The needle is smaller in size than that used during a conventional epidural approach. The procedure is performed with the patient lying on their belly using fluoroscopic (real-time x-ray) guidance, which helps to prevent damage to the nerve root. A radiopaque dye is injected to enhance the fluoroscopic images and to confirm that the needle is properly placed (See Figure 2). This technique allows the glucocorticoid medicine to be placed closer to the irritated nerve root than using conventional interlaminar epidural approach. The exposure to radiation is minimal.
Patients considering back surgery using a TLIF procedure will usually be asked to quit smoking prior to surgery as this can significantly reduce the chances of a successful fusion. The pre-donation of blood is usually unnecessary with this minimally invasive back surgery. Patients with disabling back and leg pain are likely to achieve some degree of relief from this procedure but should be aware that in some cases the extent of pre-existing nerve damage will preclude a full recovery. Discussing expectations of outcome with the physician prior to surgery will help reduce disappointment if poor results are experienced. Conservative treatments such as physical therapy, medications (NSAIDs, and epidural steroid injections), and alternative treatments like acupuncture, chiropractic, massage, and yoga, may be helpful and postpone or remove the need for back surgery and are usually utilized for six month or so prior to surgery being considered.
As a skilled and experienced Pain Medicine Interventionalist, Dr. Levin evaluates each patient very thoroughly and carefully to help determine appropriate treatment options in order to provide the most effective individualized care. These treatment options may include: Lumbar, Thoracic and Cervical Epidural Steroid Injections utilizing targeted transforaminal techniques, Lumbar and Cervical Sympathetic Blocks, Sphenopalatine, Facial and Head and Neck Procedures, Discography, Percutaneuos Discectomy or Disc Decompression procedures, precision joint and nerve injections, Radiofrequency Neuroablative procedures, Peripheral or Spinal Cord Stimulator trials and implants, Foraminoplasties and several patented and patent pending advanced interventional procedures.