Interventional Radiology

Therapeutic And Diagnostic

interventional-therapy

Diagnostic And Therapeutic Procedures

Interventional Radiology is a medical sub-specialty of radiology which utilizes minimally invasive image-guided procedures to diagnose and treat a large variety of medical conditions in nearly every organ system. Due to the limited invasiveness of these procedures, the goal of maximizing treatment and minimizing patient discomfort and downtime is easily met.

At Open Advanced MRI Northwest we provide both therapeutic and diagnostic interventional radiology procedures to both diagnose and treat many conditions. We specialize in pain management. These procedures are combined with image-guidance- such as CT, X-Ray, Ultrasound, and MRI- to optimize diagnostic and therapeutic benefit.

Appointment Preparation

Please be sure to read the following pre-exam preparation.

If you have any questions or concerns please contact Open Advanced MRI Northwest.

  • A driver on call is recommended for most interventional for most procedures.
  • It is mandatory for some procedures.
  • It is also mandatory should you require a sedative.
  • Please bring prior imaging (digital copies please) and reports.
  • If possible, please bring to our office before your appointment.
  • Remember- not all facilities are open first thing in the morning- and if the report/images from are not available the appointment may be delayed.
  • Please bring a current medication list (available by request at your pharmacy) OR bring in your prescription bottles for a staff member to review.
  • If you do not have a driver available/on call, please still maintain your appointment as in some cases we are still able to safely proceed after the in office assessment. Please alert a staff member upon arrival to facility.
  • Please note we continue to reserve the right to ask for the procedure to be rescheduled if there is a concern for safety.
  • Wear loose, comfortable clothing.
  • Please stop eating* and drinking** two hours prior to procedure.
  • *Please eat something small if you will have been fasting more than 6-8 hours before your appointment to avoid possible complications like low blood sugar, nausea, syncope etc.
  • **Small sips of water may be consumed to take medications (only that medications that are NOT on the list above IF there is approval from the prescribing provider).
  • Please bring pain medication(s) to take after appointment as needed.
  • Please notify Open Advanced MRI Northwest if you are pregnant, breast feeding or think you may be pregnant.
  • If you did not discontinue a medication on the list below- please still maintain your appointment as in some cases we are still able to safely proceed after the in office assessment. Please alert a staff member upon arrival to facility.
  • Please note: If a medication is NOT on the list below and there is a question- please call immediately and verify with a staff member
  • If you are on antibiotics, please call to inform us as soon as possible.

The following medications should be stopped prior to your injection- with the prescribing physician’s approval and protocol in writing.

These should be stopped at least 7 days prior to procedure:

  • Aggrenox (aspirin/extended release dipyridamole)
  • Pletal (cilostazol)
  • Trental (xanthine)
  • Ticlid (ticlopidine)
  • Plavix (clopidogrel)

These should be stopped at least 48 hours prior to procedure:

  • Persantine (dipyridamole)
  • Aggrastat (tirofiban)
  • Integrilin (eptifibadtide)
  • Coumadin (warfarin)
  • Dicumerol
  • Miradon (anisinidone)
  • Reopro (abciximab)
  • All anti-inflammatories such as Ibuprofen, Naprosyn, Naproxen, Lodine, Aleve, Motrin
  • All Aspirin or Aspirin containing medications
  • Low molecular weight heparin compounds such as Lovenox
  • Vitamin E and Ginkgo Biloba
  • Pain medications with anti-inflammatory properties such as Ultram and Tramadol.

For narcotic medications, please see below. Please stop taking narcotic pain medication 8 hours prior to injection such as:

  • Vicodin
  • Percocet
  • Oxycodone
  • Hydrocodone
  • MS Contin
Recovery After Procedures/Discharge Instructions

After most interventional procedures, particularly therapeutic interventions, it is routine to follow-up with our office. The follow-ups are made to typically to assess a procedural response/review results or assess response/review results and treatment plan, so it is suggested that patients keep a journal of symptoms to review with staff at the subsequent appointments. Sample follow-up questions are listed below. Follow-up appointments range from one to six weeks after a procedure in most cases.

Benefit from interventional procedures like the ones described above are measured in several ways. Most common questions to help determine improvement include: Were any/all of the symptoms improved—including pain, numbness, tingling, and weakness? If so, how much improved, and for how long? Was there any improvement in tolerance to previously aggravating activities were you able to tolerate previously activities/positions for longer periods of time? Were you able to take less pain medication (to include prescription/over-the-counter)?

Please note: Numbness from the procedure may last four to six hours. It is not abnormal after the numbing medications have worn off to have a return of regular symptoms and/or increased symptoms the night of the procedure for up to several days after. Benefits of the steroid typically occur within three days; however, it can take up to five and even seven days.

