We have the ultimate expertise performing delicate interventional cervical, lumbar and thoracic spinal procedures, joint injections and nerve blocks. Please read below all the services we offer to our Portland and Vancouver patients.
Vertebral augmentation (vertebroplasty)
Recommended as a non-surgical treatment of a fractured spine, vertebral augmentation or vertebroplasty utilizes specialized bone cement to stabilize compression fractures, provide support to weakened vertebrae and thus relieve pain. Positive results are often immediate and some patients become symptom-free.
- Relieves the pain of compression fractures
- Ideal for osteoporosis sufferers
- Well suited to elderly patients
- Improves mobility and functional abilities
- Can prevent height loss & spine curvature
Using a hollow needle, or trocar, that is X-ray guided to the fractured vertebra through a small prick in the skin, the Columbia Pain & Spine Institute physician and specialists inject orthopedic cement into the vacant spaces of a fractured vertebrae. The cement quickly hardens to strengthen the vertebrae, provide spinal support and reduce pain.
- One hour procedure (longer for multiple vertebra)
- Requires little or no hospital stay
- Minimally invasive; no surgical incision
- Immediate results possible; normally within a few days
Vertebral augmentation is most effective when performed within eight weeks of initial symptoms, before the vertebral structure(s) begin to heal in a collapsed state.
Columbia Pain & Spine Institute performs numerous vertebroplasty procedures each year. Our staff are expert at offering an accurate diagnosis, pinpointing the exact area of pain and working with a team of specialists to provide a solution to your pain.
Spinal cord and nerve stimulation for failed back syndrome
Both modalities can provide relief where other conservative therapies – physical therapy, nerve blocks or medication – have failed. Our experienced staff can make the proper diagnosis and recommend the best treatment for your condition.
Stimulation of the spinal cord
SCS (neurostimulation by electrotherapy) utilizes an implanted pulse generator to block pain signals at the spinal cord. It has been shown to provide significant relief:
- 50% to 70% of cases!
- Dull or aching pain
- Reduced mobility
SCS stimulation is accomplished with implanted electrodes inside the epidural space of the spinal canal that act to block the pain signals going to the brain and provide analgesic relief. The first step in the application of this modality is a trial phase (approximately one week) to determine efficacy of the procedure. If the trial phase is successful, the electrodes are then permanently implanted, along with a pulse generator. There are several varieties of electrodes and generators available, and your Columbia Pain & Spine Institute physician can discuss with you the recommended devices.
SCS is a surgical procedure and does carry some risks. It is not recommended for all patients.
Transcutaneous electrical nerve stimulation
TENS utilizes pads applied to the patient’s skin to provide pain therapeutic relief through electrical stimulation of nerves in the lower back.
- No implantation required
- Utilizes two or more electrical pads
- For acute and chronic conditions
- Battery operated
SCS and TENS are complex procedures that require an accurate diagnosis, and carry some risks. Our staff at Columbia Pain & Spine Institute can provide the proper diagnosis and help determine the best treatments for your condition.
1. Kunnumpurath S., Srinivasagopalan, R., Vadivelu, N. (2009). Spinal cord stimulation: Principles of past, present and future practice: A review. Journal of Clinical Monitoring and Computing, 23, 333-339.
Electro diagnosis: nerve conduction studies (NCS) and electromyography (EMG)
Advanced Tests for Nerve & Muscle Pain
Nerve Conduction Studies and Electromyography are diagnostic procedures used by Columbia Pain & Spine Institute staff to evaluate the severity of symptoms and recommend treatment options. In overview, NCS and EMG tests evaluate the electrical conduction of motor and sensory nerves and the electrical activity of skeletal muscles. Results can aid in the accurate diagnosis of such disorders as:
- Carpal tunnel syndrome
- Amytotrophic lateral sclerosis
- Ulnar neuropathy
- Guillain-Barré syndrome
- Peipheral neuropathy
- Muscular dystrophy
- Spinal disc herniation
- Cubital Tunnel Syndrome
- Not an exhaustive listing of possible conditions
Nerve Conduction Studies
Motor and Sensory NCS tests measure the time it takes for an electrical impulse to travel from the generator to the recorder. In general, a slower than expected measurement can help indicate the specific cause of a nerve disorder.
