Spine Pain Management, Lower Back Pain, Sciatic Nerve Pain Treatment, Metro Spine and Rehab Kansas City http://www.metrospine.com Fri, 01 Jul 2011 15:35:31 +0000 http://wordpress.org/?v=2.9.2 en hourly 1 Welcome http://www.metrospine.com/blog/welcome/ http://www.metrospine.com/blog/welcome/#comments Wed, 14 Apr 2010 14:07:45 +0000 admin http://www.metrospine.com/?p=199 Welcome to our new Metrospine blog. Please keep checking back for regular blog postings.  Our skilled professionals will provide back and neck pain management and non-surgical treatments.   Remember to contact MetroSpine if you’re experiencing any back or neck pain.   Thank you!

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Diagnostic Testing http://www.metrospine.com/articles/diagnostic-testing/ http://www.metrospine.com/articles/diagnostic-testing/#comments Sat, 09 Jan 2010 19:29:00 +0000 admin http://www.panasall.com/webtest/metrospine/?p=102

Plain Radiographs (X-Rays)

The main purpose of plain x-rays is to detect serious underlying
structural and/or pathologic conditions. The typical types of x-rays
we order are AP, lateral, flexion/extension, and outlet films to
help us determine if there is degenerative arthritis, a fracture,
malalignment or motion between vertebral levels (instability).




Bone Scan

Bone scans are rarely needed to evaluate acute low back pain. They
can be helpful in cases where a tumor, infection, fracture, or CRPS
is suspected. A positive bone scan finding should generally be
followed by confirmatory imaging such as MRI or CT, which help
provide better anatomic detail of the spine.




Magnetic Resonance Imaging (MRI)

MRI has demonstrated excellent sensitivity in diagnosing lumbar
disc herniation and is considered the imaging study of choice. The
specific indications for a patient to have an immediate MRI include
progressive neurological deficits, bowel/bladder dysfunction and
patients with a possible malignancy or inflammatory condition.
MRI may be helpful in patients with neurogenic claudication due
to suspected central or foraminal stenosis. MRI’s can also be useful
to help determine the level of pathology in patients when physical
examination and electrodiagnostic findings are otherwise not
definitive. Some clinicians reserve MRI for those patients not
responding to treatment as expected.




Computer Tomography (CT)

CT imaging of the lumbar spine provides superior anatomic imaging
of the bones in the spine and good resolution for disc herniation.
It is less sensitivity for detecting disc herniation when used
without myelography than an MRI. CT imaging is best used when
there is a suspected fracture or tumor, but can also be used to
detect a disc injury in patients who cannot undergo MRI scanning.

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Electrodiagnostic Study (EMG/NCS) http://www.metrospine.com/articles/electrodiagnostic-studynerve-conduction-study-emgncs/ http://www.metrospine.com/articles/electrodiagnostic-studynerve-conduction-study-emgncs/#comments Mon, 28 Dec 2009 23:24:29 +0000 admin http://www.panasall.com/webtest/metrospine/?p=88 The EMG / Nerve Conduction Study is a useful test to study the nerves in the arms and legs. The test will determine whether or not you have a pinched nerve in the back, neck, or extremities. This is a very useful test if your doctor wants to confirm that you have a carpal tunnel syndrome, a peripheral neuropathy, or other nerve entrapment syndromes. The EMG/Nerve Conduction study is a minimally-invasive test and should not cause you any significant discomfort.

The EMG / NCS can provide the following information:

  • Presence of a nerve injury
  • Age of the nerve injury (acute vs. chronic process)
  • Area of the nerve injury (proximal vs. distal)
  • Severity of the nerve injury
  • Whether the nerve is healing


This test is often correlated with MRIs and physical exam to evaluate whether a condition may require surgery.

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Epidural Steroid Injection http://www.metrospine.com/articles/epidural-steroid-injection/ http://www.metrospine.com/articles/epidural-steroid-injection/#comments Mon, 28 Dec 2009 23:22:40 +0000 admin http://www.panasall.com/webtest/metrospine/?p=86 Epidural steroid injection is the placement of cortisone, a powerful anti-inflammatory agent, into the epidural space, which lies next to the disc and spinal cord. The epidural steroid injection has been used for over 40 years as treatment for back pain. It involves using either steroids or anesthetic agents allowing good benefits with minimal risk factors. The main goal of the epidural injection is to shrink the swelling in bulging or herniated discs, and to decrease any inflammation that surrounds the disc and nerve root.