Post Procedure:

  • Do not drive or operate heavy machinery for 24 hours (if sedated)
  • Do not engage in strenuous activity; rest/light activity recommended for 1-48 hours post procedure
  • Continue to follow any activity restrictions as directed by providers involved in care to include exercise, lifting/weight limits and the like
  • Resume all regular medications
  • Resume normal diet and fluids as tolerate
  • Avoid soaking the injection site for 24-48 hours (baths, hot tubs; showering is acceptable
  • May remove bandages 24 hours after procedure
  • Any sign of infection/bleeding, call the office immediately
  • If needed may use ice 15-20 minutes 2-3 times a day

Side Effects of Anti-Inflammatory Steroid Most commonly reported:

  • Headaches
  • Heart palpitations
  • Insomnia
  • Hot flashes

Less commonly reported:

  • Hiccups, increased heart rate and fluid retention

Most side effects will resolve typically three to four days post procedure. Please call if these symptoms or any other side effects are not improving and/or causing distress.

Please call the office and inform a staff member immediately (or call the provider if after hours) if any of these occur after a procedure:

  • If symptoms worsen and/or more medications are required to manage symptoms
  • If a change in bowel or bladder habits begins (incontinence specifically)
  • If any signs of infection are noted- such as fever, swelling, redness, etc

Procedures

Epidural Steroid Injection

An epidural steroid injection (ESI) is a minimally invasive procedure that can help relieve neck, arm, back, and leg pain/discomfort/numbness caused by inflammation in the spine. Common causes of inflammation may include the following: disc disease, a herniated (“blown”) disc, nerve irritations or spinal stenosis. An epidural steroid injection usually includes both a long-lasting corticosteroid and an anesthetic numbing agent. The medications are delivered into the epidural space of the spine, which is the area between the protective covering (dura) of the spinal cord and the bony vertebrae. Relief may last for several days or even years; it varies from patient to patient. The goal is to reduce inflammation with the anti-inflammatory steroid to reduce the distressing symptom(s).

There are two types of epidural injections- an interlaminar epidural steroid injection and a transforaminal epidural steroid injection. The injection technique is determined by several factors to include (but not limited to) the patient’s complaints, the request from the patient’s referring/primary provider, a brief physical examination, diagnostic imaging findings and the interventional radiologist’s assessment. Epidurals are usually performed in a series of three injections, about two weeks apart. The number of injections depends on symptoms. The series of epidurals may be repeated every six months, depending on symptoms and physician decision.

For The Procedure > Interlaminar ESI:

This method accesses the large epidural space in the back of the spinal canal. For cervical, thoracic and lumbar ESI’s the patient is positioned on their abdomen. A tiny needle will numb the skin after being scrubbed with an agent such as Betadine or Hibiclens. Next, the spinal needle is placed between the lamina of two vertebrae almost directly in the middle of the target location- the neck, mid back or lower back. A small amount of dye/saline/air will be injected into the epidural space to confirm the location of the needle. After the needle location is confirmed with the dye/saline/air and imaging guidance, the medication will be injected- usually a combination of anti-inflammatory steroid and anesthetic. Medication is usually delivered to the region of the nerve roots on both the right and left sides of the inflamed area simultaneously. The goal of the procedure is to reduce the inflammation around the disc/nerves and subsequently alleviate the symptoms.

For The Procedure > Transforaminal ESI:

This method targets the nerves that exit the foramen at a particular spine level while also concurrently treating the epidural space. For cervical transforaminal ESI’s the patient is positioned on their back. For thoracic and lumbar transforaminal ESI’s the patient is positioned on their abdomen. A tiny needle will numb the skin after being scrubbed with an agent such as Betadine or Hibiclens. Next, the spinal needle is placed to the side of the vertebra near the neural foramen, just above the opening for the nerve root and outside the epidural space. A small amount of dye/saline/air will be injected to confirm the location of the needle near the nerve. After the needle location is confirmed with the dye/saline/air and imaging guidance, the medication will be injected- usually a combination of anti-inflammatory steroid and anesthetic. With this approach, the medication is typically a unilateral distribution- it is treating one specific nerve on one side. This procedure can be done on both sides, however with two injections. This injection approach may be used due to anatomical variances, for example, post-surgical changes.

Facet Joint Block

A facet joint block is a minimally invasive procedure that can temporarily relieve neck or back pain caused by inflamed facet joints. The cause of facet joint pain can include but is not limited to arthritis, injury and/or degeneration. The procedure potentially has two purposes. First, it can be used as a diagnostic test to see if the pain is actually coming from the facet joints. Second, it can be used as a treatment to relieve inflammation and pain caused by various spine conditions. A facet joint block usually includes both a long-lasting corticosteroid and an anesthetic numbing agent. The goal is to reduce the inflammation in the joint to reduce the symptoms.