EMG studies are used to identify neuromuscular diseases and to determine the severity of lower-back pain. There are two types of EMG: Surface and Intramuscular. In an intramuscular EMG test, an electrode needle is inserted into the muscle and electrical signals are monitored as the body part is coached through states of rest and contraction.
Intramuscular EMG is not always necessary. In such cases, a surface electrode can achieve acceptable results.
NCS and EMG tests generate complex data and require specialized knowledge to read and interpret the findings. Staff members at Columbia Pain & Spine Institute are trained to use such tests and can help you understand the scientific information.
Ultrasound guided joint injections and nerve blocks
Ultrasound Technologies Home In on the Pain Source
Joint injections of a steroid or other medications is a common procedure used to help reduce pain and swelling of joints. Ultrasound guided joint injections utilize proven technologies to help guide the physician to specific pain centers, and thus help produce more significant results. The procedure can often be performed in an office setting and is relatively quick. It is used to treat inflammatory joint conditions, such as:
- Rheumatoid arthritis
- Psoriatic arthritis
Ultrasound guided joint injections are especially helpful in reducing pain and stiffness associated with hip and lower back disorders. The advantages of ultrasound guidance also make treatments in some areas easier to accomplish. Treatment areas include:
Nerve blocks are often administered in the same method as joint injection: with a needle inserted through the skin to the affected area. The procedure is done for two primary reasons:
- To reduce pain
- To assist in diagnosis
A substance such as alcohol or phenol is injected into or around the affected area, which interrupts the pain signals being sent to the brain.
As with joint injections, using ultrasound technologies to administer nerve blocks not only helps make the procedure more effective, it is sometimes the only way to accurately treat the precise area of pain.
Platelet rich plasma therapy (PRP) – latest advancement of treatment of arthritis, sports related in
Use Your Own Blood Cells for Pain Relief
This exciting medical advancement offers non-surgical pain relief and healing using your body’s natural processes. By delivering a concentration of your own platelets directly to the affected area, PRP boosts your body’s healing power and speeds the repair of injured tissues.
For sports injuries and arthritis sufferers
Active adults suffering from sports injuries may heal faster and with less pain using PRP therapy. Arthritis sufferers can experience dramatic reductions in pain through reduced swelling and the regeneration of cartilage tissue. PRP also has been shown to slow the progression of the disease. Both types of patients can expect long-lasting results.
- Rotator cuff tears
- Anterior cruciate ligament injuries
- Back and neck pain
- Tennel elbow
- Ankle sprains
Because PRP uses your own platelets, the procedure is considered very safe. The risks of transmissible infection and allergic reaction are limited.
A small sample of your own blood is withdrawn, then spun in a centrifuge to separate out the platelet rich plasma which is then injected back into your system at the site of injury or pain. There, the platelets enhance the body’s natural healing processes, even attracting stem cells to help. Results can be noticed in weeks. Up to three injections are common.
PRP therapy requires highly-trained specialists. Columbia Pain & Spine Institute is proud to be one of only a very few practices to offer this revolutionary treatment.
Percutaneous disc decompression – removal of herniated disc material without incision
Non-surgical removal of herniated disc material, called decompression, provides back pain relief by reducing the pressure on the spine’s neural tissue. It is a minimally invasive procedure that uses X-ray guided instruments to remove or dissolve material from a herniated, ruptured or bulging disc.
This outpatient procedure requires little recovery time. Most patients are up and walking within one or two hours. Results are often seen within a few weeks. It is an ideal treatment for the symptoms of sciatica:
- Back pain
- Leg pain
A 2009 study by the Radiological Society of North America (RSNA) reported that patients of Percutaneous Disc Decompression experienced improvement in mobility and reduced pain, and that their conditions continued to improve up to two years after treatment.
Diagnostic discography – helps to establish and confirm painful disk and guide levels of fusion
Discography Experts at Columbia Pain & Spine
This diagnostic test helps your physician ‘see’ in to the interior of your discs to determine the precise point(s) of pain and to help in determine the proper course of treatment. It is used on all portions of the back — lumbar, thoracic and cervical (neck) – and is particularly useful in pre-planning of lumbar fusion procedures.
Using X-ray guidance, a needle is inserted into the target disc(s) and a dye is injected for observation by a trained physician. Leakage of the dye from the disc indicates a tear, scarring or other problems.
