Lumbar transforaminal epidural steroid injection cost

If you are using an old operating system, you may find that Google Chrome will allow you to visit modern websites without requiring an update to your operating system. Learn how to update your browser The ILIF Procedure (Interlaminar Lumbar Instrumented Fusion) was developed to overcome the potential shortcomings of standard lumbar spinal stenosis treatments (. decompression alone and decompression with fusion), using a minimally disruptive surgical technique. Lumbar spinal stenosis is a gradual narrowing of the space where nerves pass through the spine, which can be a result of aging and “wear and tear” on the spine from everyday activities and/or resultant positional changes of the vertebrae. The most common surgical treatment for lumbar spinal stenosis is a procedure called a decompression, which involves removing bone or ligaments that are pressing on the spinal cord and/or nerves.
The ILIF procedure involves a minimally disruptive decompression procedure called a laminotomy, which involves temporary distraction (opening up) of the space between the spinous processes, and careful removal of only small sections of bone to release the pressure on the spinal cord and nerves.

Contrast is used to verify epidural location and to indicate the distribution of injectate. Some physicians use contrast as a volume expander while others prefer saline for this use. The contrast is typically nonionic and lowosmolar. In patients with contrast allergies gadolinium can be safely used in most lumbar procedures. 30,31,52,53 If using gadolinium, the amount should be just enough to document epidural injection. Gadolinium should not be used as a substitute for volume expander. The typical amount of contrast or contrastsaline mixture used for either cervical or lumbar interlaminar epidurography is 4 cc to 5 cc (less in nerve blocks; see below). A smaller amount will not provide sufficient contrast for an epidurogram to evaluate for adhesions or distribution of injectate. For coding purposes, an epidurogram is considered to have been performed when approximately 4 cc to 5 cc of contrast is injected regardless of the route (transforaminal or interlaminar). The report, CPT code, and amount billed must be adjusted if an epidurogram is not performed. The amount of contrast injected may be reduced in spinal stenosis. Many patients will feel pressure or leg cramping from almost any volume, no matter how small. Patients undergoing first-time injections may confuse this with pain. Careful questioning and reassurance that pressure is normal will be adequate in most cases. The injectate volume should be reduced if significant pain is experienced.

Patients will return for a follow-up visit to see the doctor approximately 12-14 days after surgery. The incision will be inspected. The incision will be inspected and the stitches or staples will be removed. Medications will be refilled if necessary. Patients will usually return to see Dr. Spoonamore every 4-6 weeks thereafter, and an x-ray will be taken to confirm the fusion area is stable and healing appropriately. At 8-12 weeks after surgery, patients will be given a prescription to begin physical therapy for gentle back exercises.

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 may return to light work duties as early as 2-3 weeks after surgery, depending on when the surgical pain has subsided. Patients may return to moderate level work and light recreational sports as early as 3 months after surgery, if the surgical pain has subsided and the back strength has returned appropriately with physical therapy. Patients who have undergone a fusion at only one level may return to heavy lifting and sports activities when the surgical pain has subsided and the back strength has returned appropriately with physical therapy. Patients who have undergone fusion at two or more levels are generally recommended to avoid heavy lifting, laborious work, and impact sports.

Lumbar transforaminal epidural steroid injection cost

lumbar transforaminal epidural steroid injection cost

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.

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