Because of the low risk and low incidence of any significant side effects, this is felt to be a reasonable procedure to follow when traditional conservative therapy for disc pain has failed to provide improvement. A large percentage (60-90%) of patients upon whom this procedure is performed will get significant improvement of symptoms; a small percentage may experience no real improvement at all. It is generally an accepted practice that this procedure be repeated up to three times within a year, although in some cases, additional injections may be administered. Injections may be given as a single dose, or given every two weeks up to three injections or until symptoms are gone. If no improvement is seen after two injections, then addition treatments may be considered.

Side effects and adverse reactions are rare. Some of these potential (uncommon) side effects include fluid retention. The most common side effect is local tenderness around the injection site. We ask that you rest the day of your injection and ice the area 20 minutes every hour for the first day. Other risks involve infections and bleeding. We cannot inject you if you are on antibiotics, have an infection or are running a fever. You should be afebrile for 48 hours after completing your antibiotics before we can proceed with your injection. You cannot receive an injection if you have been on aspirin or other blood thinners. You must be off of blood thinners 7 days before we can inject you. If your doctor has put you on these medications, then we must get approval in writing before we can proceed. If you are on Coumadin, then we must get written approval from your doctor and have your PT/ INR normal before we can inject you. An additional risk is the possibility that the epidural needle may nick the dura (the covering of the spinal cord). Should this occur, there could be leakage of cerebrospinal fluid, which could cause a severe “spinal headache.” If this should happen, bed rest and an increase in fluid and caffeine intake frequently will alleviate the headache completely. Should this not resolve the problem, it could be necessary to do what is called a “blood patch”, in which (under sterile conditions) blood is removed from a vein in the arm and placed into the same epidural space. This completely resolves symptoms of the headache. The incidence of a spinal headache is approximately 1 in 1,000. Other rare, but serious side effects may include: worsening of symptoms, allergies from the dye that we use, bleeding, infection or epidural abscess, backache, steroid side effects, bowel or bladder dysfunction, hematoma, cord compression, avascular necrosis, paralysis, neurological damage or impairment, or death. In order to avoid these complications, the procedure is done under strict sterile conditions, utilizing fluoroscopy to localize the epidural space and guide the needle.

If there is improvement from the steroid epidural, it likely will occur over the next several days to two weeks. The improvement should not be expected immediately. Patients are advised to rest on the day of the epidural, although bed rest is not required. By the next day, previous activities can be resumed. An occasional patient will feel such significant relief that they are tempted to resume various strenuous activities. They are cautioned not to do this, however. It is generally advised to pursue a course of gradual increase in activity, often coordinated with physical therapy or other training once the injections have been completed.

Patients are usually seen 14 days following the procedure for a follow-up exam, to evaluate their response to the steroid epidural(s) and to discuss if further injections are necessary.

If you have worsening in your symptoms; increase numbness in your extremity, fever, severe headache, or bowel or bladder incontinence, please call your physician immediately.

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Facet Injections http://www.metrospine.com/articles/facet-injections/ http://www.metrospine.com/articles/facet-injections/#comments Mon, 28 Dec 2009 23:21:20 +0000 admin http://www.panasall.com/webtest/metrospine/?p=84 What is a Facet Joint Injection?
A facet joint injection is an injection of an anesthetic with a long lasting steroid (“cortisone”) in the facet joints. Facet joints are located in the back and neck at each vertebral level. They are paired (right and left) and are surrounded by a joint capsule like the finger joints.

What is the purpose of it?
The steroid injected reduces the inflammation in the joint space. This can reduce pain, and other symptoms caused by inflammation such as nerve irritation and joint inflammation. This type of pain is usually associated with mechanical back pain.

How long does the injection take?
The actual injection takes approximately 10 minutes.

What is actually injected?
The injection consists of a mixture of local anesthetic (like lidocaine) and the steroid medication. Many times prior to injecting the medicine, a small volume of contrast dye is used to confirm proper needle placement.

Will the injection(s) hurt?
This procedure is done under local anesthesia. You may feel a “bee sting” when the local anesthetic is injected. After you are numb, you may feel a slight pressure when we inject the medication.

