interventional orthopaedic radiology

The Interventional Orthopaedic Radiology Department of The Kauvery Institute of Orthopaedic and Neurosciences is equipped with state-of-the-art diagnostic and image-guiding systems. The Interventional Orthopaedic Radiology department provides diagnostic and image-guided therapies to patients troubled with joint and spine disorders. Our skilled team comprising of physicians, technologists, radiologists and specialists provide superior care in a personalized environment. We are easily accessible, centrally located and we take pride in providing quick and efficient services.

Our musculoskeletal radiologists are experienced and experts in clinical practice. Our advance technological equipment include:

  • MRI- magnetic resonance imaging
  • CT Scan – Computerized Tomography
  • Digital Fluoroscopy
  • Ultrasound
  • PET – Positron Emission Tomography
24 hours Accident and Trauma care

Our team from the Interventional Orthopaedic Radiology department works in close coordination, with our team of orthopaedic surgeons, neurosurgeons, neurologists, oncologists and rheumatologists to provide our patients under our care with multidisciplinary diagnostics and treatment services.

Our range of services include:

  • Pain management procedures
  • Metabolic disorders
  • Sports related injuries
  • Arthritis
  • Musculoskeletal tumours
  • Infection
  • Trauma
  • Congenital abnormalities

We adeptly perform MRI arthrography of the joints in the musculoskeletal like shoulder, elbow, wrist, knee and ankle. We use our image-guidiance systems to provide diagnostic information and for pain treatment procedures, to inject steroids and anesthetize in and around the joints, the cervical, lumbar and thoracic parts of the spine. We use platelet rich plasma (PRP) to treat injured tissue, to accelerate the tissue healing process. We also provide image-guidance services for minimally invasive treatment of osteoid osteoma (benign non-cancerous bone tumour. We perform needle biopsies of soft tissue and of bone.

  • Percutaneous Vertebroplasty for Spine Fractures

    Percutaneous Vertebroplasty (PVP) is a new, minimally invasive and image-guidance technique used to manage pain, resulting from vertebral collapses or fractures. This technique is used for malignant or osteoporotic fractures. Vertebroplasty was initially used to treat spinal hemangiomas and later on developed to treat malignant or osteoporotic fractures. This treatment helps increase a patient’s mobility, prevents further vertebral collapses and decrease the patient’s dependency on medications.

    The procedure involves the injecting of an acrylic cement, with the guidance of a florescent x-ray, into the fractured or collapsed vertebra, to stabilize the fracture. This treatment process is also used to treat certain malignant or benign lesions in the vertebral column or to treat certain painful vertebral compression fractures that fail to respond to the more traditional and conservative treatments. Pain relief is accomplished with the use of mechanical support and by stability that is provided by the cement applied to the bone. PMMA or Polymethylmethacrylate as it is called is the acrylic cement that is used in orthopaedic procedures and it has demonstrated its ability to restore strength and stiffness to the vertebrae or spinal column.

    The cement used for percutaneous vertebroplasty has proved to be safe for use in orthopaedic procedures. On occasions the cement PPMA has been implanted manually into the vertebral abrasions, in open surgical procedures.

    The main aim of a percutaneous vertebroplasty, procedure is to stop the pain caused by the fracture by stabilizing the spinal fracture. PVP is a minimally invasive surgical procedure, considering that the procedure is performed by the puncturing of the skin with the jab of a needle, as opposed to the traditional incision.

    Prior to undergoing the procedure, an x-ray will be taken and the Orthopaedic doctor will also study the patient’s medical history and will conduct a physical exam to zero in on the exact location and type of pain. The examining doctor may use a MRI or a CT/ CAT scan, if required. At this juncture of gathering all data related to the spinal pain, the patient will need to disclose all medications being taken (prescribed allopathic medications, over the counter medications, and any herbal supplements, Ayurveda, Siddha, and Homeopathic), to the doctor. Also do not forget to tell your doctor if you are taking any blood thinners (anticoagulants), like aspirin or any other that may affect the clotting of blood and whether you have any history of bleeding disorders.

