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Injection Treatment for Back Injury

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Although back pain is a common problem, treatment options will vary depending on how long you had the pain and the severity of it. Dr. Rohit Oza explains the different types of injections you can use to help treat back pain.

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Injection Treatment for Back Injury

  1. 1. Low Back Pain Injection Treatments for Back Injury Rohit Oza, MD Physiatry Department Summit Medical Group
  2. 2. Low Back Pain The Low Back Pain Story  60-90% of adults will have low back pain  2nd most common reason to see primary care physician
  3. 3. Low Back Pain Common Thinking  40-50% of patients with low back pain will improve within one week
  4. 4. Low Back Pain The Full Story  62% of patients likely to have one or more relapses during a one-year follow-up
  5. 5. Low Back Pain The Full Story  Low back pain is the #1 disability in patients under 45
  6. 6. Low Back Pain Common Thinking  90% of patients with low back pain improve without any medical care
  7. 7. Low Back Pain The Full Story  Longer pain for patients who wait 6-10 weeks  80% have pain at six months and one year  12% disability at one year
  8. 8. Low Back Pain Difficulties in Treating LBP 1. Difficult to diagnose source 2. Requires “whole care” approach 3. Preventive program needed to minimize recurrence
  9. 9. Low Back Pain Other Complicating Factors  Complexity  AHCPR guidelines  Lack of research  Managed care restrictions
  10. 10. Low Back Pain Leading cause of disability 70-90% of adults will experience LBP In their lifetime Financial Impact: medical expense anually In medical bills, disabilty, and loss of productivity
  11. 11. Interdisciplinary Team Approach at SMG Complex Problem Physiological factors Social factors Psychological factors Low Back Pain Interdisciplinary Management • Orthopedic Surgeons • Neurosurgeons • Pain specialists • Psychiatrists/ Psychologists • Physiatrists • Radiologists • Neurologist • Internists • Chiropractor
  12. 12. Low Back Pain  Anatomy – Vertebral body – Disc – Facet joints
  13. 13. Spine Anatomy  Cervical – C1-C7  Thoracic – T1-T12  Lumbar – L1-L5  Sacrum – S1-S5 (fused) Low Back Pain
  14. 14. Low Back Pain  Spinal cord  Nerve roots  Disc
  15. 15. Prevention  Stretching  Strengthening  Posture  Lifting techniques  Ergonomics Low Back Pain
  16. 16. Low Back Pain  Common sources for LBP: Structural Myofascial Muscles, Tendons, ligaments, fascia Neural Tissue Nerve root irritation, epidural inflammation, epidural fibrosis, arachnoiditis Joints Intervertebral discs: Skeletal bone abnormalities Facet joints, sacro iliac joints Disc degeneration/disruption, disc herniation Osteoporosis, compression fractures, spinal stenosis, spondylosis, spondylolysis, spondylolisthesis,
  17. 17. Low Back Pain Injections  Muscle  Nerve  Joint
  18. 18. Low Back Pain Injection Treatments: Muscle/Ligaments Trigger Point Injection A trigger point is a knot or tight, rope-like band of muscle that forms when a muscle fails to relax after activity Lidocaine is an injectable medication that can be used to numb a joint or treat muscle pain. Research shows that injections used to inactivate trigger points can provide prompt relief of painful symptoms related to joint and muscle ailments.
  19. 19. Low Back Pain Injection Treatments: Muscle/Ligaments Trigger Point Injection
  20. 20. Low Back Pain Injection Treatments: Nerve “Sciatica” Sciatica is a relatively common form of low back and leg pain, but the true meaning of the term is often misunderstood. Sciatica is a set of symptoms rather than a diagnosis Symptoms include lower back pain, buttock pain, and pain, numbness or weakness in various parts of the leg and foot. Other symptoms include a " pins and needles" sensation, or tingling and difficulty moving or controlling the leg
  21. 21. Low Back Pain Epidural Injection GOAL: Control inflammation
  22. 22. Epidural Injection Been around for 40 years. The epidural space is accessed through the caudal, interlaminar approach and transforaminal approach. Low Back Pain
  23. 23. Disc Herniation Location Determines Affected Nerve Low Back Pain Far Lateral Foraminal Paracentral
  24. 24. Caudal Epidural Blocks Low Back Pain Low risk for thecal puncture. Dura ends at S2. Unreliable above the L4-5 levels. Requires higher volumes of medication
  25. 25. Zygapophyseal Mediated Pain(Facet Joint) 1. Cartilage degeneration with or 2. Osteophyte formation 3. Biomechanical transfer of weight in disc degeneration 4. Trauma to the joint 5. Spondylolisthesis Low Back Pain
  26. 26. Facet (Zygapophysial) Joint Pain Lumbar facet joints recognized as a source of pain since 1911 Facet syndrome: lumbosacral pain with or without sciatica Pain after rotary movement or twisting Low back pain with radiation to thighs and buttocks Poor clinical correlation with imaging or exam Low Back Pain Primary Pain Secondary Pain
  27. 27. Low Back Pain Facet Injections Intra-articular Joint Injections Therapeutic (Local and steroid) Paravertebral Facet Joint Nerve Blocks(Medial Branch Blocks) Diagnostic (Local only) Therapeutic only with Neurolysis (Radiofrequency)
  28. 28. Low Back Pain
  29. 29. Neuroablation:RF Low Back Pain Radiofrequency ablation produces indescriminate destruction of all nervous tissue including motor and propioceptive fibers Lesion Shape Produced by RF: Typical Energy Delivered 2-7 watts * Thermal lesion is least at tip and greatest along active shaft of RF needle * Typical tissue temp 70-90 degrees C * Optimum angle is parallel to nerve 4 mm
  30. 30. SI Joint Accepted source of low back and buttock pain Prevalence of SI pain: 13 to 30% of cases of low back pain Moderate evidence for efficacy of SI joint injections Low Back Pain
  31. 31. Disc Degeneration Discs well innervated and can be source of pain Internal architecture disrupted Presence of radial fissures that reach the outer third of the annulus Low Back Pain
  32. 32. Severe Degenerative Disc Disease Biomechanical Transfer of Load to the Annulus and Z-joints Low Back Pain Complete Degradation of Nucleus Pulposis Internal architecture of the disc is disrupted External surface remains normal, no bulge or herniation Characterized by degradation of the matrix of the nucleus pulposus and presence of radial fissures that reach the outer third of the annulus
  33. 33. Stem Cells for Disc Degeneration Low Back Pain Dr. Alon Terry(newest SMG Physiatrist) trained at HSS where he worked on regenerative strategies for the disc In a recent study by Dr. Terry and Dr. Lutz, cells from a patient’s blood were taken out and injected into the disc to see if can stimulate a repair response. They also worked on a study injecting growth factor into the disc to try to turn on the disc’s inherent ability to heal itself. These are some of the first studies that have been done in the world in this area.
  34. 34. Conclusion Low Back Pain Lumbar spine injections can be a valuable tool in the management of LBP Some injections can be diagnostic and/or therapeutic Injections represent one strategy in the management of LBP Multimodal treatment strategies have shown to be most helpful in the long-term management of chronic LBP

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