How is the injection performed?
It is done with the patient lying on the stomach with fluoroscopic (x-ray) guidance. The skin in the back is cleaned with antiseptic solution and then the injection is carried out. After the injection, you are returned to your room and monitored for 15-20 minutes before you are released with someone to drive you home.

What should I expect after the injection?
Immediately after the injection, you may feel that your pain may be gone or quite less. This is due to the local anesthetic injected. This will last for a few hours. Your pain may return and you may have a sore back for a day or two. Icing will reduce this. This is due to the mechanical process of needle insertion as well as initial irritation from the steroid itself. You should start noticing pain relief starting the 3rd to 7th day.

What should I do after the procedure?
You must have a ride home. We advise patients to take it easy for the day of the procedure. You should apply ice to the injection site 20 minutes every hour on the day of your injection. After the first day, you can perform activity as tolerated.

Can I go to work the next day?
Yes. Unless there are complications, you should be able to return to your work the next day. The most common thing you may feel is soreness in the back.

How long will the effects of the medication last?
The immediate effect is usually from the local anesthetic injected. This wears off in a few hours. The cortisone starts working in about 3 to 7 days and its effect can last for several days to many months.

How many injections do I need to have?
If the first injection does not relieve your symptoms in one to two weeks, you may be recommended to have one more injection. If you respond to the injections and still have residual pain, you may be recommended for a third injection, or a different procedure.

Can I have more than three injections?
In a twelve-month period, we generally do not perform more than three injections. Giving more than three injections will increase the likelihood of side effects from cortisone. Also, if three injections with fluoroscopic guidance have not helped you much, it is very unlikely that you will get any further benefit from additional injections.

What are the risks and side effects?
This procedure is safe when performed in a controlled setting (surgical center sterile equipment, and the use of x-ray.) However, with any procedure there are risks, side effects, and possibility of complications. The most common side effect is local tenderness – which is temporary. The other risks involve, infection, bleeding, worsening of symptoms. As with other types of injections, you should not have the procedure if you are currently taking blood-thinning medicine (Aspirin or Coumadin.) Side effects related to cortisone include: fluid retention, weight gain, increased blood sugar (mainly in diabetics,) elevated blood pressure, mood swings, irritability, insomnia, and suppression of body’s own natural production of cortisone. Fortunately, the serious side effects and complications are uncommon, but include nerve damage, coma, and death. You should discuss any specific concerns with your physician.

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Medications http://www.metrospine.com/articles/medications/ http://www.metrospine.com/articles/medications/#comments Mon, 28 Dec 2009 19:23:04 +0000 admin http://www.panasall.com/webtest/metrospine/?p=82 Medications can be very helpful in the initial treatment of musculoskeletal pain. These types of medications are often utilized in treating both acute and chronic pain. They can be used in combination or by themselves.

Anti-inflammatory Medications: These help to decrease the swelling and inflammation in the spine. They also promote healing.

Muscle Relaxants: These help the muscles to relax and also decrease muscle tension and spasm.

Analgesic Medications/Narcotic Medications: These are used primarily for acute pain.

The treatment of chronic back pain also utilizes some of the above classifications of medications, as well as longer acting analgesics. Often, antidepressant medications are used in small doses to increase the pain threshold, and restore sleep disturbances that are a result of severe pain.

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Physical Therapy http://www.metrospine.com/articles/physical-therapy/ http://www.metrospine.com/articles/physical-therapy/#comments Mon, 28 Dec 2009 19:21:11 +0000 admin http://www.panasall.com/webtest/metrospine/?p=77 Physical Therapy is an important component in the treatment and prevention of musculoskeletal disorders. The initial treatment ranges from passive modalities such as ultrasound, back school, and spinal rehabilitation. The second phase focuses on flexibility and strengthening, conditioning exercises, and muscle endurance training. Dr. Galate will design a physical therapy program specific for your injury, and incorporate the treatment with other non-operative measures such as injections or medications.