    Before the minimally invasive procedure is done, the patient will be anesthetized or lightly sedated. Using a biopsy needle and under the guidance of a fluoroscopy, a small puncture is made as the needle is guided into the fractured vertebra. The acrylic cement that is introduced into the vertebral lesion forms a type of internal cast that stabilizes the vertebral bone. Once the procedure is over, the cement begins to harden quickly and a bandage is applied to cover the small puncture.

    Once the cement hardens, the patient may go home and are advised bed rest, regular medications, not to drive the day of the procedure, and that they may increase their level of activity slowly. Patients who undergo the percutaneous vertebroplasty procedure, have experienced relief from pain within a day or two and also perceived an increased ability to perform their daily activities. Percutaneous vertebroplasty has demonstrated that it is an effective procedure to remove pain from vertebral compression fractures for up to about 3 years, following the procedure.

  • Image Guided Injections for Pain Management

    Image guided injections to relieve pain, are administrated by a doctor, who injects medication using a small needle to perform a minimally invasive procedure on soft tissue, guided by direct visualization. To target the precise spot, our Interventional Orthopaedic Radiologists use digital fluoroscopic x-ray guidance technology or ultrasound guidance techniques. Consequent to these procedures, the patient will experience relief from pain immediately, and these procedures are also of a very low risk.

    24 hours Accident and Trauma care

    Patients afflicted with the following disorders will generally benefit from undergoing our image-guidance injections:

    • Soft tissue or ligament injuries
    • Local chronic pain
    • Arthritis
    • Pain before undergoing joint replacement procedures

    The areas on the body that are commonly treated are:

    • The joints such as the knees, shoulders, elbows, wrists, thumbs and ankles
    • Hips and Lumbar Spine

    At The Kauvery Institute of Orthopaedic and Neurosciences, our Interventional Orthopaedic Radiologists use an array of pain therapies to identify, diagnose and to treat the pain. Our treatments include:

    • Steroid (Cortisone) injections
    • Platelet-rich plasma (PRP) injections
    • Viscosupplementation injections (Hyaluronic acid – a fluid that is similar to the type of fluid found in the human musculoskeletal joints)
    • Tendon Fenestration and Therapy for Calcific Tendinopathy

    The nature of our treatments explained further:

    • Cortisone Injection is an anti-inflammatory medication that is injected into soft tissues and joints to decrease the inflammation and to reduce the pain. The steroid is injected with the aid of a fluoroscopic x-ray or ultrasound guidance system. The conditions treated by this method include, inflammation of bursa, arthritis, and tenosynovitis (around a tendon)
    • In the platelet-rich plasma procedure, the patient’s own blood is used and is injected using an image guidance equipment. This is also a very effective and safe treatment used in the healing of new injuries and repairing chronic injuries. This procedure has been found to be very effective in the treatment of chronic ligament and tendon injuries. It further quickens the healing of fresh muscle or tendon injuries
    • Viscosupplementation injection or Hyaluronic acid is a fluid akin to the fluid present in a healthy cartilage. When injected the Hyaluronic acid helps reduce the pain, improves mobility and stimulates the joints to produce more hyaluronic acid. This injection is always delivered under an image-guidance x-ray, to ensure that the medication is delivered to the exact spot, under treatment. Viscosupplementation injections are used mostly to treat osteoarthritis and the areas under treatment generally include, the shoulder, elbow, wrists, knee, hip and ankle.
    • Our Intervention Orthopaedic Radiology department also offers two types of Tendon Fenestration and therapy for calcific tendinopathy. The process of tendon fenestration is similar to acupuncture, whereby the radiologist will make tiny jabs, using an image-guidance system, in the inflamed tendon. If need be the radiologist will also inject steroids in the adjacent tissues to control the inflammation, subsequent to the procedure. In the Therapy for Calcific Tendinopathy, the radiologist with the aid of an ultrasound guidance system, uses a needle to remove the excess deposit of calcium on the tendons or muscles around the joints. This extra calcium deposit impairs the movement of the joints and causes pain.
  • Bone Tumour Management by RF Ablation

    The bones are the third and most familiar part of the body, where cancer cells proliferate and metastasize. Metastases occurs when the cancer cells in the bones get into the bone marrow and consequently into the blood stream. They then begin to develop new blood cells to collect both oxygen and food to multiply, grow and proliferate. Some metastases tend to be painful, owing to the tumour eating away the bone and forming holes that consequently make the bone thinner and brittle. The nerve endings positioned around the bone, emit pain signals that are routed to the brain, as the tumour replaces the bone. Sans treatment eventually, bone metastases will lead to fractures, especially of the ribs, spine and pelvis.