Reliable discography requires the expertise of an experienced discographer. Columbia Pain & Spine Institute is proud to offer diagnostic discography for our own patients and as consults for other area physicians.
Epidural steroid injections – caudal, intralaminar or transforaminal
Temporary Relief for Sciatica and Lower Back Pain
Epidural steroid injections target the ‘sleeve’ surrounding the spinal cord to reduce swelling around the nerves and provide pain temporary relief. Often, that break in pain and swelling allows the body’s natural healing processes to start. Effects can last for several months, and ESI can be repeated periodically at the physician’s recommendation. The procedure is often used for temporary pain relief due to:
- Herniated discs
- Bone spurs
- Ligament injuries
- Slipped vertebrae
The three methods of delivering steroid injections into the epidural space — caudal, intralaminar and transforaminal — all involve the use of X-ray guidance technology to insert a small needle into the desired location. All can be performed in an office setting and require little or no recovery time. Results can felt in one to three days.
Caudal epidural steroid injections target the very bottom of the epidural space just above the tailbone. Injection of a steroid at this location allows it to spread widely and to all sides of the epidural sac. The same is true for Intralaminar injections which are useful in treating wide areas of the spine.
Transforaminal ESI delivers the steroid near the nerve where it exits the spine. The medication travels up the nerve sleeve and into the epidural space. This method allows the physician to target a specific area with a concentrated amount of medication, even to the level of single nerves. The procedure is also useful in diagnosing specific pain centers.
Your Columbia Pain & Spine Institute physician can determine which procedure is recommended for your condition.
Selective nerve blocks – cervical, thoracic and lumbar
Nerve Blocks Help in Diagnosis and Offer Pain Relief
Treating your pain requires knowing — precisely knowing — where the source of your pain exists. Selective nerve blocks do that; they help your physician pinpoint the source of your pain — down to the specific nerve and musculoskeletal system. Nerve blocks can be used for therapeutic purposes (to provide pain relief) and for diagnostic purposes (isolating a specific cause of pain).
In general, nerve blocks interrupt pain signals going to the brain. By administering a nerve block to a specific nerve, your Columbia pain & Spine Institute physician can determine the exact nerve or nerves that are sending those agonizing pain signals. Then, treatment can begin.
There are three types of selective nerve blocks. In each case, a local anesthetic is injected into the sleeve surrounding a specific nerve. Fluoroscopy, or X-ray imaging, is used to help the physician guide the needle to the desired location.
- Cervical nerve blocks
- Thoracic nerve blocks
- Lumbar nerve blocks
Cervical nerve blocks are useful for the diagnosis of pain sources in the shoulder, arm, hand or neck. Lumbar nerve blocks focus on pain sources in the legs, feet and the lower back. Thoracic nerve blocks deal with mid and upper back conditions.
In addition to being important diagnostic tools, nerve blocks also provide targeted pain relief. Selective nerve blocks are one way to provide targeted pain relief by interrupting pain signals to the brain at specific locations.
Facet joint injection – major source of pain in aging spine
Facet Joint Injections Ideal for Elderly Patients
Damage to the facet joints — the bone structures behind and between your vertebrae — is one of the leading causes of pain in the elderly population. Not only does facet joint damage cause pain, it can also severely limit mobility, stability and daily function. Facet joint injections help relieve that pain and return patients to a more active lifestyle, with increased mobility and the ability to participate in physical therapy. The procedure is also useful in diagnosing specific pain centers.
- Back/neck pain relief
- Supports a return to physical therapy
- Pain site identification & diagnosis
Using fluoroscopy (X-ray imaging), a needle is inserted to the specific facet joint location(s) and medication — typically an anesthetic or steroid — is injected. This is an outpatient procedure using local anesthetics and typically takes approximately one hour to complete. Most patients can return to their normal activities the following day.
Radiofrequency denervation of facet joints (nerve burning procedure)
For Long-Term Relief from Facet Joint Pain
Radiofrequency denervation of facet joints utilizes high-voltage electrical current to heat and disrupt the medial branch nerve of the spine and thus ‘block’ pain associated with facet joint damage. The procedure is non-surgical and is typically performed in an office setting with local and intravenous anesthetics. Most patients return to their normal schedules within two days; however, some pain from the procedure may last a week or more.