For The Procedure > Facet Joint Block:

For (the majority of but not all) cervical, thoracic and lumbar facet joint blocks the patient is positioned on their abdomen. A tiny needle will numb the skin after being scrubbed with an agent such as Betadine or Hibiclens. Next, the spinal needle is placed into the inflamed joint. A small amount of dye/saline/air will be injected to confirm the location of the needle in the joint. After the needle location is confirmed with the dye/saline/air and imaging guidance, the medication will be injected-usually a combination of anti-inflammatory steroid and anesthetic.

Nerve Root Block - Segmental

A segmental nerve block is a minimally invasive procedure that can help relieve neck, arm, back, and leg pain/discomfort/numbness caused by inflammation in the spine. Common causes of inflammation may include the following: disc disease, a herniated (“blown”) disc, nerve irritations or spinal stenosis. A nerve block typically includes both a long-lasting corticosteroid and an anesthetic numbing agent; however, this procedure can be done with anesthetic only for diagnostic purposes only. Therapeutic nerve blocks allow the medication to be delivered to the area around the spinal nerve where it exits the spine (neural foramen). This injection can be helpful for patients who have a specific pain pattern along a certain dermatome with corresponding imaging findings.

For the Procedure > Nerve Root Block- Segmental:

For cervical nerve blocks, most patients will be positioned on their backs. Most other nerve blocks will be done with the patient lying on their abdomen. A tiny needle will numb the skin after being scrubbed with an agent such as Betadine or Hibiclens. Next, the spinal needle is placed to the side of the vertebra near the neural foramen, just above the opening for the nerve root and outside the epidural space. A small amount of dye/saline/air will be injected to confirm the location of the needle near the nerve. After the needle location is confirmed with the dye and imaging guidance, the medication will be injected – usually a combination of anti-inflammatory steroid and anesthetic. With this approach, the medication is typically a unilateral distribution- it is treating one specific nerve on one side. This procedure can be done on both sides, however with two injections. This injection approach may be used due to anatomical variances, for example, post-surgical changes.

Joint/Bursa Injection

A joint/bursa injection is a minimally invasive procedure that can treat pain related to inflammation in the joints and bursa. This pain can be related to etiologies such as arthritis or bursitis. Some common joints injected are the sacro-iliac joint, the glenohumeral joint (shoulder), the hip joint, the knee joint and into the feet and hands—just to name a few. Some common bursae injected are the greater trochanteric bursa (hip) and the subacromial bursa (shoulder). Injectates include anesthetic, steroid, Synvisc®, PRP (plasma rich protein)

For the Procedure > Joint Injection:

For injections into the joint or bursae such as shoulders, hips and knees the patient will be laying on their back. For injections such as the sacro-iliac joint the patient will be laying on their abdomen. A tiny needle will numb the skin after being scrubbed with an agent such as Betadine or Hibiclens. Next, the needle is placed into the inflamed joint/bursa. A small amount of dye/saline/air will be injected to confirm the location of the needle in the joint. After the needle location is confirmed with the dye and imaging guidance, the medication will be injected- usually a combination of anti-inflammatory steroid and anesthetic or Synvisc® or PRP (plasma rich protein).

Tendon Sheath/Ligament Injection

A tendon sheath or ligament injection is a minimally invasive procedure that can treat pain related to inflammation along or near a particular tendon or ligament. Two major problems associated with tendons include tendonitis and tenosynovitis. Tendonitis, inflammation of a tendon (the tough cords of tissue that connect muscles to bones) can affect any tendon. When the tendons become irritated, swelling, pain, and discomfort will occur. Tenosynovitis is the inflammation of the lining of the tendon sheaths which enclose the tendons. The tendon sheath is usually the site which becomes inflamed, but both the sheath and the tendon can become inflamed simultaneously. The cause of tenosynovitis is often unknown, but usually strain, overuse, injury, or excessive exercise may be implicated. Tendonitis may also be related to various medical conditions. One common cause of symptoms near a tendon sheath is tendonitis- inflammation of a tendon. Tendons are the tough cords of tissue that connect muscles to bones. Ligaments are soft tissue structures that connect bones to bones. The ligaments around a joint usually combine together to form a joint capsule. A joint capsule is a watertight sac that surrounds a joint and contains lubricating fluid called synovial fluid. When the tendons become irritated, swelling, pain, and discomfort will occur. One common tendon sheath injection is the posterior tibial tendon sheath (ankle region). Injectates include anesthetic, steroid, Synvisc®, PRP (plasma rich protein).

For the Procedure >Tendon Sheath/Ligament Injection:

For tendon sheath and ligament injections- the positioning depends much on the target location. However, the staff at Open Advanced MRI NW will ensure that you are positioned comfortably. A tiny needle will numb the skin after you have been scrubbed with an agent such as Betadine or Hibiclens. Next, the needle is placed into the region of the inflamed tendon sheath or ligament. A small amount of dye/saline/air will be injected to confirm the location of the needle in the target location. After the needle location is confirmed with the dye and imaging guidance, the medication will be injected- usually a combination of anti-inflammatory steroid and anesthetic or Synvisc® or PRP (plasma rich protein).

