Generally speaking, most procedures are safe. However, with any procedure there are risks, side effects, and the possibility of complications. The risks and complications are dependent upon the sites that are lesioned, or the type of nerve block to be performed. The closer the procedure is to the spine, the more serious the risks are. Great care is taken when placing the radio frequency needles, block needles, or lesioning probes, but sometimes complications can occur.
1. Infection: Any time there is an injection through the skin, there is a risk of infection. This is why sterile conditions are used for these blocks. There are four possible types of infection:
a. Localized skin infection.
b. Central Nervous System infection - this can be in the form of meningitis, which can be deadly.
c. Epidural Infections - this can be in the form of an epidural abscess, which can cause pressure inside of the spine, causing compression of the spinal cord with subsequent paralysis. This would require an emergency surgery to decompress, and there are no guarantees that the patient would recover from the paralysis.
d.
Discitis
- this is an infection of the intervertebral discs. It occurs in about 1% of
discography procedures. It is difficult to treat and it may lead to surgery.
2.
Pain:
The needles have to go through skin and soft tissues, which will cause
soreness.
3.
Damage to
internal structures: The nerves to be lesioned may be near blood vessels or
other nerves which can be potentially damaged. Please discuss your specific
concerns with your physician.
4.
Bleeding:
Bleeding is more common if the patient is taking blood thinners such as
aspirin, Coumadin, Ticlid, Plavix, etc., or if he/she have some genetic
predisposition such as hemophilia. Bleeding into the spinal canal can cause
compression of the spinal cord with subsequent paralysis. This would require an
emergency surgery to decompress and there are no guarantees that the patient
would recover from the paralysis.
5.
Pneumothorax:
Puncturing of a lung is a possibility, every time a needle is introduced in the
area of the chest or upper back. Pneumothorax refers to free air around the
collapsed lung(s), inside of the thoracic cavity (chest cavity). Another two
possible complications, related to a similar event, would include: hemothorax
and Chylothorax. These are variations of the Pneumothorax, where instead of air
around the collapsed lung(s), you may have blood or chyle, respectively.
6.
Spinal
headaches: They may occur with any procedures in the area of the spine.
7.
Persistent
CSF (cerebro-spinal fluid) leakage: This is a rare problem, but may occur
with prolonged intrathecal or epidural catheters, either due to the formation
of a fistulous track or a dural tear.
8.
Nerve
damage: By working so close to the spinal cord, there is always a
possibility of nerve damage, which could be as serious as a permanent spinal
cord injury with paralysis.
9.
Death:
Although rare, severe deadly allergic reactions known as "Anaphylactic
Reaction" can occur to any of the medications used.
10. Worsening of the symptoms: We can always make things worse.
Chances of any of this occurring are extremely low. By statistics, you have more of a chance of getting killed in a motor vehicle accident, while driving to the Hospital, than any of the above occurring. Nevertheless, you should be aware that they are possibilities. In general, it is similar to taking a shower. Everybody knows that you can slip, hit your head, and get killed. Does that mean that you should not shower again? Nevertheless, always keep in mind that statistics do not mean anything, if you happen to be on the wrong side of them. Even if a procedure has a 1(one) in a 1,000,000 (million) chance of going wrong, if you happen to be that one... Also keep in mind that by statistics, you have more of a chance of having something go wrong when taking medications.
If you are on a blood thinning medication (e.g. Coumadin, Plavix , see list of "Blood Thinners"), or if you have an active infection going on, you should not have the procedure. If you are taking any blood thinners, please inform your physician.
· Do not eat or drink anything, at least six hours prior to the procedure.
· Bring a driver with you. Cannot be a Taxi.
· Come accompanied by an adult that can drive you back, and that is strong enough to help you, if your legs get weak or numb, from the local anesthetic.
· Take all of your medicines the morning of the procedure, with just enough water to swallow them.
· If you have diabetes, make sure that you are scheduled to have your procedure done, first thing in the morning, whenever possible.
· If you have diabetes, take only half of your Insulin dose and notify our nurse, as soon as you arrive to the clinic, that you have done so.
· If you are a diabetic, but only take blood sugar pills (oral hypoglycemics), then do not take them on the morning of your procedure. You may take them after you have had the procedure.
· Do not take aspirin or any aspirin-containing medications, at least eleven (11) days prior to the procedure. They may prolong bleeding.
· Do not take any non-steroidal anti-inflammatory drugs, at least one day prior to the procedure. They may prolong bleeding.
· Wear loose fitting clothing that may be easy to take off and that you would not mind if it got stained with Betadine or blood.
· Take a shower the morning of the procedure, using a bactericidal soap to minimize chances of infection.
· Do not wear any jewelry or perfumes.
· Remove any nail coloring. It will interfere with some of our monitoring equipment.
Note: Remember that this is not meant to be interpreted as a complete list of all possible complications. Unforeseen problems may occur.