The treatment is designed to offer long-term relief from facet joint pain in the neck and back, but because the medial branch nerve will eventually regenerate, subsequent procedures may be necessary.
Radiofrequency denervation, also called radiofrequency ablation, neurotomy or lesioning, is a therapeutic treatment that is only performed after a specific diagnosis of facet joint damage has been determined using nerve block tests. Facet joints are the bones on and between vertebrae that stabilize the spine and provide for mobility. Damage to facet joints through trauma or aging can lead to severe pain and lack of mobility.
- X-ray (fluoroscopy) guided
- Non-surgical, minimally invasive
- Short (1- to 2-day) recovery
- Interrupts pain signals
Columbia Pain & Spine Institute is proud to offer this advanced therapeutic procedure to appropriate pain sufferers.
Stellate ganglion block – treatment of complex regional pain syndrome
Stellate Ganglion Block for Complex Regional Pain Syndrome
The Stellate ganglion block targets nerve tissue on either side of the throat. Like nerve blocks discussed in other sections of this site, the procedure is intended to interrupt or block pain signals from the neck, arms and face from reaching the brain.
The procedure can be done in an office setting in approximately one hour. Recovery time is short and most patients can return to their normal schedule within a day or two. Results can be felt immediately and may last up to several hours, and it is common for relief to last longer with each injection.
CRPS Pain Compared to that of Childbirth
Complex Regional Pain Syndrome (CRPS) usually starts in the leg or arm and spreads to the entire body. It is a chronic condition and often occurs following an injury, stroke, heart attack or surgical procedure. The pain of CRPS is reported to be among the most severe, and is sometimes considered out of proportion to the injury or initiating event. The condition can lead to loss of function and disability.
CRPS sufferers often experience dramatic changes in quality of life and may be susceptible to depression and even suicide.
In addition to relief from symptoms of CRPS, the Stellate ganglion block has been shown to be effective with breast cancer survivors and women going through menopause.
- Extreme sweating
- Hot flashes
- Night awakenings
The staff at Columbia Pain & Spine Institute is experienced with treating sufferers of CRPS and can help determine if the Stellate ganglion block holds promise for your personal pain relief.
Celiac plexus block – alleviation of abdominal pain
Celiac Plexus Block for Relief from Chronic Abdominal Pain
The celiac plexus block is a nerve block procedure aimed at managing and relieving pain in the abdomen, typically as a result of cancer or pancreatitis.
Similar to other nerve block procedures, the celiac plexus block can be used as a therapeutic as well as a diagnostic tool. As a diagnostic procedure, anesthetic is used to numb the plexus nerves which come from the stomach, liver, pancreas and bowels; if the numbing eliminates the patient’s pain then a diagnosis can be made. If used as a therapeutic treatment, alcohol or other medications are used to destroy the targeted nerve fibers. In both cases, the physician utilizes X-ray guidance to insert a needle into the plexus nerve bundle below the diaphragm and perform the required task.
This is a non-surgical office procedure which takes approximately one hour to perform. Although some discomfort from the procedure may linger for several days, most patients can expect immediate relief from symptoms. Because nerve fibers regenerate, the celiac plexus block may need to be performed more than once.
Pain specialists at Columbia Pain & Spine Institute are experienced with all types of nerve block procedures and can provide in-depth information about your condition and your pain relief options.
Superior hypogastric block – treats pelvic pain
A Nerve Block Alternative for Pelvic Pain Sufferers
The superior hypogastric block is an injection procedure for relieving pelvic pain when traditional medications are either ineffective or result in unwanted side effects such as nausea. The block can relieve pain from patients suffering from pelvic cancers, endometriosis and injuries to the descending colon, rectum, testes, penis, prostate, perineum, vulva, vagina, uterus, urethra and bladder.
Using X-ray guidance, the physician inserts a needle into the superior hypogastric plexus nerve bundle and injects medication to block pain signals from reaching the brain. Medication is usually an anesthetic or alcohol which destroys the nerve fibers.
Results can last for weeks to several years, and multiple treatments are sometimes necessary to reduce or eliminate the need for oral medications.
A non-surgical, non-narcotic treatment for:
- Chronic inflammation
- Irritable bowel syndrome
- Interstitial cystitis
- Pelvic pain
Talk to a pain specialist at Columbia Pain & Spine Institute about your current pain relief regimen and if superior hypogastric block could offer a better solution for you.