Test Blocks: Medial/Lateral Branch Blocks

A medial branch block is a minimally invasive procedure that can temporarily relieve neck or back pain caused by inflamed facet joints/sacroiliac joints- it is specifically targeting the tiny nerves that innervate (“make-up”) the facet/SI joint(s) and provide sensory information. These nerves are sensory nerves only.

Medial/lateral branch blocks are a diagnostic test, as well as temporarily therapeutic procedure. It is a “test” to confirm that the pain complaints are truly stemming from arthritis in your spine/pelvis, and if this can be verified then the patient can safely be offered a more “permanent” treatment called a rhizotomy/neurotomy. This is done by careful placement of the injectate, and assessing the patient’s complaints immediately post procedure. If the patient reports an 80% or more reduction in symptoms while in the office– the rhizotomy/neurotomy will be offered as a treatment option. The patient will be given a “pain diary” to track the symptoms for 6-8 hours, and once the “pain diary” is complete the patient is to return it back to our office to submit to the insurance company in order to obtain authorization.

For The Procedure > Medial Branch Block/Lateral Branch Block:

For cervical, thoracic, lumbar and sacroiliac test blocks the patient is positioned on their abdomen. A tiny needle will numb the skin after being scrubbed with an agent such as Betadine or Hibiclens. Next, the spinal needle is placed near the inflamed joint and near the region of the target nerve(s) – medial branches for facet joints, lateral branches for sacroiliac joints. Each spine/facet joint has two nerves to be treated, and each sacroiliac joint has three nerves to be treated. A small amount of dye/saline/air will be injected to confirm the location of the needle near the target nerves. After the needle location is confirmed with the dye/saline/air and imaging guidance, the medication will be injected- usually a combination of and anti-inflammatory steroid and strong anesthetic/numbing medication. The anesthetic/numbing medication is used as a “mimic” of the projected final results rhizotomy/neurotomy (after the healing process), to determine if you are a candidate for the next procedure- the rhizotomy/neurotomy. Patients must have an 80% reduction in symptoms post procedure in order to move forward with the next procedure.

Please note the test blocks are mainly for diagnostic purposes and to provide the medical necessity for insurance purposes. If the significant relief appreciated post procedure wears off after a short while this is not abnormal. The length of time the anesthetic is felt does NOT correlate with the expected response to the rhizotomy/neurotomy.

Rhizotomy/Neurotomy

Both rhizotomy and neurotomy are interchangeable terms – this procedure involves the elimination of the tiny nerves that innervate the facet joints and sacroiliac joints (sensory nerves). It is the more “permanent” version of the medial/lateral branch test blocks. It is a minimally invasive procedure in which the needle tip heats up and eliminates the nerves that generate the sensation of pain. This procedure can virtually eliminate the pain related to arthritis in the region discussed with you from about 6 months to 2 years.

For The Procedure > Rhizotomy/Neurotomy:

For cervical, thoracic, lumbar and sacroiliac rhizotomy/neurotomies the patient is positioned on their abdomen. A tiny needle will numb the skin after being scrubbed with an agent such as Betadine or Hibiclens. Each spine/facet joint has two nerves to be treated, and each sacroiliac joint has three nerves to be treated. Next, the specialized needle is placed near the inflamed joint(s) and near the region of the target nerve(s) – the same ones targeted during the “test blocks”. Once the needle is in position, the physician will do safety testing to verify the needle placement in conjunction with the images.

After the testing is completed, you will typically receive a combination of an anti-inflammatory steroid and strong anesthetic/numbing medication to alleviate some discomfort that may be associated with the procedure itself and any residual discomfort during the healing process. Once the anesthetic/numbing medication has started to work, the cauterization will begin. It typically is 80 seconds per location, up to twice per nerve in some patients. Once the first location is completed, the needle will be removed and the procedure will begin again at the second location, and then again at the subsequent locations in some patients.

Recovery After Your Procedure(s)/Discharge Instructions:

Similar to other interventional procedures, it is routine to follow-up with our office post neurotomy. Follow-up occurs at two weeks and six weeks in most cases. Again the follow-up typically is to assess the response to the procedure for treatment planning. See above for further details on follow-up questions.

Please note: Numbness from the procedure may last four to six hours. It is not abnormal after the numbing medications have worn off to have a return of regular symptoms and/or increased symptoms the night of the procedure for up to several weeks post neurotomy. Symptom relief post neurotomy can begin immediately in some cases. Most patients report a reduction of complaints beginning approximately two weeks post procedure, with a continued reduction in symptoms until approximately six weeks post procedure. Most patients appreciate maximum improvement at six weeks, and that level of improvement is often sustained for six to twenty-four months, or even longer in some cases.

