Orthopaedics

What is vertebroplasty?

Osteoporosis is a disease that causes the bones in your body to become brittle, which may lead to a fracture (break) of one or more vertebral bodies (bones?). It can result in medical concerns, including breathing problems, chronic pain and difficulty with walking. With vertebroplasty, the doctor carefully injects a cement-like material into the bone to support the fracture and prevent further collapse.

An X-ray image showing the cement placement in the vertebral body (bone) with a vertebroplasty procedure.

What is a cervical fusion?

One of the most common cervical spine problems is a herniated disc. A disc may be herniated by injury, or it may gradually wear out. This may cause pressure on the nerves, creating neck and arm pain. With a cervical fusion, the disc is removed and a piece of bone is placed between the vertebrae. As healing takes place, the graft and vertebrae grow together. A metal plate is sometimes placed for stabilization.

An X-ray image of an instrumented anterior cervical discectomy and fusion surgery.

What is a lumbar fusion?

Lumbar fusion improves instability of the spine. As a disc degenerates and flattens, the vertebrae slip back and forth. This irritates the joints and creates or worsens stenosis (arthritis of the spine), irritating the nerves, causing back and leg pain. A bone graft is placed along the vertebrae and fuses or grows together with the vertebrae.

An x-ray image of a posterior lumbar decompression and posterolateral instrumented fusion surgery

What is a lumbar discectomy?

A herniated lumbar disc can press on the nerves in the spine and may cause pain, numbness, tingling or weakness of the leg, called sciatica. Most patients (80% - 90%) with an acute lumbar disc herniation improve without surgery. Surgery is less effective in relieving back pain, but for some patients, especially those with leg pain, surgery may be recommended. Surgery removes part of the herniated disc through a small incision, relieving the pressure on the nerve.

What is an epidural injection?

During an epidural injection, lidocaine (a numbing medicine) and cortisone (a very strong anti-inflammatory medication) are injected into the epidural space, or spinal canal, for relief of pain. The injection is performed by a physician using fluoroscopy (X-ray) to guide the needle and medication placement. The procedure takes 15-30 minutes, with the total appointment lasting 1 ½ to 2 hours. The epidural injections can help back and leg pain by reducing or resolving inflammation in the epidural space (spinal canal)

An X-ray of the lower spine, showing site of caudal (tail bone) epidural injection

An illustration of the lower spine, showing the site of a caudal epidural injection

What is a nerve root injection?

A nerve root injection is done primarily to determine if a specific nerve root is the source of back, buttock and leg pain. The procedure is similar to an epidural injection, where the lower spinal canal is injected. Selective nerve root injections of cortisone and anesthetic can help diagnose as well as treat nerve root inflammation that causes sciatica, a numbness or pain in the leg. This very precise injection can help alleviate leg pain coming from nerve roots in the lower back.

X-ray of spine showing transforaminal L-5 selective nerve root injection.

What is a discogram?

A discogram is a diagnostic procedure to help identify if the disk is the source of the pain. It provides additional information to your physician to help establish a diagnosis, to more clearly determine the source of pain, and to help with choices for appropriate treatment. Small needles are placed into the disks through the skin of the back. A water-soluble dye is injected, and X-rays are taken. Pain responses are recorded throughout the procedure.

An X-ray image of needle placement into vertebral disk. In this image, the dye is being placed to determine if there is a tear and if it reproduces exact pain on dye injection.

A CT image of an abnormal discogram. The light area highlighted by the arrow indicates a dye leak.

What are EMG / NCS?

EMG, or electromyogram, is a diagnostic test performed by a physician to determine if the body has a nerve or muscle problem. It generally consists of two parts, nerve conduction studies (NCS) and EMG. The testing involves small shocks to stimulate the nerves, and the insertion of tiny needle electrodes through the skin into the muscles. The responses are recorded and analyzed. The results help locate which nerve root may be causing leg pain (sciatica).

What are facet joint and S-I (sacroiliac) joint injections?

Sometimes lower back pain may come from different joints in the lower back. A facet joint injection is done to reduce inflammation in a joint that is felt to be the source of pain. Precise x-ray guided injections of cortisone and anesthetic can diagnose as well as treat these painful joints. An epidural injection is done when disc herniation or a narrowed spinal canal causes nerve root irritation or compression.

Oblique (side) view of facet joint showing needle placement. The light fluid is dye.

S-I Joint injection.

Front view of facet joint. The dark color in the lower part of the image is dye.

What is Radiofrequency (RF) denervation of facet joints?

If facet joint injections help only temporarily, RF nerve ablation may help long-term. Under X-ray guidance, a fine needle is placed over the small nerves that supply the facet joint and the tip of the needle is heated using radio-frequency energy and the joint is denervated. This procedure can help alleviate pain coming from the facet.