The medial branch nerves are small nerve branches that transmit pain from the facet joints of the spine to the brain. In patients struggling with facet disease, the degeneration of these joints can cause constant pain.

If a patient is deemed to be a candidate for these procedures, Dr. Zarse starts this process with a diagnostic medial branch block. If this initial block is successful, he will proceed with the confirmatory block, and will finally performed the radiofrequency ablations if the confirmatory block is a success as well.

During the MBB, a local anesthetic will be placed on the identified level(s) of the spine, which can be done with or without sedation in our office. This is a very quick procedure (only takes about 10-20 minutes), but the relief is only temporary (lasting from several hours to a few days) in order for us to ensure we are in the right area before moving onto the RFA to make your relief more permanent.

Once two successful medial branch blocks (MBBs) have been performed, we can now move on to the radiofrequency ablations (RFAs).

This procedure can also almost always be done with or without sedation in our office (cervical RFAs require sedation). During this procedure, the area is numbed with a local anesthetic, then a radiofrequency probe is placed on the medial branch nerve, which heats up to 80 degrees Celsius to cauterize the nerve and prevent constant pain signals from being sent to the brain. Afterwards, a steroid is given to minimize pain and inflammation. Though relief from the MBB is instant, the RFA typically takes around 3 weeks to notice a change because the body must heal from the cauterization.

Relief from this procedure generally lasts anywhere from 6 months to two years, at which point we can repeat the procedure to keep you pain free.

We offer epidural injections in the cervical, thoracic and lumbar spine. This procedure can treat various conditions, such as bulging discs, and enlarging facet joints that can all contribute to nerve impingement.

When nerves are compressed they react with swelling and inflammation, only worsening the impingement. A vicious cycle of pain, swelling, inflammation, and further impingement can occur. Epidural steroid injections act to break that cycle by bathing the affected in steroid, an anti inflammatory medication. Patients will often require a series of injections to achieve full relief.

Patients can expect to see relief in the first three days, as it does take some time for the anti-inflammatory effect to take place.

A trigger point is an area of muscle injury that is in continual spasm. This causes localized pain as well as referred pain. Once a trigger point is identified, it can be injected under ultrasound guidance if needed, and achieve quick relief.

A small needle is gently advanced into the focal area of spasm and gently injected with local anesthetic and steroid. This allows additional blood flow and healing to eliminate the spasm. You can expect to feel instant relief due to the anesthetic, but it’s common to feel a bit sore on day two from the mild trauma of the injection.

The procedure is low risk and well tolerated. It requires no sedation and can be done in the office by any of our providers.

The genicular nerves are sensory nerves that innervate the knee. Genicular block/Radiofrequency ablation is a great option for patients that have had a total knee replacement or are not candidates for a knee replacement.

During this procedure, the knee is evaluated under X-ray and numbed. A needle is placed in each nerve (three total) and instant relief is expected.

If this procedure is successful, we can proceed with the ablation. This is performed similarly to the RFAs we do on the spine; a probe is inserted into the knee and the genicular nerves are cauterized, resulting in more permanent pain relief.

Patients can typically expect between 6-12 months of relief.

Sedation is required for this procedure.

This service is not covered by insurance

As we age, our bodies have a harder time healing from injuries and illness. An effective way to supplement this is by injecting Platelet Rich Plasma (PRP). This is done by drawing the patient’s blood and spinning it down in a centrifuge to separate it into layers of red blood cells, platelet poor plasma, and platelet rich plasma. The platelet rich plasma (PRP) is then drawn into a needle and reinjected into the identified site.

Injecting the PRP back into the body helps to regenerate the tissue in the area to help it heal faster and more effectively without more invasive procedures.

Common ailments that can be treated with PRP include soft tissue injuries, such as tennis elbow, rotator cuff tendinitis, bursitis of the hip, and plantar fasciitis.

This block is commonly performed on patients experiencing chronic pain, such as CRPS, circulation issues, and even long COVID and PTSD.