Post Procedure:

  • Do not drive or operate heavy machinery for 24 hours
  • Do not engage in strenuous activity; rest/light activity recommended for 72 hours post procedure, with a gradual increase in activity as tolerated
  • Continue to follow any activity restrictions as directed by providers involved in care to include exercise, lifting/weight limits and the like
  • Resume all regular medications
  • Resume normal diet and fluids as tolerated
  • Avoid soaking the injection site for 48 hours (baths, hot tubs; showering is acceptable)
  • May remove bandages 48 hours after procedure
  • Any sign of infection/bleeding, call the office immediately
  • If needed may use ice 15-20 minutes 2-3 times a day

Please see above for anti-inflammatory steroid-related side effects. In some patients, a mixture containing a very small amount of anti-inflammatory steroid and a strong anesthetic may be injected immediately prior to cauterization to assist with post procedure discomfort. Due to the dose of steroid injected, most patients do not complain of side effects, however, if they should become an irritation, please contact the office

Most side effects will resolve typically three to four days post procedure. Please call if these symptoms or any other side effects are not improving and/or causing distress.

Please call the office and inform a staff member immediately (or call the provider if after hours) if any of these occur after a procedure:

  • If symptoms worsen and/or more medications are required to manage symptoms
  • If a change in bowel or bladder habits begins (incontinence specifically)
  • If any signs of infection are noted- such as fever, swelling, redness, etc
Discogram/Intradiscal Steroid Injections

A discogram is an enhanced x-ray examination of the intervertebral discs that involves a dye and antibiotics being injected into the center of the injured disc(s). This is done for several reasons- to determine the amount of structural damage to a disc – specifically the annulus (outer layer) and to confirm which disc is the cause of the current complaint, which is used for treatment planning. Normal discs, and even those which are severely degenerated do not usually cause pain.

An intradiscal steroid injection is a minimally invasive procedure that can help relieve neck, arm, back, and leg pain/discomfort/numbness caused by inflammation of the intervertebral discs. Common causes of inflammation may include the following: disc disease, a herniated (“blown”) disc, or an annular injury or “tear” in the annulus of the disc itself. An intradiscal steroid injection typically includes both a long-lasting corticosteroid and an anesthetic numbing agent mixed with antibiotics; however, this procedure can be done with anesthetic and antibiotics only for diagnostic purposes only.

For the Procedure > Discogram:

Some degree of discomfort is expected during the procedure.

For cervical intradiscal steroid injections, the patient is typically positioned on their back. For thoracic and lumbar transforaminal ESI’s the patient is positioned on their abdomen. A tiny needle will numb the skin after being scrubbed with an agent such as Betadine or Hibiclens. Next, a spinal needle is positioned into the disc(s) thought to be causing pain as well as a “control level(s)” under imaging guidance. Contrast/antibiotic mix is then injected into the disc(s) and x-rays are taken. During and immediately following the procedure, the patient is asked several questions. The typical questions are similar to the following: “Are you having symptoms during the injection? Pain or pressure? If pain, are the symptoms you feel currently familiar– meaning does it feel like your normal complaint(s).” This information is included in the procedure report to help with treatment planning. After the procedure, a CT or MRI may take place for additional diagnostic data.

For the Procedure > Intradiscal Steroid Injection

For cervical intradiscal steroid injections, the patient is typically positioned on their back. For thoracic and lumbar intradiscal steroid injections the patient is positioned on their abdomen. A tiny needle will numb the skin after being scrubbed with an agent such as Betadine or Hibiclens. Next, the spinal needle is placed in the center of the intervertebral disc. A small amount of dye/saline/air will be injected to confirm the location of the needle in the intervertebral disc. After the needle location is confirmed with the dye/saline/air and imaging guidance, the medication will be injected- usually a combination of anti-inflammatory steroid, anesthetic, and antibiotics.

Recovery After Your Discogram/Intradiscal Steroid Injection

Similar to other interventional procedures, it is routine to follow-up with our office after both intradiscal steroid injections and discograms. As intradiscal steroid injections are therapeutic, the follow-up typically is to assess the response to the procedure for treatment planning one to two weeks post injection. See above for further details on follow-up questions. Discograms are diagnostic, and the follow-up is typically one to two weeks post-procedure to assess for post-procedure complications such as infection. Due to the poor blood supply to intervertebral discs, the risk for infection post intradiscal steroid injection/discography is slightly higher than that of other interventions. Extra precautions are taken to include injection of prophylactic antibiotics with the diagnostic/therapeutic medications into the disc(s).

