Change in the whole motion segment
34. • 56 yrs /Female
• Severe radicular pain in Rt Leg
• H/o frequent back pains
• Sensory loss in L5 Distribution and EHL- 4/5.
• Known case of Rheumatoid Arthritis, Uncontrolled DM,
CAD, Interstitial Lung disease.
Case-3
38. • 70 Yrs male/ obese
• Back pain Rt > lt
• Radiation to rt thigh --- lat surf of rt leg
• Tossing on chair
• 1st
Investigation ordered –MRI LS SPINE
Case-4
52. • 38 yrs male
• Low back pain radiating to both legs more on
right side.
• He had history of disc prolapse of L4-5 & L5-S1
and has undergone surgery 2 times before
(laminectomy, discectomy & excision of scar).
• Pain is increasing day by day.
• Repeated investigations & visit to 16 consultants
for last 4 years has taken away all faith from any
form of medical treatment.
• MRI-Epidural Fibrosis
Case-8