Sedation is required to perform this procedure; once the sedation is administered, Dr. Zarse uses ultrasound to accurately place a needle into the stellate ganglion and inject a local anesthetic, which then blocks sympathetic nerve signals from being transmitted to the brain.

This procedure is a great option for those struggling with lower limb Complex Regional Pain Syndrome (CRPS).

Sedation is required for this procedure; once sedation is administered, Dr. Zarse carefully places a needle into the anterior portion of the vertebral body and injects a dye to confirm the placement. Once this is identified, a local anesthetic is injected to block pain signals from the lower limb from communicated to the brain.

Patients typically require a series of these blocks to achieve lasting relief; early and aggressive treatment is the most effective way to prevent long term disability due to CRPS.

Neuromodulation is an advanced method of treating conditions such as CRPS, failed back surgery syndrome, phantom limb pain, and more.

SCS therapy is a viable option for patients who are not surgical candidates and have failed other conservative treatments, such as physical therapy and interventions.

Once the leads are placed and the settings are programmed, low voltage impulses are generated superficially in the dorsal column. These impulses intercept pain signals from the lower extremities and block them from traveling all the way up the spinal cord to the brain.

Before a permanent implant is placed, a trial is required to ensure that this therapy is right for you.

The patient is sedated while Dr. Zarse places leads on either side of the spine in the epidural space. Once the leads are in place, the ends are left outside the body and connected to a battery pack that is taped to the skin for seven days. After the seven day trial period, the leads are pulled out from the epidural space.

If the trial is successful, a permanent implant can now be placed with a battery pack under the skin and the leads permanently placed in the epidural space.

Depending on the hardware and settings, the battery can last for several years before needing a replacement. Rechargeable options are also available depending on your individual needs.

A kyphoplasty is a minimally invasive surgical procedure that is performed as an effective treatment for compression fractures. These fractures are common amongst older adults diagnosed with osteoporosis, because this degeneration of the bones makes them very fragile and prone to breaking, even from normal daily activities.

Kyphoplasty achieves three primary goals. If caught early, it can reestablish the height of the vertebral body back to its normal configuration, preventing the postural deformity called kyphosis, which causes a “c” shaped or hunched upper back. It also remedies the pain, as the fractured bone will no longer be mobile, which stops it from irritating the fibrous lining of the backbone. Lastly, this procedure stabilizes the fracture, preventing progression and retro-pulsion into the spinal cord.

Sedation is required for this procedure. Once this is administered, A live x ray will be used to identify the area in both the straight on view and lateral view. Skin marks will be placed on your skin and local anesthetic will numb the skin, subcutaneous tissue and periosteum over the bone. A device called a trochar is advanced carefully into the vertebral body through a structure called the pedicle. A balloon is then inflated under live X ray to assure proper placement and reestablishment of height. Depending on the location of the balloon, this may be repeated on the other side. This balloon creates a void in the bone, and cement is then injected into that void to stabilize the fracture.

Pain relief post-procedure is typically instant, with patients able to return to their usual routines within 24 hours.

QUTENZA® is a topical 8% capsaicin treatment that comes in a sticker-like topical system and is used to treat diabetic neuropathy of the feet, as well as post-herpetic neuralgia associated with shingles. These patches are applied in-office to the affected area, and the capsaicin works directly at the nerve receptors causing the pain. Everyone is different, but patients typically start to see an improvement in their pain after four treatments.

Idaho Spine and Pain happily works with Idaho worker’s compensation claimants to design an effective treatment plan to minimize your pain as much as possible.

*We unfortunately do not accept out of state claims at this time.

Our providers have many years of experience working with auto insurance claims and personal injury cases; we are happy to discuss potential treatment options with you and do all that we can to get you back on your feet.

If you have recently been involved in a motor vehicle accident and are interested in partnering with an attorney, we highly recommend Fielding Law Group. To learn more, please contact Fielding Law Group at (509) 765-7777.