Now major spine surgeries can be avoided with minimally invasive Spine Interventions.

1. Dr (Maj) Pankaj N Surange
MBBS, MD (Anesthesiology), FIPP (Hungary)
Director, Interventional Pain and Spine Centre, New Delhi
Chairman, World Institute of Pain, India Chapter
Founder Member and Treasurer, MSK Ultrasound Society

2. Interventional Pain management
Interventions are Minimally Invasive, Non
Surgical and Target Specific procedures to
Diagnose and to treat Various painful conditions
It fills the gap between
pharmacologic management of
pain & more invasive
operative procedure

3. • 36 Years, Executive
• Back pain with radiation
to Left leg for 4 months.
• Lost his job.
• Progressively increasing and
association with paraesthesia.

4. Case 1-Contained Disc Herniation

6. .
Management : Disc Herniation
Under fluoroscopic Guidance
Correct level of the prolapsed
disc is identified
Needle is inserted into the centre
of the Disc and ozone is Injected.
Pain relief starts usually within
one week and ozone takes 3-4
weeks for its complete effect
Percutaneous Ozonucleolysis + Transforaminal L5 and S1

7. Minimally invasive procedure using small needle and probe to remove disc
material of prolapsed disc ,releasing pressure on nerves and relieving pain in
most of the patients of prolapsed/ bulging / slipped disc
Management : Disc Herniation
Percutaneous disc decompression

8. Rotating tip removes
small portion of disc
material.
Because only enough of
the disc is removed to
reduce pressure inside
the disc, the spine
remains stable.
Insertion site covered with bandage.
Recovery is fast as unlike surgical
decompression no bone or muscle is cut.
2-3 days of bed rest and may return to normal
activity within one week.
Management :
Case 1
Percutaneous disc decompression

9. Nucleotomy

10. Hydrodiscectomy

11. Extruded disc

12. Radicular Pain

14. Transforaminal Selective nerve root block

15. Transforaminal Endoscopic
Discectomy

20. • 42 Yrs/ Male
• Back pain X 2 yrs
• No h/o radiation to legs
• Aggravating factors
• Sitting > 40 min
• Driving
• Forward bending
Case-2

21. Case 2- Discogenic Pain

23. Discogenic Pain

24. Risk Factors for degeneration of disc

26. Intradiscal Electrotherapy (IDET)

27. Biculoplasty

28. • Intradiscal Ozone
By inhibiting inflammatory nociceptors

29. Facet Arthropathy
• Low back pain- unilateral or
bilateral
• Tenderness over facet joints
• Pain is deep, dull aching,
difficult to localize
• Referred to the buttocks, groin,
hip, or posterior and lateral
thigh.
• Pain is more prominent in the
morning and with inactivity
• May aggravate on extension after
forward flexion

30. Facet Arthropathy secondary to
Disc degeneration
• Disc bears 80% of weight
• Facet joints bears 20 % of weight
A change in the intervertebral disc produces
Change in the whole motion segment

31. Management- Facet Arthropathy
Inflammatory Type Degenerative type

32. Intra-articular Steroid

33. RF Ablation Median Branch

34. • 56 yrs /Female
• Severe radicular pain in Rt Leg
• H/o frequent back pains
• Sensory loss in L5 Distribution and EHL- 4/5.
• Known case of Rheumatoid Arthritis, Uncontrolled DM,
CAD, Interstitial Lung disease.
Case-3

35. Intraspinal Synovial Cyst

36. Management :Case 3
• Percutaneous Transforaminal Cyst Aspiration

38. • 70 Yrs male/ obese
• Back pain Rt > lt
• Radiation to rt thigh --- lat surf of rt leg
• Tossing on chair
• 1st
Investigation ordered –MRI LS SPINE
Case-4

39. MRI

40. Physical Examination
Rt SI Joint Tenderness +++

41. Management- Case 4
S I Joint Injection

42. • 35 yrs/Female
• Known case of CA Cervix
• Metastasis
• Sudden onset of severe pain mid back
• No neurological deficit
Case-5

43. Compression Fracture Vertebral body

44. – 45 Yrs Male, only earning member
– Traumatic Fracture D12 Vertebra
– Totally bed ridden, Urinary catheter, Ryles tube feed
Case-7

45. Fracture D12 Vertebra

46. Osteoporotic Compression fracture

47. Vertebroplasty

50. Kyphoplasty

52. • 38 yrs male
• Low back pain radiating to both legs more on
right side.
• He had history of disc prolapse of L4-5 & L5-S1
and has undergone surgery 2 times before
(laminectomy, discectomy & excision of scar).
• Pain is increasing day by day.
• Repeated investigations & visit to 16 consultants
for last 4 years has taken away all faith from any
form of medical treatment.
• MRI-Epidural Fibrosis
Case-8

53. Failed Back Syndrome (FBSS)
• Epidural Adhenolysis

54. Resistant Case of FBSS

55. Interventional Pain Procedures
• Limitations
• Contraindications
• Complications
• Not Alternative to Surgery