    The treatment procedures available for treatment of bone metastases is more palliative than curative. The purpose of the treatment is to:

    24 hours Accident and Trauma care
    • Reduce the pain
    • Prevent the growth of fresh new cancerous cells
    • Prevent destruction of the bone
    • Improving patient’s functionality

    Interventional Orthopaedic Radiologists may possibly use either of the thermal ablation techniques; radiofrequency ablation or cryoablation. The treatment is used to desensitize the bone by ablating the nerve endings in proximity to the metastases.

    Bone pain, bone fracture or spinal cord compression are the symptoms by which bone metastases is identified.

    During a radiofrequency ablation (RFA) procedure our intervention orthopaedic radiologists use a CT scanner to pinpoint the tumour, then guide a specialized needle probe into the spot. Radiofrequency current is then passed through the needles or electrodes to heat and burn away the tumour tissues, thereby eliminating or ablating it.

    Electrical current in the magnitude of radio waves are passed between a needle electrode positioned on the tumour and grounding pads are placed on the patient’s skin, during an RFA procedure. A temperature of 90 degrees Centigrade, is applied for about 4 to 6 minutes, to kill the cancerous growth. The radiofrequency current produces tremendous amount of heat, within the cancerous cell tissues that are in and around the electrodes. The heat emitted by the radiofrequency energy also seals the tiny blood vessels, thereby reducing any risk of bleeding.

    Prior to the procedure, either general anesthesia or sedatives are administrated as ablation by radiofrequency energy is quite painful. Subsequent to the procedure, pain related to the annihilation of the tumour, is natural. This pain usually lasts anywhere from 2 to 3 days, and your treating doctor will prescribe anti-inflammatory, non-steroidal medications, to reduce the pain. Patients gain enormous relief from the pain in a matter of days and complications are rare, if any at all. Removal of bone, is limited to the needle trail, which does not exceed the caliber of a 14 gauge perforation needle. Post-operative the patient can continue with weight bearing activities and can resume their normal activities within five days.

    Success rate in this procedure is believed to be over 90% and any reoccurrence of pain due to incomplete treatment can be corrected in a repeat ablation procedure.

  • Bone Biopsy

    A bone biopsy is required when certain abnormalities or growths in the bone tissue is suspected. The bone biopsy procedure involves the removal of cells or bone tissue, from the body and is examined under a microscope. The bone tissue sample is either removed using a special biopsy needle or through a traditional surgical procedure. The sample that is taken is from the outer layers of the bone and not from the innermost layer. This is an image-guided procedure.

    Bone biopsy is of two types:

    • A closed or needle biopsy
    • Surgical or Open biopsy

    A closed or needle biopsy involves the insertion of a special biopsy needle into the outer layer of the bone to remove a sample which will then be examined under a microscope. This procedure is performed with the aid of a CT scan or Computed Tomography, or an MRI or Magnetic Resonance Imaging. Prior to this procedure the patient will be locally anesthetized. In the second procedure, after the patient has been given general anaesthesia, the doctor makes a surgical incision into the skin and removes a piece of the bone, to be studied, under the microscope. Depending on the results of the microscopic examination of the sample, further surgery may be required.

    A biopsy is performed to investigate the reason for pain or tenderness observed in the bone, or to further investigate any ensuing results of an x-ray, to determine whether there is any other issues with the bone problems like unexplained infections or inflammation, or to simply to determine whether the bone tumour is benign or malignant.

    Before a patient undergoes the procedure, the doctor may require a complete physical examination, like blood tests and other diagnostic tests to be performed, to ensure that the patient is in good health. This is in addition to the complete, medical, histological data already available.