Therapy may include:

  • Modalities, such as ultrasound or electrical stimulation
  • Exercise programs for spine strengthening and flexibility
  • Spine stabilization programs with the therapist
  • Work Conditioning
  • Work Hardening
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Sacral Iliac Joint Injection (SI) http://www.metrospine.com/articles/sacral-iliac-joint-injection-si/ http://www.metrospine.com/articles/sacral-iliac-joint-injection-si/#comments Mon, 28 Dec 2009 19:19:36 +0000 admin http://www.panasall.com/webtest/metrospine/?p=75 What is an SI Injection?
An SI injection is an injection of an anesthetic with a long lasting steroid (“cortisone”) into the SI joints. SI joints are located between the small of your back and the hips. They are paired (right and left) and are surrounded by a joint capsule like the finger joints. There is approximately 3° of motion in these joints. They usually get inflamed by trauma; i.e. a fall, or motor vehicle accident, or by altered gait.

What is the purpose of it?
The steroid injected reduces the inflammation in the joint space. This can reduce pain, and other symptoms caused by inflammation such as nerve irritation.

How long does the injection take?
The actual injection takes only approximately 10 minutes.

What is actually injected?
The injection consists of a mixture of local anesthetic (like lidocaine) and the steroid medication. Prior to injecting the medicine, a small volume of contrast dye is used to confirm proper needle placement.

Will the injection hurt?
This procedure is done under local anesthesia. You may feel a ‘bee sting’ when the local anesthetic is injected. After you are numb, you may feel a slight pressure when we inject the medication.

How is the injection performed?
It is done with the patient lying on the stomach with fluoroscopic (x-ray) guidance. The skin in the back is cleaned with antiseptic solution and then the injection is carried out. After the injection, you are returned to your room and monitored for 15-20 minutes before you are released with someone to drive you home.

What should I expect after the injection?
Immediately after the injection, you may feel that your pain may be gone or quite less. This is due to the local anesthetic injected. This will last for a few hours. Your pain may return and you may have a sore back for a day or two. Icing will reduce this. This is due to the mechanical process of needle insertion as well as initial irritation from the steroid itself. You should start noticing pain relief starting the 3rd to 7th day.

What should I do after the procedure?
You must have a ride home. We advise patients to take it easy for the day of the procedure. You should apply ice to the injection site 20 minutes every hour on the day of your injection. After the first day, you can perform activity as tolerated.

Can I go to work the next day?
Yes. Unless there are complications, you should be able to return to your work the next day. The most common thing you may feel is soreness in your back.

How long will the effects of the medication last?
The immediate effect is usually from the local anesthetic injected. This wears off in a few hours. The cortisone starts working in about 3 to 7 days and its effect can last for several days to many months.

How many injections do I need to have?
If the first injection does not relieve your symptoms in one to two weeks, you may be recommended to have one more injection. If you respond to the injections and still have residual pain, you may be recommended for a third injection, or a different procedure.

Can I have more than three injections?
In a twelve-month period, we generally do not perform more than three injections. Giving more than three injections will increase the likelihood of side effects from cortisone. Also, if three injections with fluoroscopic guidance have not helped you much, it is very unlikely that you will get any further benefit from additional injections.

What are the risks and side effects?
This procedure is safe when performed in a controlled setting (surgical center sterile equipment, and the use of x-ray.) However, with any procedure there are risks, side effects, and possibility of complications. The most common side effect is local tenderness – which is temporary. The other risks involve, infection, bleeding, worsening of symptoms. As with other types of injections, you should not have the procedure if you are currently taking blood-thinning medicine (Aspirin or Coumadin.) Side effects related to cortisone include: fluid retention, weight gain, increased blood sugar (mainly in diabetics,) elevated blood pressure, mood swings, irritability, insomnia, and suppression of body’s own natural production of cortisone. Fortunately, the serious side effects and complications are uncommon, but include nerve damage, coma, and death. You should discuss any specific concerns with your physician.

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Selective Nerve Root Injections http://www.metrospine.com/articles/selective-nerve-root-injections/ http://www.metrospine.com/articles/selective-nerve-root-injections/#comments Mon, 28 Dec 2009 18:48:40 +0000 admin http://www.panasall.com/webtest/metrospine/?p=72 What is a Selective Nerve Root Injection (SNRI)?
A Selective Nerve Root Injection is a more precise injection done under fluoroscopic guidance (X-Ray) using anesthetic with a long lasting steroid (“cortisone”) around the nerve root as it exits the spinal column. This injection is sometimes referred to as a transforaminal injection.

