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One Fortunate Coincidence

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LEXINGTON The great thing about coincidence, since we never see it coming, is how fortunate we feel when that chance happening brings with it a golden opportunity we never even knew we wanted.

That’s what happened to George Privett, MD, medical director of Lexington Diagnostic Center & OPEN MRI, when he was looking to expand his radiology staff. Surprisingly, the two best candidates were both musculoskeletal radiologists, and both were fellows at Virginia Commonwealth University/ Medical College of Virginia, albeit just one year apart.

Prior to their eventual employment with Lexington Diagnostic, the two radiologists Jason Harris, MD, and Robert Pope, DO, had never met. But they spoke enthusiastically to Privett about their fellowship experiences which included extensive training in image guided injections and procedures, the safety and efficacy of the C-Arm fluoroscopy, and the rewarding smiles of patients who benefited from the image-guided pain injections.

Duly impressed, Privett suddenly found himself contemplating the launch of his center’s first medical service line since the imaging and diagnostic center opened 24 years ago.

“I’m very excited to be getting involved in interventional pain management,” says Privett. “For a long time, we have had a close relationship with the field, and as providers move away from narcotics, image-guided pain injections offer us a great opportunity to continue to serve our patient community through a time of change.”

Epidural and Facet Joint Injections

Both lumbar epidural steroid injections and facet joint injections involve the doctors placing anti-inflammatory corticosteroids under the guidance of C-Arm fluoroscopy. Steroid injections decrease the inflammation of the nerve root so as to reduce pain in the back or legs, hopefully for several months while the injury or cause of pain is healing.

With facet joint injections, the steroid is mixed with the anesthetic lidocaine. “When we are in the right spot,” says Pope, “the patient frequently gets immediate relief. Sometimes, people require multiple injections to calm down the inflammation, and I enjoy seeing patients who maybe were apprehensive the first time come back with a big smile because the injections are very effective in helping to manage their pain.

With the introduction of this service, it is important to note that Lexington Diagnostic is not becoming a pain management facility but, according to Pope, “offering image-guided pain injections to our patients and providers in much the same way they can order an arthrogram or MRI.”

To assure patient safety and comfort, there are important factors that referring physicians should consider, notes Harris. Patients must have had an MRI within a year and have stopped any anticoagulants. Also, regarding the recent and tragic meningitis outbreak, Harris affirms that they get all of their products direct from a major pharmaceutical company, not a compounding pharmacy.

“Joint and spine injections are very safe procedures,” he says. “We use a very small needle to inject a local anesthetic, and then we use a fine, 22-gauge needle for the epidural or joint injection. In this procedure, common complications arise from not injecting into the right space, so we use contrast and watch under the fluoroscope to make sure we are avoiding important structures, like veins, for both the local anesthetic and the joint or epidural injection.

“Of course, any time you puncture the skin, you have a risk of infection, and that is one thing we work very hard to minimize.” Most patients tolerate the small amount of pain associated with the procedure “very well,” says Harris, but he also recognizes that patients with very inflamed nerve roots tend to feel a pressure sensation, which he compensates for by injecting very slowly.

As radiologists, Harris and Pope have extensive experience with the fluoroscopy and interpretation of the MRI, and, Pope observes, “Our fellowship training in the administration of these injections helped us gain greater confidence handling the needle.”