    Depending on the patient’s medical history, the doctor will administrate either a local anaesthesia or a general or spinal anaesthesia.

    The computed tomography scanner or magnetic resonance imaging system comprises of a tunnel structure in the center of a large box like machine, with a narrow table that slides in and out of the tunnel. The patient will be placed on this table. Within the tunnel are the x-ray and electronic x-ray detectors, placed opposite each other in a ring (called the gantry) and the gantry will rotate around the patient. The computer workstation which will be operated by the technologist will be located in another room adjacent to the room where the CT scan is located. The technologist will communicate with the patient using a speaker and microphone, while the technologist operates the scanner, monitors the examination and stays in direct visual contact. The doctor may need to use additional equipment such as an IV line (intravenous), an ultrasound machine and other devices to monitor blood pressure and heart beat.

    Post-procedure involves the patient being taken to the recovery room and depending on the anaesthesia administrated, the time of recovery will vary. While in the recovery room the patient’s blood pressure, breathing and pulse will be monitored and after the patient is found to be stable, the patient will be shifted to the ward room or discharged with instructions from the doctor to specific bathing process. It is very important to ensure that the area where the biopsy was performed is maintained clean and dry, until such time the stitches are removed or the adhesive tape falls off by itself.

  • Facet Joint Injection and Selective Nerve Root Block

    A facet joint refers to joints that are paired on either side of the spine, midline. The facet joint injection is relatively a very simple and direct procedure where a fluoroscopy x-ray guidance system is used for precision and accuracy in treatment.

    The facet joint injection is a diagnostic test that is used to narrow down the source of the pain in the patient’s spinal column and to determine whether the pain responds to the injected medication. This procedure is also used to treat symptoms of facet joint arthritis.

    The procedure is performed with the aid of an image-guidance system (CT scan or MRI), where a needle is placed into the facet joint, and a steroid or local anesthetic is injected into the nerve root. Generally this procedure is performed without administration of any sedation, but an intravenous line may be started, in case it is necessary. The area on the skin, where the procedure is to be performed, is cleaned and a local anesthetic is given, which may smart for a few seconds. Using an image-guidance system (fluoroscopy), our physician will direct a very small needle into the facet joint, and inject a small amount of contrast dye to affirm that the needle is in the right spot and will simultaneously check to see that the medication stays contained inside the joint. On confirmation, the physician will then slowly inject a mixture of an anesthetic (lidocaine) together with a steroid (cortisone), into the joint. Injecting the mixture is a matter of minutes but the whole procedure could take anywhere from a quarter to half an hour.

    Another standard procedure performed by our Interventional Orthopaedic Radiologists, is the selective nerve root block or SNRB. While the facet joint injection is used to determine the exact pain point of the facet joint, SNRB is used to diagnose the particular source of the pain in the nerve root and also to provide therapeutic relief to relieve lower back pain or leg pain.

    Inflammation or compression of a nerve root causes back or leg pain and occasionally an MRI may not clearly pinpoint the source of the pain. Consequently an SNRB injection procedure is performed, as it assists in sequestering the source of pain. SNRB is also used to treat a far lateral disc herniation (rupturing of a disc outside the spinal column).

    The nerve that is causing the pain, in a spinal nerve root block procedure, is approached on the same plane at which the root exits from the foramen (the spinal canal). The medication, in this procedure, is a mixture of an anti-inflammatory medication (steroid) and lidocaine (anesthetic) and is delivered with the aid of a fluoroscopy, live x-ray. Using the fluoroscopy in the procedure ensures that the medication is delivered precisely to the location where the pain emanates from. Consequent to the procedure the patient will get relief from back pain and the steroid also helps reduce the inflammation around the nerve root.

    Our Interventional Radiology department, at The Kauvery Institute of Orthopaedic and Neurosciences, provides a competent array of advanced imaging technology in radiology, interventional radiology, and interventional oncology treatments. Our skilled radiologists, interventionists, physicians and care givers all function with one goal in mind - to provide patients under their care with the most caring, the best diagnostic and result-oriented services.

Back to Top