Intradiscal Steroid Injection: Please note: Numbness from the procedure may last four to six hours. It is not abnormal after the numbing medications have worn off to have a return of regular symptoms and/or increased symptoms the night of the procedure for up to several days after. Benefits of the steroid typically occur within three days; however, it can take up to five and even seven days.

Discogram: Please note: Numbness from the procedure may last four to six hours. In some cases, patients report symptoms worse than baseline. If symptoms do increase, and if they do not trend towards improvement or signs of infection are becoming apparent please call the office immediately.

Post Procedure (Intradiscal Steroid Injection and Discogram):

  • Do not drive or operate heavy machinery for 24 hours
  • Do not engage in strenuous activity; rest/light activity recommended for 1-72 hours post procedure
  • Continue to follow any activity restrictions as directed by providers involved in care to include exercise, lifting/weight limits and the like
  • Resume all regular medications
  • Resume normal diet and fluids as tolerated
  • Avoid soaking the injection site for 24-48 hours (baths, hot tubs; showering is acceptable)
  • May remove bandages 24 hours after procedure
  • Any sign of infection/bleeding, call the office immediately
  • If needed may use ice 15-20 minutes 2-3 times a day

Side Effects of Anti-Inflammatory Steroid (Intradiscal Steroid Injection). Most commonly reported:

  • Headaches
  • Heart palpitations
  • Insomnia
  • Hot flashes

Less commonly reported:

  • Hiccups, increased heart rate and fluid retention

Most side effects will resolve typically three to four days post procedure. Please call if these symptoms or any other side effects are not improving and/or causing distress.

Please call the office and inform a staff member immediately (or call the provider if after hours) if any of these occur after a procedure:

  • If symptoms worsen and/or more medications are required to manage symptoms
  • If a change in bowel or bladder habits begins (incontinence specifically)
  • If any signs of infection are noted- such as fever, swelling, redness, etc.

Please keep track of therapeutic procedure response (intradiscal steroid injection) to discuss with our staff upon the return visit. Please see above for sample follow-up questions.

Myelogram/Spinal Puncture

Myleography is an examination of the spinal cord and/or nerves, which involves injecting contrast into the spinal canal, followed by x-rays and possibly a CT. They are usually performed to evaluate for: disc herniation, stenosis, arachnoiditis, ruptured discs and bone spurs.

A spinal puncture/”spinal tap” is when the thecal sac (the lining of the canal) is pierced with a very tiny needle to obtain spinal fluid. After the fluid is obtained, it is typically sent off to pathology for testing.

Preparation For The Procedure:

In addition to the preparations indicated in the “Pre-Exam Preparation”, please drink plenty of fluids (water and juices, not soda), one day prior to, the day of and the day after the exam. This will help eliminate the contrast from your body.

For The Procedure > Myelogram/Spinal Puncture:

For cervical, thoracic and lumbar myelograms the patient is positioned on their abdomen. A tiny needle will numb the skin after being scrubbed with an agent such as Betadine or Hibiclens. Next, the spinal needle is placed between the lamina of two vertebrae almost directly in the middle of the target location- in most cases the lumbar spine. A small amount of dye/saline/air will be injected into the spinal canal to confirm the location of the needle. After the needle location is confirmed with the dye/saline/air and imaging guidance, more contrast is injected and then the table and patient are rotated to distribute the contrast evenly in the canal. In most cases, the injection is typically followed by x-rays and/or a CT exam. Myelograms are for diagnostic purposes.

Spinal Puncture – The procedure is same as above until the small amount of dye/saline/air is injected into the spinal canal to confirm the location of the needle. Once the needle location is confirmed, no more fluid is injected. Instead, the physician will draw out cerebral spinal fluid and collect in several vials to send off to pathology for testing.

Recovery After Myelogram/Spinal Puncture/Discharge Instructions:

After the procedure, patients are to remain flat for 48 hours after.

Driver mandatory for this procedure — for the ride home patients must be flat.

Recommend refraining from being more than 30 degrees upright.

  • Only to get up to use the bathroom.
  • Food and water should be brought to the bedside.
  • Make sure to drink plenty of fluids to help flush the contrast from the body.
  • Avoid alcohol for at least 24 hours after the procedure.
  • The contrast is absorbed by the body and excreted from the urine as a clear substance within 24 hours.
  • A headache may occur post procedure.
  • The headache is positional- meaning it occurs when upright, and alleviates itself when lying down.
  • If patients remain laying down for the time recommended, the headache will most likely not occur.
  • If the headache persists, please call the office for further management options to include a possible epidural blood patch.

Please call the office and inform a staff member immediately (or call the provider if after hours) if any of these occur after a procedure:

  • If symptoms worsen and/or more medications are required to manage symptoms
  • If a change in bowel or bladder habits begins (incontinence specifically)
  • If any signs of infection are noted- such as fever, swelling, redness, etc
Arthrography

Arthrography is an imaging study designed to evaluate a specific body region- usually a joint. Dye will be injected directly into the joint to better evaluate for abnormalities.

