Orthopedics/Pain Management

As a physician specializing in minimally invasive techniques, our Interventional Radiologist encounters patients with a broad range of medical conditions including cancer, liver disease, musculoskeletal disease and vascular disease. These patients are often living with pain and reduced quality of life. At the Vascular Institute of Virginia, we are often able to treat the underlying condition and ready to provide palliative treatments to these patients when needed.


Vertebroplasty and kyphoplasty are used to treat painful vertebral compression fractures in the spinal column, to stabilize the bone, and to restore some or all of the lost vertebral body height due to the fracture.  Such fractures are a common result of osteoporosis, and can be secondary to injury, or a tumor. Your doctor may use imaging guidance to inject a cement mixture into the fractured bone (vertebroplasty) or insert a balloon into the fractured bone to create a space and then fill it with cement (kyphoplasty). Following vertebroplasty, about 75 percent of patients regain lost mobility and become more active.

During a kyphoplasty procedure, a small incision is made in the back through which the doctor places a narrow tube. Using fluoroscopy to guide it to the correct position, the tube creates a path through the back into the fractured area through the pedicle of the involved vertebrae.

Under X-ray guidance, the doctor inserts a special balloon through the tube and into the vertebrae, then gently and carefully inflates it. As the balloon inflates, it elevates the fracture, returning the pieces to a more normal position. It also compacts the soft inner bone to create a cavity inside the vertebrae.

The balloon is removed and the doctor uses specially designed instruments under low pressure to fill the cavity with a cement-like material called polymethylmethacrylate (PMMA). This pasty material hardens quickly, stabilizing the bone.


Steroid Injections

Cortisone shots are injections that may help relieve pain and inflammation in a specific area of your body. Cortisone shots are most commonly given into joints — such as your ankle, elbow, hip, knee, shoulder, spine and wrist. Even the small joints in your hands and feet may benefit from cortisone shots.

Cortisone shots usually include a corticosteroid medication and a local anesthetic. In many cases, cortisone shots can be administered in your doctor's office. However, the number of cortisone shots you can receive in one year generally is limited because of potential side effects from the medication.

Nerve Root Block

A nerve root block is an injection into the sheath surrounding a nerve root in the spine to decrease your pain temporarily and to identify where the pain is coming from precisely. The exam uses therapeutic steroid and local anesthetic (numbing medication) to decrease pain and inflammation. Pain relief from the procedure varies from minimal to long-term, depending on the specific symptoms.


Within the body, there are nerve fibers that arise from the spinal cord that help regulate blood pressure and heart rate, along with a variety of other functions. These nerve fibers are called sympathetic nerve fibers, and they form a part of the autonomic nervous system. Some of these sympathetic nerve fibers lie around the lumbar spine and are involved in regulating the functions of the blood vessels in the lower part of the body, along with other organs such as the bladder. A lumbar sympathetic block is where the function of these nerves is completely blocked off using a local anesthetic agent. This is called neurolysis.

A lumbar sympathetic block is performed in a variety of clinical conditions that cause pain, swelling and alteration in the normal physiology of the lower extremities. Some conditions include peripheral vascular disease, reflex sympathetic dystrophy or complex regional pain syndrome, herpes zoster of the legs, phantom pain following limb amputation, and even pain due to cancer.