Prolo Hawaii

Fluoroscopic Spinal Injections

Fluoroscopic Spinal Injections Treating the root cause of chronic pain and related conditions.

Most of our patients have suffered a long time from symptoms of chronic pain or infectious conditions. They've usually tried other forms of treatment before they come to our office. Before you live another day with an uncomfortable, even disabling condition, contact us to learn about relief options. Dr. Liza Maniquis-Smigel works with patients seeking to restore health and vitality through comprehensive pain management.

Western style medicine is very effective for acute conditions. It focuses on what is dysfunctional and it is vital to know this. Traditional Western medicine works on symptom relief and the end results of specific measurements, such as a bulge on an MRI. It doesn't always ask why there is a dysfunction and evaluate the overall function of the body's systems, so it sometimes falls short in treating chronic conditions. Our bodies are so complex that the reasons we are experiencing a dysfunction can often seem unrelated to the presenting symptoms.

With Dr. Smigel, she will ask why. We strive to understand and treat the cause of chronic conditions, not just the resulting dysfunction. We look at all factors that influence health and then provide a combination of therapies that tap the human body's amazing ability to heal and correct itself.

Her integrative approach utilizes both conventional and alternative methods that facilitate the body's innate healing response. She researches treatments that are proving helpful in other parts of the country and the world and bring the best of them to our patients.

To help you feel better so you can live better, Dr. Smigel will:

  • Conduct a thorough  review of medical records and diagnostic process.
  • Look at all the factors that could contribute to your chronic condition.
  • Evaluate how well your body's systems are working.
  • Provide proper multidisciplinary therapy to treat the root cause of your problems.

Dr. Liza Smigel specializes in treating patients who are experiencing chronic pain from the following conditions and illnesses.

  • Chronic neck, back and spinal pain Degenerative joint disease
  • Arthritis
  • Hip, knee, or other joint injuries and pain
  • Chronic ligament and tendon injuries
  • Chronic fatigue
  • Headache, migraines
  • Abdominal pain
  • Pelvic pain


  • Complex Spinal Injection Procedures
  • Prolotherapy - also known as Regenerative Injection or Therapy RIT
  • Coordination of rehabilitation team.

Interventional Pain: History & