Advanced Pain Management Technique

1. Percutaneous Endoscopic Discectomy

Percutaneous Endoscopic Discectomy (PED) is a minimally invasive spine surgery technique that utilizes an endoscope to treat herniated, protruded, extruded, or degenerative discs that are a contributing factor to leg and back pain. This technique has quicker recovery time, earlier rehabilitation, and avoidance of general anesthesia. An excellent visualization via the endoscope permits to selectively remove a portion of the herniated nucleus pulposus that is contributing to the patients’ leg and back pain.

How is it performed?

A small flexible tube called cannula is inserted into a body cavity for draining off fluid and introducing medication. The working cannula is placed at the border of the disc. The disc space is opened and the herniated inner core of the vertebral disc (nucleus pulposus) is removed under endoscopic control. The procedure is performed in local anesthesia.


PED has emerged as a better technique over conventional methods. In 95% cases it has shown progressive results and immediate pain relief. It provides direct access to herniated disc with a sparing local anesthesia and small incision. Once done it has better rehabilitation with faster return to everyday life.

How do I know PED is for me?

Percutaneous Endoscopic Discectomy a good option for the patients with low pain threshold and those not responding well to conservative treatments like pain killers and anti inflammatory drugs. PED is indicated for all levels of slip disc. Prolapsed and isolated discs can be safely treated with this technique. It is also suitable for elderly patients, patients with cardiovascular problems, pregnant patients, and patients who are fearful of surgery and general anesthesia.


2. Percutaneous Nucleotomy

A Percutaneous Nucleotomy is a minimally invasive procedure involving the removal of the inner material of a bulging or herniated disc that has compressed a nerve root or the spinal cord. A bulging or herniated disc occurs mainly due to age, but a variety of injuries can lead to the conditions as well. With age the normally spongy cartilage discs between the vertebrae begin to dehydrate. This loss of water begins to weaken the usually fibrous outer layer of the disc, called the annulus fibrosus. The nucleus pulposus is the jelly-like material found in the center of the disc. The inner material can push outward as the outer wall continues to break down, which can cause a bulge in the wall, hernia or a rupture in the wall that allows disc material to escape. Pain, tingling, weakness and numbness may develop if the disc compresses on the spinal cord or one of its nerve roots.

How is Percutaneous Nucleotomy performed?

The objective of Percutaneous Nucleotomy is to reduce the prolapsed part of the nucleus pulposus enough so that the pressure on the nerve root is released. The procedure begins with the insertion of a needle into the damaged disc and a suction device is inserted into the disc. It is used to remove a portion of the nucleus pulposus, releasing the pressure off the nerve root and thus relieving the pain. Mostly, Percutaneous Nucleotomy is performed on an outpatient basis, which means that the patient returns home after completion of the procedure. It will probably be carried out under local anesthesia and sedation. The scar left will be actually very small.


With Percutaneous Nucleotomy, the patient’s quality of life improves over the few days following surgery, and a considerable relief of pain is already felt on the day of the procedure. However in few cases, additional therapy may be recommended.

Is Percutaneous Nucleotomy for me?

Percutaneous Nucleotomy is recommended only if conservative treatments such as bed rest, pain medications, exercise and physical therapy have not helped alleviate symptoms. The procedure mainly has the purpose to relieve pressure from the afflicted nerve root or spinal cord.


3. Radiofrequency Lesion Procedure

Radiofrequency Lesion Procedure is used to treat pain of joints in the spine. It is a procedure in which special needles are used to create lesions along selected nerves. The needles heat the nerve to a desired temperature. When this heat is applied to the nerve for about 2-3 minutes, the nerve stops carrying pain signals. The body tends to try to re-grow nerves that are blocked in this manner but that process can take up to a year or longer.

How is Radiofrequency Lesion Procedure performed?

Since nerves cannot be seen on x-ray, the needles are positioned using bony landmarks that indicate where the nerves usually are. Once positioned appropriately, a fluoroscope (X-ray guidance machine) assists in identifying the specific area to be treated. The area is cleaned and the skin is numbed. The special radiofrequency needle is inserted under X-ray guidance next to the pain fibers in your spine. The microelectrode is then inserted through the needle to begin the stimulation process. The object of the stimulation process is to help determine if the electrode is in the optimum area for treatment, thus producing the best relief. The small radiofrequency current will travel through the electrode and into the surrounding tissue, causing the tissue to heat and eliminate the pain pathways.


The procedure disrupts nerve conduction (such as conduction of pain signals), and it may in turn reduce pain, and other related symptoms. Patients generally get a good block of the intended nerve. This helps relieve that part of the pain that the blocked nerve controls. Sometimes after a nerve is blocked, it becomes clear that there is pain from the other areas as well. Patient is able to return to your work the next day. Sometimes a rest of two to three days is also advised.

Is the procedure for me?

Radiofrequency Lesion Procedure is offered to patients with certain types of low back or neck pain, usually pain from the facet joints. It blocks pain signals for a prolonged period of time; though, the human body may regenerate the pain pathways over time. It is not unusual that the procedure may need to be repeated, but most patients report long lasting relief than with other spinal injections.


4. Vertebroplasty and Kyphoplasty

Vertebroplasty and Kyphoplasty are minimally invasive procedures performed to treat vertebral compression fractures (VCF) of the spine. The fractures, which can be painful and limit spine mobility, are commonly caused by osteoporosis, spinal tumors, and traumatic injury. These procedures are accomplished by using the imaging guidance to inject a cement mixture into the fractured bone, or insert a balloon into the fractured bone to create a space and then fill it with cement. They are effective and safe procedure for treating vertebral compression fractures in the elderly. It provides immediate pain relief and allows early mobilization, thus avoiding potentially severe complications related to persistent back pain and prolonged bed rest. When performed by experienced surgeon complication rate is low, representing a safe procedure with an ability to provide a desired outcome.

How are Vertebroplasty and Kyphoplasty done?

Both Vertebroplasty and Kyphoplasty are similar procedures. These are performed through a hollow needle passed through the skin of the patient’s back into the fractured vertebra. In vertebroplasty, bone cement (called polymethylmethacrylate) is injected through the hollow needle into the fractured bone. In kyphoplasty, a balloon is first inserted and inflated to expand the compressed vertebra to its normal height before filling the space with bone cement. The procedures are repeated for each affected vertebra. The cement-strengthened vertebra allows the patient to stand straight, reduces pain, and prevents further fractures. The vertebra is returned to normal position before the bone hardens. Patients report significantly less pain after treatment.


The sooner a fracture is repaired, the better the results. About 90% of the patients are relieved and pain free post these procedures. The reduction in pain and increased ability to move significantly improved the patients’ quality of life. Various studies in cancer patients with multiple myeloma have shown similar results.

Are these procedures for me?

Both the procedures, Vertebroplasty and Kyphoplasty, can be a treatment option if you have painful vertebral compression fractures from diseases like Osteoporosis, Bone cancer, cancer of the bone marrow (Multiple myeloma) or benign vascular tumor. However it is advised to consult your medical specialist before stepping for these options.