Botox® injections for headache and spasticity
Botox® Injections for Chronic Migraine Headaches
Botox® is the first and only preventive treatment approved by the FDA for people with chronic migraine headaches, defined as 15 or more headache days each month with each event lasting four hours or more. Our pain specialists at Columbia Pain & Spine Institute can help you determine if Botox® treatments are right for you, and can administer the injections.
Typical treatment protocols call for 31 injections at seven locations on and around the head and neck at intervals of about every 12 weeks.
The FDA’s approval of Botox® to treat migraines was based on two studies which reported significant decreases in the frequency of headache days for people diagnosed with chronic migraine.
Botox® treatments are not right for everyone, and multiple possible side effects do exist. Talk to a pain specialist at Columbia Pain & Spine Institute to learn more.
Sacroiliac joint injection
Diagnosis and Treatment of Sacroiliac Pain
Injury to or degeneration of the two sacroiliac joints of the lower back can cause excruciating pain, and the sacroiliac joint injection procedure can help diagnose and treat the condition.
As a diagnostic tool, the injection uses anesthesia to determine if the medication’s numbing effect has eliminated the pain. If so, then a therapeutic sacroiliac joint injection is used and other medications are added to provide anti-inflammatory and other benefits. In some cases after studying the results of the joint injection, your physician may also recommend Radiofrequency Denervation of the Sacroiliac Joints as a long-term therapeutic solution.
The physician uses fluoroscopy (X-ray imaging) to guide a needle to the sacroiliac joint(s) and inject medication. This is typically an office procedure that takes only minutes, and recovery time is limited. Most patients can go home that same day.
A key goal of sacroiliac joint injection is for the patient to be able to participate in regular physical therapy to further reduce pain levels and help the patient establish a normal activity level. Multiple treatments are sometimes needed.
Prompt treatment of back pain conditions can dramatically improve therapeutic results. Talk to a pain specialist at Columbia Pain & Spine Institute about your symptoms and see what treatments may be available to help you.
Radiofrequency denervation of sacroiliac joints
For Long-Term Relief from Sacroiliac Pain
Radiofrequency denervation of sacroiliac joints utilizes high-voltage electrical current to heat and destroy the lateral branch nerve of the lower spine and thus ‘block’ pain associated with sacroiliac joint damage. Since the lateral branch nerve does not control muscle or sensory functions, the procedure does not cause any loss of function.
Radiofrequency denervation is non-surgical and is typically performed in an office setting with local and intravenous anesthetics. Most patients return to their normal schedules within two days; however, some pain from the procedure may last a week or more.
The treatment is designed to offer long-term relief from sacroiliac joint pain, but because the lateral branch nerve will eventually regenerate, subsequent procedures may be necessary.
Radiofrequency denervation, also called radiofrequency ablation, neurotomy or lesioning, is a therapeutic treatment that is only performed after a specific diagnosis of sacroiliac joint damage has been determined using nerve block tests.
- X-ray (fluoroscopy) guided
- Non-surgical, minimally invasive
- Short (1- to 2-day) recovery
- Interrupts pain signals
Columbia Pain & Spine Institute is proud to offer this advanced therapeutic procedure to appropriate pain sufferers.
Piriformis Injections for Sciatica Sufferers
Piriformis injections serve double duty as diagnostic tools and as a therapeutic treatment in relieving buttock and sciatica pain.
As a diagnostic tool, the piriformis injection employs anesthesia to determine if the medication’s numbing effect has eliminated the pain. The goal is to isolate the specific site of pain in order to make an accurate diagnosis and recommend treatment. If the injected anesthesia relieves pain, then a therapeutic piriformis injection is used and other medications are added to provide anti-inflammatory and other benefits.
In both cases, your physician inserts a needle into the piriformis muscle in the pelvis, using X-ray imaging (fluoroscopy) to align the needle in the exact position desired, and makes the injection.
The piriformis muscle attaches to the sacrum and the femur and serves critical functions in helping to rotate the hip and legs. Abnormal conditions in the muscle can cause:
Treatment with a piriformis injection often is coordinated with physical therapy to further reduce symptoms to an acceptable level. Talk to a pain specialist at Columbia Pain & Spine Institute about your conditions and whether or not a piriformis injection may help.