What is the purpose of it?
This injection is used as a diagnostic as well as a therapeutic injection. It helps us determine if the nerve is irritated by “numbing” the nerve. The steroid will therapeutically reduce the inflammation and pain caused by pressure on the nerve.

How long does the injection take?
The actual injection takes only approximately 10 minutes.

What is actually injected?
The injection consists of a mixture of local anesthetic (like lidocaine) and the steroid medication. Prior to injecting the medicine, a small volume of contrast dye is used to confirm proper needle placement.

Will the injection hurt?
This procedure is done under local anesthesia. You may feel a “bee sting” when the local anesthetic is injected. After you are numb, you may feel a slight pressure when we inject the medication.

How is the injection performed?
It is done with the patient lying on the stomach with fluoroscopic (x-ray) guidance. The skin in the back is cleaned with antiseptic solution and then the injection is carried out. After the injection, you are returned to your room and monitored for 15-20 minutes before you are released with someone to drive you home.

What should I expect after the injection?
Immediately after the injection, you may feel that your pain may be gone or quite less. This is due to the local anesthetic injected. This will last for a few hours. Your pain may return and you may have a sore back for a day or two. Icing will reduce this. This is due to the mechanical process of needle insertion as well as initial irritation from the steroid itself. You should start noticing pain relief starting the 3rd to 7th day.

What should I do after the procedure?
You must have a ride home. We advise patients to take it easy for the day of the procedure. You should apply ice to the injection site 20 minutes every hour on the day of your injection. After the first day, you can perform activity as tolerated.

Can I go to work the next day?
Yes. Unless there are complications, you should be able to return to your work the next day. The most common thing you may feel is soreness in your back.

How long will the effects of the medication last?
The immediate effect is usually from the local anesthetic injected. This wears off in a few hours. The cortisone starts working in about 3 to 7 days and its effect can last for several days to many months.

How many injections do I need to have?
If the first injection does not relieve your symptoms in one to two weeks, you may be recommended to have one more injection. If you respond to the injections and still have residual pain, you may be recommended for a third injection, or a different procedure.

Can I have more than three injections?
In a twelve-month period, we generally do not perform more than three injections. Giving more than three injections will increase the likelihood of side effects from cortisone. Also, if three injections with fluoroscopic guidance have not helped you much, it is very unlikely that you will get any further benefit from additional injections.

What are the risks and side effects?
This procedure is safe when performed in a controlled setting (surgical center sterile equipment, and the use of x-ray.) However, with any procedure there are risks, side effects, and possibility of complications. The most common side effect is local tenderness – which is temporary. The other risks involve, infection, bleeding, worsening of symptoms. As with other types of injections, you should not have the procedure if you are currently taking blood-thinning medicine (Aspirin or Coumadin.) Side effects related to cortisone include: fluid retention, weight gain, increased blood sugar (mainly in diabetics,) elevated blood pressure, mood swings, irritability, insomnia, and suppression of body’s own natural production of cortisone. Fortunately, the serious side effects and complications are uncommon, but include nerve damage, coma, and death. You should discuss any specific concerns with your physician.

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Trigger Point Injection http://www.metrospine.com/articles/trigger-point-injection/ http://www.metrospine.com/articles/trigger-point-injection/#comments Mon, 28 Dec 2009 18:38:24 +0000 admin http://www.panasall.com/webtest/metrospine/?p=65 Trigger points are “knotty” areas or bands in muscle tissue. Trigger points are commonly seen in “Myofascial Pain Syndrome.”


Trigger Point Injections (TPI) are sometimes given for neck pain, headaches, and low back pain to treat muscle spasm and other soft tissue problems. Typically a low dose of anesthetic medication is injected into the trigger point(s) after careful examination. This is a simple “in office procedure” and can give excellent relief for headaches of myofascial origin and soft tissue damage.


A mixture of lidocaine, marcaine, and steroid is often used to inject into the muscle trigger point, which helps to relieve muscle spasm. Often, the patient is sent to physical therapy afterwards to be stretch out while the muscle is anesthetized.


Trigger Point Injections are not painful, and may be repeated on an occasional basis. The mechanism of action is by reducing the focal point of the muscle spasm. TPI are useful in the following situations:


  • Muscle spasm in the back or neck
  • Headaches associated with neck pain
  • Focal areas of muscle hyperactivity
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