Interventional treatment of painful conditions
All diagnostic and therapeutic procedures are performed under the control of a special designed X-ray device (C-arm) and the contrast dye, or controlled by ultrasound in order to ensure accuracy and to avoid side effects.
All procedures are performed with usage of a local anesthetic and the patient is released from the clinic after a few hours.
For patients suffering from chronic pain, it may be hard to navigate through all the information. Your pain may have numerous causes and our priority at Polyclinic KORAK is not only to find its source but also to get you rid of it using interventional procedures and bring you relief.
To precisely localize the pain, we will proceed with subsequent diagnostic procedures which will help us find the true cause of your pain. Each procedure lasts approximately 15 minutes.
The basic diagnostic procedures are:
Medial branch blocks
Medial branches are very small nerves that make us feel pain coming from the small joints securing the connection of spinal vertebrae – facet joints. We block these nerves by injecting an anesthetic into their proximity to see whether or not they are the source of the pain. This diagnostic procedure is not painful except for the small sting and it may relieve you from pain for a longer period of time
By injecting a local anesthetic into the proximity of the spinal nerves to see if the nerve is the source of the pain. The active substance also operates against nerve inflammation and can thus alleviate or even eliminate the pain.
This procedure is carried out in case the disc is suspected to be the source of the pain. We insert a guiding needle to its periphery and using a syringe, we inject contrast dye into the disc. This will help us see its structure. It will also trigger pain in the patient’s body, which allows them to confirm or disconfirm that this is the kind of pain they suffer from.
Diagnostic block of sacroiliac joint
This procedure is carried out in case the sacroiliac joint is suspected to be the source of pain. We insert a guiding needle into the sacroiliac joint and inject contrast dye, to confirm that we are in the joint, and then inject local anesthetic which confirm or reject the sacroiliac joint as a source of pain
Interventional regeneration laboratory
- Platelet reached plasma (PRP) therapy
- Bone marrow concentrate (BMC) therapy
Knowing the source of your pain, we will recommend further procedures. Some diagnostic procedures may relieve from pain for a longer period of time. Very often though, a more permanent solution needs to be sought in the form of therapeutic procedures.
The most commonly used are:
Thermal radio-frequency ablation
Thermal radio-frequency ablation, or RF thermal ablation, is a procedure, which, with the use of local anesthetic, utilizes a needle-shaped electrode to apply electric current of the radio frequency to the damaged tissue. The tip is placed alongside the small nerves of the selected location. This creates a relatively high temperature (80-85°C) on the electrode’s isolated tip and the heat destroys the targeted nerve. This interrupts the transmission of the pain from the afflicted joint to the brain (however, this technique does not improve the condition of the joint itself and should be thus complemented with physiotherapy).
Pulsed radio-frequency uses a needle-shaped electrode to apply electric current to the damaged tissue. However, this technique is different from thermal radio-frequency ablation. The word "pulsed" means the energy is supplied to the electrode intermittently, which allows for keeping the temperature of the electrode low (42-45°C) as opposed to higher temperatures necessary for ablation. Applying the radio-frequency pulses to the nerves blocks the transmission of painful stimuli, thus blocking the sensation of pain. When we apply the electric field of pulsed radio-frequency directly to the nerve, it only affects the part of the nerve responsible for transmitting pain signals.
Epidural steroid injection
Epidural steroid injection is a procedure in which we inject corticosteroid and a local anesthetic in the epidural space, usually after diagnosis of radicular pain (discus hernia, stenosis of spinal channel).
There are 3 epidural technique (access):
- - transforaminal steroid injections (TFESI)
- - alternative interlaminar steroid injections (ILESI)
- - caudal epidural steroid injections (SCESI)
The aim of epidural injections is to reduce inflammation and pain and thus maintain the patient's mobility and ability to perform physical therapy. In many cases, this can be an option to avoid classical surgery.
DiscoGel® is the procedure which we use to treat mild to moderate stage of discus hernia which is not intended for a classical surgical treatment. We introduce a spinal needle in damaged disc and apply DiscoGel® (gelled ethanol + tungsten) to conduct chemonucleolisis.
Ethanol is an active substance which gel form prevents leakage of agent out of the disc structure what makes the procedure safer. Tungsten is a contrast agent that visually determine expansion of DiscoGel®.
Disc FX is an innovative system allowing for a safe and effective approach to a damaged disc without injury to the surrounding structures. This method provides an option for those people who have not benefited from conservative treatment, and are not yet ready for major surgery. It is a minimal-access procedure performed on an out-patient basis. Its big advantage is the fact that the patient may go home the same day.
The procedure consists of three phases:
- During the first phase, the disc is punctured with a special needle that functions as a working channel. This needle is used to remove part of the degenerate inner tissue.
- Then, using a radio-frequency probe, the disc is sealed to minimize the risk of repeated herniation.
- In the final step, the pathological nerves in the back part of the disc are destroyed with the use of radio-frequency.
Epiduroscopy is a procedure suited for patients suffering from persisting pain after a spinal surgery. The pain in the spinal canal is most commonly caused by fibrosis (or excess fibrous connective tissue) resulting from already performed surgery. During epiduroscopy, we insert endoscope connected to a special camera via the opening in the sacral bone. This allows us to see which places are affected by fibrosis and remove it with the use of laser.
Physical medicine and rehabilitation
The rehabilitation principles of Polyclinic KORAK is, other than the top equipment and modern technology, is an interdisciplinary team of experts led by physician and other medical specialists and ultimately high educated therapists as the ultimate providers of physical therapy procedures. Doctor Grgurev implements interventional diagnostic and therapeutic methods that have become an integral part of the rehabilitation process by which the clinic itself is specific and recognized. In this way we have treated and continue to treat our patients who are the best indicator of the success of our concept.
From physical therapy procedures and units we highlight:
- Kinesiotherapeutical concepts and techniques (proprioceptive neural facilitation (PNF), myofascial relaxation techniques, soft tissue mobilization, Bobat concept, McKenzy concept, William's exercises, Brook's exercises for scoliosis)
- The latest kineziorehabilitation devices (SportsArt)
- Kinetek Center (continuos pasive range of motion devices (shoulder, elbow, hip, knee))
- Galvanic current
- Interference current
- Diadynamic currents
- Pulsed current
- Nerve electrostimulation (ENS)
- Electrical stimulation of muscles (EMS)
- Ultrasound therapy (US)
- Large and small magnetic tunnels
- Magnetic plates
- Monochrome spot laser
- Cluster polychromatic laser
- HILT laser - high intensity laser