non operative techniques for back pain management

1. Dr. Shiraz Munshi MBBS,DNB(fellow) Interventional Pain Specialist Sterling Hospital, HCG Medi-Surge Hospital, Ahmedabad Chronic Back Pain A More Effective Approach

2. NO ONE should live or die in pain

3. Precision Diagnosis and Treatment of Back Pain

9. Return to Work Odds

11. “ It is clear from clinical experience and formal studies that when a patient presents with spinal pain there are no clinical features that permit the source of pain to be diagnosed. Even imaging studies do not provide a diagnosis. The appropriate investigations are the ones that answer the questions ( where does the pain come from )” Bogduk et al

14. Lumbar Disk

19. Diskogram

22. CONTRAST DISTRIBUTION [80] : (AS EVALUATED BY FLUOROSCOPY ) Disk has a complete radio fissure that allows injected fluid to escape. Can be in any stage of degeneration. “ Ruptured” (R) Degenerated disk with radio fissure leading to the outer edge of the annulus. “ Fissured” (F) Degenerated disk with fissures and clefts in the nucleus and inner annulus. “ Irregular” (I) Mature disk with nucleus starting to degenerate into fibrous lumps. “ Lobular” (L) No signs of degeneration, Soft white amorphous nucleus “ Cotton Ball” (CB) Stage of Disk Degeneration (C-arm View) Discogram Type “ Ruptured” “ Fissured” “ Irregular” “ Lobular” “ Cotton Ball”

24. Nerve Root

27. Injection Technique

28. Injection Technique

30. L4 nerve Root

31. L4 nerve Root

32. L4 nerve Root

33. L4 nerve Root

38. DISC Nucleoplasty Plasma coblation technology decompresses the disc

43. Equipment

44. Trial

45. Trial

47. Trial

48. Locate the “sweet spot”

49. Facet Joint

50. FACET JOINTS SPINAL NERVES

63. Facet Joint Injections

64. Needle Placement for Median Branch Block

65. Needle Placement for Median Branch Block

67. RADIOFREQUENCY GENERATOR MACHINE

69. Lumbar Facet Medial Branch Block Needle position at junction of SAP and TP Medial branch of Dorsal ramus

70. FACET JOINTS - RF DENERVATION PATIENTS SELECTION - FLOW CHART FACET JOINTS BLOCK ( diagnostic – prognostic ) Unsteady pain relief Lasting pain releif Facet joints block repetition Unsteady pain relief RF DENERVATION

71. Sacroiliac Joint

73. Diagnostic - Sacroiliac Joint - Intraarticular injection

74. Sacral Iliac Joint Injection

76. Muscles Soft Tissue ---Trigger Points

77. IN SUMMARY…..

79. THERAPEUTIC WINDOW OF OPPORTUNITY

80. Expectations – Good quality of life

81. Treatment continuum

83. Thank you for your attention! Are there any questions?

84. NO ONE should live or die in pain