Vertebroplasty:
Advanced age, trauma, fall in the ground, asthma, diabetes, emphysema, menopause, chronic steroid use and rheumatoid arthritis are all risk factors for osteoporosis. The resultant weakening of bones can lead to compression fractures of the spine causing severe pain, deformity, loss of height, immobilization, and in some cases, failure to thrive.
Historically, vertebral compression fractures have been treated either with conservative methods of cast or brace immobilization with long term bed resting or with major surgery. This surgery requires a long incision, screws and rods for fixation and is done under general Anesthesia. These treatments are limited by long recovery times and disruption of daily life.
Now, these painful spine fractures can be treated with a Minimally Invasive, Non Surgical procedure known as VERTEBROPLASTY, an innovative alternative to traditional treatments which stabilizes fractures of the spine safely and effectively, often providing immediate pain relief.
In addition, percutaneous vertebroplasty can be performed in vertebrae that are not suitable for surgical fixation, for instance because of osteoporosis or because general anesthesia may not be advised in patients who are very sick.
“After performing good number of vertebroplasties, I can confirm that this is one of the most significant procedures for the treatment for vertebral compression fractures,”
The beauty of this procedure is its simplicity. “A small needle is advanced into the fracture using only local anesthetic followed by the placement of bone cement into the fractured area.The cement hardens in about 30-40 minutes and remarkably the pain is gone.”
Radio frequency Nerve Ablation:
A radiofrequency ablation procedure is a minimally invasive and non-surgical procedure that can be done as outpatient treatment. In this procedure, the nerve fibers carrying pain signals to the brain are destroyed using heat. It is usually performed under image guidance like USG or X-ray. This procedure usually takes 30 minutes. It provides long-term pain relief in patients suffering from chronic neck, back, lower back, osteoarthritis knee, and sacroiliac pain.
What are the goals of radiofrequency ablation?
Reduces pain for a longer duration.
Improves the neck, back, knee, and shoulder functions by improving the range of motion. As a result, the patient returns to work quickly, performs routine activities, and enjoys an active lifestyle.
Reduces consumption of pain medications.
Avoid or delay surgery- for example, to avoid TKR at a younger age.
The success of radiofrequency depends on multiple factors like the accuracy of diagnosis, anatomical variations of nerve, and techniques. Some patients have 100% pain relief. For example, the RFA of the facet joint provides 45 to 60% pain relief, while the RFA of the SI joint provides 75 to 85% pain relief. Repeated RFA may provide longer pain relief. Following the procedure, pain relief starts after 10 days, but in some cases, it may take up to two to three weeks. Even after 3 weeks of the procedure, if there is no pain relief, then the procedure might not be successful and should be repeated.
Radiofrequency is a relatively safe procedure with less chance of complications. The complications are a temporary increase in nerve pain, accidental damage to other nerves, neuritis /deafferentation pain, neuroma, localized numbness, infection, and/or failures with no pain relief; also pain relief is not immediate.
Cryoablation:
Cyoablation is a procedure in which an extremely cold liquid or an instrument called a cryoprobe is used to freeze and destroy some tissue. A cryoprobe is cooled with substances such as liquid nitrogen, liquid nitrous oxide, or compressed argon gas.
When cryoablation is done to ablate a nerve to relieve pain it is called cryoneurolysis. cryoneuroablation, also known as cryoanalgesia or cryoneurolysis, is a specialized technique for providing long-term pain relief in pain management.
Cryoneurolysis is much safer way of performing neurolysis. Long term complications are less with cryoneurolysis.
Chances of differentiation (increase of pain instead of decreasing) pain is not there in cryoneurolysis, which is an important complication of radiofrequency procedures.
What are the Contraindications?
General contraindications to percutaneous cryoneurolysis are quite basic:
Bleeding diathesis
Infection (local or systemic)
Spine Cord Stimulator:
Spinal cord stimulators consist of thin wires (the electrodes) and a small, pacemaker-like battery pack (the generator). The electrodes are placed between the spinal cord and the vertebrae (the epidural space), and the generator is placed under the skin, usually near the buttocks or abdomen. Spinal cord stimulators allow patients to send the electrical impulses using a remote control when they feel pain. Both the remote control and its antenna are outside the body.
Experts still don’t fully understand the mechanisms behind spinal cord stimulation, but they now know that it may target multiple muscle groups directly from the spine and even alter how the brain senses pain.
Traditional spinal cord stimulators replace the sensation of pain with light tingling, called paresthesia. For patients who find these paresthesiae uncomfortable, newer devices offer “sub-perception” stimulation that cannot be felt.
Many of the latest devices are placed by physicians with highly specialized training in interventional pain management under X-ray and/or ultrasound guidance.
Spinal Cord Stimulator Complications
Complications of spinal cord stimulator surgery are rare, but no procedure is without risk. A small percentage of patients may experience:
Infection, which may occur in the first 2-8 weeks.
Bleeding.
Device migration (i.e., the electrodes move from their original location and the stimulator doesn’t block pain as effectively). This often requires a follow-up surgery to put the electrodes back in the proper spot.
Device damage (e.g., a fall or intense physical activity breaks the stimulator).
Dural puncture. The dura mater surrounds the spinal cord. Spinal cord stimulators are inserted in the epidural space, the area just outside the dura mater. If a needle or electrode goes too deep and pierces it, cerebrospinal fluid may leak out. These punctures can cause severe headaches.
Spinal cord trauma. Although extremely rare, spinal cord stimulator insertion can cause nerve injury and paralysis.