Frequently Asked Questions - Clinical

FREQUENTLY ASKED QUESTIONS (FAQs)

 If you have questions that we do not cover below, please feel free to contact us at 303-327-5511.

Q:  How do I know if I am a candidate for a radiofrequency (RF) nerve ablation procedure?

 

If your spine physician has suspected that you have pain from the facet joints of the spine (neck, middle or lower back) or pain arising from the sacroiliac joint, then it may be offered to you that you undergo diagnostic spinal injections to accurately diagnose the source of your pain.  You may undergo injection of local anesthetic (numbing medication) into the facet or sacroiliac joint, along with corticosteroids.  Also, we can inject local anesthetic around the small nerve branches that travel to the suspected painful joint (facet or SIJ).  For the facet joints of the neck or back, these nerve blocks are called medial branch blocks.  For the sacroiliac joint (SIJ), these nerve blocks are called lateral branch blocks.  You must undergo at least one set of medial or lateral branch blocks before undergoing an RF procedure.  You have a very good chance of achieving significant pain relief if you have had two sets of blocks with 70-80% relief of pain, or at least one set of medial (or lateral) branch blocks with 80% relief of pain while the blocked nerves are numb.  The numbing medicines should take away the majority of the pain in the targeted (index) area.  It is occasionally appropriate to proceed forward with RF procedures if less pain relief is achieved during the test blocks, although this needs to be discussed with the treating care provider.

 

Q:  How do I know if I need a second (or third) epidural steroid injection?

 

The use of epidural steroid injections can be very helpful in reducing the radicular pain of pinched nerves in the neck or low back.  These injections are used along with activity modification, medication management, physical therapy and other pain management tools to help reduce pain and increase levels of function.  (See “Overview of Treatment Guideline for Cervical (and Lumbar) Radicular Pain”).

 

If your first epidural steroid injection provides some length of time of pain relief or improved strength, then a second injection may be considered.  If there were a partial response, say 50% pain reduction, then it would be reasonable to try a second injection in hopes of eliminating additional pain.  Also, if there is a very substantial response that lasts several days, weeks or months, and the pain begins to return again, then another injection would be reasonable at that time.   The decision to proceed forward with a second or third injection should be made in consultation with your spine care provider.  It is usual to wait two weeks or more between epidural injections.

 

Q:  When should I undergo spine x-rays or MRI?

 

In general, when neck or back pain, with or without arm or leg pain, is present for six weeks or more, then x-rays and/or MRI or other radiological studies are more helpful.  If these imaging studies are obtained prior to this, they tend not to help with treatment decision-making, and there is still a high likelihood that the pain will resolve without spinal injections or surgery.  Exceptions to this do exist, however, and there are several situations where x-rays, MRI, or other studies such as CT or bone scans might be indicated sooner than six weeks from the onset of pain.  These exceptions include a history of trauma with significant pain, regular nighttime awakening with pain, loss of energy or weight, or fever and chills which might indicate a tumor or infection, or in cases of significant or progressive neurological findings such as weakness, loss of coordination, or loss of bowel or bladder control.  Any of these can be an indication to obtain imaging studies immediately or earlier in the course of treatment.

 

Q: What sedation options do I have for spinal injections done at a surgery center?

 

There are essentially three levels of sedation/anesthesia care available for procedures done at an ambulatory surgery center (ASC). These are: 1) no sedation, 2) intravenous conscious sedation (IVCS), or 3) monitored anesthesia care (MAC).

 

Any of our procedures can be done without sedation. Sedation is recommended for anyone who desires help with anxiety or pain control during the procedure.

 

There are some procedures where there is some risk of fainting (cervical procedures), pain with needle placement (discography) or better comfort during the procedure is desired (radiofrequency neurotomies).  Intravenous conscious sedation (IVCS) could be administered. This would consist of small or large doses of midazolam and/or fentanyl for relaxation and pain control.

 

Monitored Anesthesia Care (MAC) is occasionally required or preferred. There are also several types of procedures that are carried out in the course of providing spine interventional care that makes the presence of an anesthesiologist or certified registered nurse anesthetist (CRNA) reasonable, and covered by insurance.    These cases such as cervical transforaminal epidural injections, C0-01, C1-2 joint blocks, cervical, thoracic or lumbar RF neurotomy cases, or diagnostic discography, either require a deeper level of sedation at some point during the procedure such that a more skilled level of anesthesia care (monitored anesthesia care) may be requested, or a patient’s anxiety level or past injection experience dictates a different sedation approach. MAC cases do have additional charges attached to them, coming from the anesthesiologist or CRNA.

 

Q: May I drive home from my spinal injection procedure?

 

The majority of spinal injection cases require that another driver take you home from your procedure. This is because anesthetic (numbing medicine) is placed around nerves and/or intravenous sedation medications are used, limiting one’s functional ability to drive. We cannot release you to a cab or other public transportation alone if you have had sedation. Diagnostic and therapeutic benefit can be obtained when numbing medicine is used with epidural or selective nerve root block injections and so it is preferred that you not plan to drive after these procedures. Exceptions can be made only if discussed and planned for before the day of the injection(s).