34 years old female presented with severe headache since 5years. Pain starts at the upper neck than spreads over the back of the head slowly to the eyes frontal region. Pain remains for many hours unless she takes some strong analgesic. Pain severity frequency is getting worse in last 6 months.
She was treated for migraine (still on anti migraine drugs), psychological assessments management was done. Nothing including physiotherapy was helping her.
She presented to our center, on examination we found she had significant pain on palpation of paraspinal muscles over the facetal column. Range of motion of neck on right side is restricted due to pain and muscle spasm.
She was advised diagnostic medial branch block under x-ray control. The test was very positive given 80-90% pain relief.
Patients was willing to go for RF ablation which was done subsequently. She improved almost 80% now she is able to do her own things without any assistance.
A Pakistani national who had multiple level disc prolepses at thoracic levels (T3-4, T8-9, T9-10, T10-11 was operated for laminectomy in Karachi. Pre-surgery he was suffering from motor weakness, severe electric type of pain in lower limbs (left >right) and numbness. He was able to walk but used to fall down if unsupported due to motor weakness in both lower limbs. Post procedure his pain reduced for 1 month but there was no improvement in power in lower limbs.
He underwent extensive physiotherapy regimen but due to burning and spastic pain in left leg he could not do aggressive PT. He saw Pain clinic Of India website and approached Dr. Kailash Kothari for his problem. He came to Mumbai for consultation when Dr. Kailash Kothari advised him to undergo repeat MRI. On New MRI discs conditions were same but there were few bands of adhesions around the nerves due to post surgical fibrosis (it”s very common after spine surgery causing continuous same or worst pain even after good quality spine surgery).
Dr. Kailash Kothari advised a procedure called percutaneous Racz Adhesiolysis a this level and at 2 nd stage Ozone Discectomy at major disc prolapse at T10-11. After his consent a small catheter was passed from patients tail bone opening and inder live Xray guidance tip was placed at the site of adhesions and as per protocol various medicines (omnipaque dye, normal saline, Hyluronidase,and steroids ) were used for lysis of adhesions. The catheter was kept for 3 days. One injection daily was given as per protocol. Patient was discharged on 4 th day. He than underwent aggressive physiotherapy at pain clinic for 3 weeks. He has shown tremendous improvement in his pain, spasticity and ability to stand.
3 weeks post Racz procedure, A percutaneous Xray guided Ozone Discectomy (A simple procedure done through a fine 22 G spinal needle) under local anesthesia was performed. Patient continued physiotherapy. 6 week post Ozone Discectomy patient informed Dr. Kothari that he was now able to walk few steps (i.e. up to bathroom and to balcony without support) and he was virtually free from pain and spasticity in lower limbs.
This classical case of FAILED BACK SURGERY SYNDROME , almost impossible to treat with routine therapy, can be effectively treated by various pain management procedures including one which is mentioned above.
A Female patient presented with burning over feet with gluteal pain. Her tips of toes on both sides were affecting her day to day life. She was so much frustrate. MRI, EMG and other tests were non significant. Our orthopedic friend referred this case to us at pain clinic of India.
When we saw her at our clinic, we were not sure as the presentation was quite vague. We started her on gabapentin with amitryptline with lidocaine patch. BUT NO RELIEF.
We decided to do a differential local anaesthetic block for diagnostic purpose to rule out if any structures in back is causing this pain?
We did bilateral L4L5 Medial branch injection to rule out back pain is caused by Facet join? Post injection up to 30mins there was no relief.
We palpated her gluteal region. Area above SI joint was tender.
We gave diagnostic S.I. joint block. Local anaesthetic sensoricaine 0.5% injected 1cc in each joint under live X-ray control.
Patients pain disappeared immediately and on examining her feet ..... to our surprise her feet pain was totally vanished. She walked, gave pressure on the legs, toes etc. Did all activities causing pain in her day to day life.
It was 80% better.
We concluded that her pain in back and feet were caused by S.I. joint inflammation.
Further treatment Options are physiotherapy, steroid injection and Radio frequency ablation.
Conclusion - Precision diagnosis is very important for back and leg pain and pain management procedures can provide us diagnosis.
Needle in S.I. Joint with good dye spread along joint line.
