Pain Management

Radiofrequency thermocoagulation (RF ablation) is a minimally invasive technique used in chronic pain management. During the procedure, nerve fibers carrying pain signals are selectively heated and inactivated using radiofrequency energy. This fluoroscopy-guided procedure is performed under local anesthesia, lasts 15-30 minutes, and allows same-day discharge. Particularly effective with 60-80% success rates for facet joint syndrome, sacroiliac joint pain, sciatic pain, neck pain, and trigeminal neuralgia. Effects last 6-24 months and the procedure can be repeated if needed. RF thermocoagulation is a safe and effective pain management option that does not require surgery. Patients can resume normal activities within several days.

Caudal epidural injection is a minimally invasive treatment method where steroid and local anesthetic medications are delivered to the epidural space through the sacral hiatus in the tailbone region. This technique is particularly effective in treating disc herniation, spinal stenosis (canal narrowing), radiculopathy (nerve root compression), and chronic low back pain. The procedure is performed under fluoroscopy guidance and typically lasts 10-15 minutes. The steroid delivered to the epidural space reduces inflammation of the nerve roots, alleviating pain and leg pain (sciatica). Local anesthetic provides immediate relief. Patients typically experience significant pain reduction several days after the procedure. Effect duration varies between individuals but averages 2-6 months. The procedure can be repeated if necessary and provides longer-term improvement when supported with physical therapy.

Transforaminal epidural injection is a targeted treatment method where steroid and anesthetic medications are delivered directly to the foramen region—the point where the spinal nerve root exits the spine. This technique is considered the most effective injection method for single-level disc herniation or radicular pain. Using fluoroscopy and contrast agent, the medication is delivered directly to the affected nerve root, providing higher success rates (70-85%). The procedure takes 15-20 minutes under local anesthesia and patients are discharged the same day. Particularly preferred for L4-L5 or L5-S1 level disc herniations and foraminal stenosis (narrowing of the nerve exit opening). Transforaminal epidural injection is considered a conservative treatment option before surgery and can eliminate the need for surgery in many patients. Patients may notice pain reduction within 2-7 days after the procedure.

Facet joint injection is a procedure in which steroid and local anesthetic are applied to the facet joints located in the posterior part of the spine that connect the vertebrae to each other. Facet joints are structures that enable spinal movement while also preventing excessive movement. Inflammation in these joints due to aging, degeneration, trauma, or arthritis can lead to chronic lower back or neck pain. Facet injection is used for both diagnostic and therapeutic (treatment) purposes. Under fluoroscopic guidance, medication is injected precisely into or around the joint. The procedure lasts 10-15 minutes and is performed under local anesthesia. Patients can go home within a few hours after the procedure. In patients with successful response (>50% pain reduction), radiofrequency thermocoagulation can provide long-term relief lasting 6-24 months. Facet injection shows a success rate of 50-75% especially in patients with facet syndrome, spondylosis, and mechanical lower back pain.

Sacroiliac (SI) joint injection is a procedure in which steroid and local anesthetic are applied into the sacroiliac joint located between the pelvic bone and sacrum. The SI joint is an important structure that transfers body weight to the legs and constantly bears load during daily activities. SI joint dysfunction or sacroiliitis (joint inflammation) can cause lower back, hip, and leg pain. This pain especially increases during prolonged sitting, climbing stairs, or standing on one leg. SI joint injection is used for both diagnostic and therapeutic purposes. The procedure is performed under fluoroscopic or ultrasound guidance and lasts 10-15 minutes. Local anesthetic provides immediate relief while steroid takes effect within 2-7 days. The effect lasts on average 2-6 months but some patients may experience longer-lasting relief. Significant improvement is seen in 60-80% of patients with SI joint pain. The procedure can be repeated if necessary or permanent solutions such as radiofrequency ablation can be considered.

Epiduroscopy or spinal endoscopy is a minimally invasive technique that allows treatment under direct visualization by inserting a thin camera (endoscope) into the epidural space within the spinal canal. This procedure is especially applied in patients with failed back surgery syndrome (FBSS), chronic radicular pain, epidural fibrosis (post-surgical scar tissue), multilevel canal stenosis, and resistant lower back and leg pain. Local anesthesia and sedation are used during the procedure. Access to the epidural space is gained through the sacral hiatus at the coccyx, and under camera guidance, adhesions are mechanically released, inflammatory areas are identified, and targeted steroid injection is performed. The procedure lasts 30-60 minutes and patients usually stay in the hospital for one night. Epiduroscopy provides significant pain reduction in 50-70% of patients. It is a valuable alternative treatment option, especially in patients who develop post-surgical adhesions or who prefer to avoid surgery.