mine if the medial branch nerves surrounding the facet joints — small
joints between the vertebrae at the back of the spine — are the source
of the patient's pain.
"The medial branch block is a diagnostic test to see if the nerve that
innervates the joint is the cause of the pain," says Dr. Shaparin.
Generally, the procedure or "test" is done twice, and if that test is pos-
itive, you proceed with an ablation. "Ablation gives the patient months
if not years of relief. But it's not forever because the nerves do grow
back," says Dr. Shaparin, adding that ideal candidates are patients
who suffer from serious joint pain, whether it's from the facet joints in
the back of the neck or the sacroiliac joint.
From a cost perspective, there's some heavy upfront investment,
says Dr. Cohen. The radiofrequency generator needed for the proce-
dure can run you more than $30,000. Plus, the time for the radiology
tech is costly. "They're very expensive. They bill at over $20 a minute,"
says Dr. Cohen. But again, there's the effectiveness factor. "Some
patients see a tremendous response to this intervention," says Dr.
Shaparin. "I've had patients who've seen relief for more than 2 years."
3. Spinal cord stimulators.
The most intensive intervention
on this list, spinal cord stimulators (SCSs) — also known as dorsal
column stimulators (DCSs) — are for patients who haven't found
relief from major surgery or who have undergone multiple back sur-
geries, have a diagnosis of failed back surgery syndrome or have a
major dependence on opioids for their chronic pain. The SCS inter-
vention involves placing an implantable neuromodulation device into
the patient that sends mild electrical signals to select areas of the
spinal cord to reduce pain.
Like radiofrequency ablation, SCSs involve a 2-step process. The
first step is a trial where the surgeon places the lead wire into the
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