A common example for both shoulders/hips: arthrograms are useful in determining if a labral tear is present due to the fluid injected distending the joint capsule slightly.

There are several different types- x-ray arthrography, CT arthrography or MRI arthrography. The type of arthrogram depends on the type requested by the referring provider. Before or after the exam you may undergo x-rays or a CT, and after the exam, you may also get x-rays, CT or MRI to evaluate the now distended joint.

Arthrograms can be strictly diagnostic or they can be a diagnostic/therapeutic combination- usually a combination of dye, anesthetic, and anti-inflammatory steroid.

For procedure specifics on positioning and what to expect please see above section on “Joint/Bursa Injection”.

Specialty Procedures

In addition to the above-listed procedures, Open Advanced MRI Northwest also offers advanced specialty procedures such as bone and soft tissue biopsies. Please contact our office for specifics.

Biopsy

A biopsy is a sample of tissue taken from the body in order to examine it more closely. Usually, a biopsy is recommended after an abnormal physical exam, abnormal lab work and/or abnormal imaging. Biopsies here are done under imaging guidance, most commonly CT, MRI, and ultrasound. Most common biopsies include MRI-guided breast biopsies, CT-guided bone, liver, pancreas or kidney biopsies as well as either CT or ultrasound-guided thyroid biopsies.

For The Procedure > Biopsy

The area to be biopsied is what will determine what modality will be used, and patient positioning. Some patients will have an IV started and certain medications may be used to help highlight the region of interest. Once the modality has been decided, a tiny needle will numb the skin after being scrubbed with an agent such as Betadine or Hibiclens. Next, the biopsy tool will be positioned into the tissue to be desired, confirmed with imaging guidance. The sample(s) will be obtained and sent to pathology. Once the biopsy tool is removed, a bandage is placed over the area. Once the patient is assessed and determined to be stable, the patient will be sent home. Patients are asked to return to the clinic in one week for a review of results.

Recovery After Biopsy/Discharge Instructions:

Post Procedure

  • After a biopsy, some site soreness may be present for several days.
  • Do not drive or operate heavy machinery for 24 hours (if sedated)
  • Do not engage in strenuous activity; rest/light activity recommended for 1-48 hours post procedure
  • Continue to follow any activity restrictions as directed by providers involved in care to include exercise, lifting/weight limits and the like
  • Resume all regular medications
  • Resume normal diet and fluids as tolerated
  • Avoid soaking the injection site for 24-48 hours (baths, hot tubs; showering is acceptable)
  • May remove bandages 24 hours after procedure
  • Any sign of infection/bleeding, call the office immediately
  • If needed may use ice 15-20 minutes 2-3 times a day

Please call the office and inform a staff member immediately (or call the provider if after hours) if any of these occur after a procedure:

  • If symptoms worsen and/or more medications are required to manage symptoms
  • If a change in bowel or bladder habits begins (incontinence specifically)
  • If any signs of infection are noted- such as fever, swelling, redness, etc

Patient Education

In the (normal) spine there are several parts divided into 4 major sections: the cervical, the thoracic and the lumbar spine. Each section is made up of individual bones called vertebrae. There are 7 cervical vertebrae, 12 thoracic vertebrae, and 5 lumbar vertebrae. Below the lumbar segment is the sacrum, a part of the pelvis. It is a large triangular bone inserted like a wedge between the two hip bones. The sacrum is made of 5 bones that are eventually fused, and connect to the coccyx (tailbone).

The spine is made up of 24 small bones, called vertebrae. The vertebrae protect and support the spinal cord. They also bear the majority of the weight put on your spine.

*The vertebral body is the large, round portion of bone. Each vertebra is attached to a bony ring. When the vertebrae are stacked on top of one another, the rings create a hollow tube (spinal canal) for the spinal cord to pass through. Each vertebra is held to the others by groups of ligaments. Ligaments connect bones to bones; tendons connect muscles to bones. There are also tendons that fasten muscles to the vertebrae. * The bony ring attached to the vertebral body consists of several parts. The lamina extends from the body to cover the spinal canal, which is the hole in the center of the vertebra. The spinous process is the bony portion opposite the body of the vertebra. You feel this part if you run your hand down a person’s back. There are two transverse processes (little bony bumps), where the back muscles attach to the vertebrae. The pedicle is a bony projection that connects the lamina to the vertebral body. *Between each vertebra is a soft, gel-like cushion, called an intervertebral disc. These flat, round “cushions” act like shock absorbers by helping absorb pressure.

*The spinal column also has joints (just like the knee, elbow, etc.) called facet joints. The facet joints link the vertebrae together and give them the flexibility to move against each other. The facets are the “bony knobs” that meet between each vertebra. There are two facet joints between each pair of vertebrae, one on each side. The facet joints give the spine its flexibility.

