History of Interventional Radiology
For many years, surgery was the only treatment option available for many conditions. Today, interventional radiology treatments are first-line care for a wide variety of conditions and pose less risk, less pain, and less recovery time than traditional surgeries.
Since the 1960’s, interventional radiologists have been responsible for much of the medical innovation and development of minimally invasive procedures that are commonplace today. According to the Society of Interventional Radiologists, they “first pioneered modern medicine with the invention of angioplasty and the catheter-delivered stent, which were first used to treat peripheral arterial disease. By using a catheter to open a blocked artery, the procedure allowed an 82-year-old woman, who refused amputation surgery, to keep her gangrene-ravaged left foot. To her surgeon’s disbelief, her pain ceased, she started walking, and three "irreversibly" gangrenous toes spontaneously sloughed. She left the hospital on her feet—both of them. Charles Dotter, MD, the interventional radiologist that pioneered this technique, is known as the "Father of Interventional Radiology," and was nominated for the Nobel Prize in medicine in 1978.”
Since that time, interventional radiologists have developed and perfected numerous non-invasive techniques for treating patients, including  the use of balloon catheters and image guided percutaneous drainage techniques.
It is important to get a second opinion and know all of your treatment options before consenting to any procedure or surgery.

How do interventional radiology procedures work?
Interventional radiologists use imaging technologies like Fluoroscopy, CT scans and MRI to see inside the body and pinpoint where a problem exists. They can then ‘map out’ a plan on how to get there without traditional surgery. Using fluoroscopy, they can guide catheters into the vascular system, or guide injections to exactly the right spot for pain relief.

What kinds of procedures do interventional radiologists do?
Interventional radiologists do dozens of different procedures, which can be accessed in great detail at the links below. It is important to get a second opinion and know all of your treatment options before consenting to any procedure or surgery.

Facet Joints are innervated or “supplied” by nerves called “medial branches”.  These nerves carry the pain signals to the spinal cord and the signals eventually reach the brain, where the pain is noticed.

If the nerves are “blocked” or “numbed”, they will not be able to carry pain sensation to the spinal cord.  It is like temporarily cutting off “wires”.  Therefore, if the pain is due to facet joint arthritis, you should have relief from pain and stiffness.  Once it is determined that the pain is indeed due to facet joint disease, we can use a procedure called “Radio-FrequencyAblation” and prevent the conduction of pain information for several weeks to months. So, in a way, medial branch block is a temporary and diagnostic procedure.

The actual injection takes only a few minutes.  More nerves to be blocked, more time it takes.

The injection consists of a of local anesthetic (like lidocaine or bupivacaine) or placebo.

The procedure involves inserting a needle through skin and deeper tissues (like a “tetanus shot”).  Therefore, there is some discomfort involved.  However, we numb the skin and deeper tissues with a local anesthetic using a very thin needle before inserting the needle into the joint.  Most patients also receive intravenous sedation and analgesia, which makes the procedure easy to tolerate.

No.  This procedure is done under local anesthesia.  Most patients also receive intravenous sedation and analgesia, which makes the procedure easier to tolerate.  The amount of sedation given generally depends upon the patient’s tolerance.

It is done either with the patient lying on the stomach for the upper and low back pain, or for the cervical (neck area) injections – in sitting position or lying on the back, under x-ray control. The patients are monitored with EKG, blood pressure cuff and blood oxygen-monitoring device.  The skin in the back is cleaned with antiseptic solution and then the injection is carried out.

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 may last only for a few hours.  Your pain will return and you may have a “sore back or neck” for a day or two.  This is due to the mechanical process of needle insertion.  It is very important for you to keep a track of your pain and stiffness for the next 2 to 12 hours following injections.  Your response to the injections will determine if the facets are the cause of your pain or not.

You should have a ride home.  We advise the patients to take it easy for a day or so after the procedure.  You may want to apply ice to the affected area.  Perform your usual activities as tolerated.

Unless there are complications, you should be able to return to your work the next day. The most common thing you may feel is sore back.

The immediate effect is from the local anesthetic injected.  Depending upon the medication injected, it can last from 2 hours to 8 hours.  Of course, if the facet joints are not the source of your pain, you may not have much relief.

Usually one session is enough to determine if the facet joints are the most likely source of your pain or not.  However, the “placebo response” can be as high as 30 to 40 % and some patients may be recommended to have repeat diagnostic injections.  In addition, “False Positive” responses can occur.  Evidence based guidelines recommend two sessions.

If the pain is originating mostly from the facet joints, you should benefit from this procedure on a temporary basis.  Some do get a “placebo response” and others may get a “False-Positive” response.  Please remember that these are diagnostic injections only and last only for a few hours.  These are done to determine if the pain is coming from the facet joints or not, and if the pain is coming from the facet joints, we will recommend “Radio-Frequency Ablation ” – which will “numb” the same nerves for many weeks to months.

Generally speaking, this procedure is safe.  However, with any procedure there are risks, side effects, and possibility of complications.  The most common side effect is pain – which is temporary.  The other risks involve, infection, bleeding, worsening of symptoms, spinal block, epidural block etc.  Fortunately, the serious side effects and complications are uncommon.

If you are allergic to any of the medications to be injected, if you are on a blood thinning medication (e.g. Plavix, Coumadin®), or if you have an active infection going on, you should not have the injection.

For a list of procedures that we offer at our Chico Spine & Vascular clinic click here.

For Patients:

Radiological Society of North America

Back Pain Information & More

For Physicians and Patients:

International Society of Spine Intervention

Society of Interventional Radiology