Image guidance is used to sterilely inject a small amount of steroid agent near the area of inflammation within the epidural space to reduce pain. This is done often in an attempt to avoid surgery.
At times the main intent is to isolate the cause of pain (diagnostic injections) ,
other times the intent is simply to remove pain (therapeutic injection).
CT or X ray guidance is used to position an electrode so that a small amount thermal energy can be delivered to disrupt pain circuits, the circuits / nerve pathways go to areas of chronic pain like for example the pain of osteoarthritis. The most common site involves the lumbar facet joints although other sites such
as the knee joint are also sometimes targeted. The pain relief typically lasts from
8 to 9 months.
X-ray guidance is used to access a fractured vertebral body with a needle,
through the center of the needle a catheter with a balloon is passed then inflated in an effort to try to “restore the fracture” next bone cement is injected to create an internal cast within the bone. Pain relief can be dramatic. This can be done for osteoporotic fractures as well as other types of fractures such as those
related to trauma or cancerous lesions.
Osteocool bone RFA
This is a procedure used for painful bone tumors which may be benign or malignant, the procedure can be performed in the spine and when done there
is very similar to Kyphoplasty but has the additional benefit of using radio frequency energy to thermally destroy a tumor if present in addition to
creating an internal cast to allow healing and pain relief.
Acute ischemic stroke therapy
In eligible patients a special type of catheter can be used to open up blood vessels in the brain in order to reverse or at lest minimize the damage of an
acute stroke, this type of therapy requires a highly trained and skilled team
and isn’t right for every patient. Removal of the “clot” is called thrombectomy
and can be done either with or without the clot buster drug TPA.
This type of study is truly the gold standard exam to evaluate the blood vessels
to the neurologic system dynamically. It is performed less often now than in
the past do to the advent of other less invasive methods. However, when a persistent question about a potentially dangerous vascular abnormality of the brain or spine exists it can be necessary and lifesaving. Recently we have
begun to offer this procedure through radial access. Radial access means that the angiogram can be performed through the wrist, this type of angiogram is typically much easier on the patient and allows rapid recovery without bed rest.
Medial branch block (MBB) and Facet injections
These tow related procedures both use X-ray guidance to try and quell pain signals from diseased (arthritic) facet joints. The MBB targets the nerve to the joint called the medial branch, The facet joint injection actual requires a very
thin needle to enter the joint to inject numbing medicines and steroids. Both procedures are typically used to try to figure out the cause of back pain prior
to deciding on the best therapy.
This group of procedures uses imaging guidance to place an antenna (needle)
into a tumor for destruction of the tumor. In many cases for solitary and relatively small tumors this can be curative. The procedure is first typically discussed with oncology and surgical team members. When the person is the right fit for the procedure they are seen in consultation and evaluated by the anesthesia team. The patient will typically be asleep for between 10 and 30 minutes to allow the interventional radiologist to place the needle/antenna in
the lesion and use thermal energy to ablate (destroy) the tumor. We have done several tumors of the kidneys, liver (both primary liver tumors and metastatic)
as well tumors of the lungs and chest (again both primary and metastatic).
Yttrium 90 radioembolization
This is a series of procedures which are performed by angiographic guidance, often through the wrist typically for primary or metastatic tumors to the liver. Common indications are hepatocellular cancer, metastatic colon cancer and neuroendocrine tumors. Once a good candidate is identified by the oncology team the patient is seen in consultation. The first step is a mapping study to further understand the patients liver anatomy, blood vessels to the small bowel and gallbladder are some times protected during this exam. About 1 week later an individualized does of Y-90 radioactive microscopic beads is placed via another angiogram into the tumor, this procedure is typically repeated about two later.