*The spinal cord branches off into 31 pairs of nerve roots, which exit the spine through small openings on each side of the vertebra called neural foramina. The two nerve roots in each pair go in opposite directions when traveling through the foramina. These nerves are what transmit signals in your body. The nerve roots that come out of the lumbar spine form the nerves that go to the lower limbs and pelvis. The thoracic spine nerves go to the abdomen and chest. The nerves coming out of the cervical spine go to the neck, shoulders, arms, and hands.

*The spinal cord is a column of millions of nerve fibers that carries messages from your brain to the rest of your body. It extends from the brain to the area between approximately L1 and L2- below this level, the spinal canal contains a group of nerve fibers, called the caude equina. Each vertebra has a hole in the center, so when they stack on top of each other they form a hollow tube (spinal canal) that holds and protects the entire spinal cord and its nerve roots, just like your skull protects your brain.

Conditions

Degenerative Disc Disease

Not actually a disease, degenerative disc disease refers to a condition in which pain is caused due to a damaged disc. A wide range of symptoms and severity is associated with this condition. It can be caused due to an acute injury, or chronic. This can occur in the cervical, thoracic and lumbar spine.

Herniated Disc

A condition in which the disc contents, specifically the inner nucleus, push through the outer edge of the disc and towards the spinal canal, putting pressure on the very sensitive spinal nerves. People commonly call this a “ruptured disc”, “slipped disc” or “bulging disc”. This can occur in the cervical, thoracic and lumbar spine. Herniations typically go backward and to the sides, but not in every case.

Spinal Stenosis/Foraminal Stenosis

Spinal stenosis is a narrowing of spaces in the spine that results in pressure on the spinal cord and/or nerve roots. This disorder usually involves the narrowing of one or more of three areas of the spine: (1) the central through which the spinal cord and nerve roots run, (2) the canals at the base or roots of nerves branching out from the spinal cord, or (3) the openings between the neural foramen (where the nerves exit). Spinal stenosis can cause radicular symptoms to the extremities, and even affect bowel/bladder function if severe enough. Spinal stenosis is typically either congenital or gradual if other conditions are occurring in the spine (disc disease/herniations, bone spurs, etc).

Compression Fracture

A compression fracture is a fracture of a vertebral body, where the bone is literally compressed and causing pain. Compression fractures can be related to trauma, or conditions such as osteoporosis, or other conditions.

Arthritis

Arthritis is inflammation of a joint. There are over 100 different types of arthritis to include osteoarthritis and rheumatoid arthritis. Arthritis also involves the breakdown of cartilage. Cartilage normally protects a joint, allowing it to move smoothly. Cartilage also acts as a shock absorber. Without the normal amount of cartilage, the bones can rub together, causing pain, swelling (inflammation) and stiffness. We commonly treat pain related to facet and sacroiliac joint arthritis with anti-inflammatory steroid or rhizotomy/neurotomy. For arthritis in other joints, we can also do injections of anti-inflammatory steroid. For pain related to osteoarthritis in the knee specifically, we offer an injection called Synvisc, which acts a lubricant for the joint.

Spondylosis

Spondylosis is a degenerative disorder that may cause loss of normal spinal structure and function. It can affect the discs, the joints, the ligaments and the connective tissue. This can make your body have to absorb mechanical stresses differently. As a result, bone spurs can develop.

Spondylolysis

Spondylolysis is a defect of a vertebra. More specifically it is defined as a defect or “fracture” in the pars interarticularis of the vertebral arch—also known as a pars defect.

Spondylolisthesis

Spondylolisthesis is a medical condition wherein one of the vertebras of the patient’s spine shifts forward or backward in regards with the adjoining vertebras. This can be related to spondylolysis. This displacement can be of a single vertebra or the whole vertebral column. As the spine moves, it can irritate the disc and nerves.

Radiculopathy

A term that is typically used to describe pain, tingling, weakness or numbness that radiates from the spine and into an extremity. It is typically caused by a nerve irritation related to a disc problem or abnormality.

The symptoms associated with radiculopathy follow, in most cases, what is known as a dermatomal pattern. Specific regions of the skin known as dermatomes are associated with particular nerve roots. When symptoms flare up in a particular dermatome as a result of problems with the nerve/nerve roots, it can usually be traced back to the area of the spine involved.

Dermatomes are affected by nerves in two different ways: sensory—felt sensation and motor—the ability to move.

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9370 SW Greenburg Road
Portland, OR 97223
Phone: (503) 246-6666
Fax: (503) 246-9465
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1026 NW Sleret Ave
Gresham, OR 97030
Phone: (503) 489-1674
Fax: (503) 489-1678
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221 NE 104th Ave
Vancouver, WA 98664
Phone: (360) 253-2525
Fax: (360) 253-3611
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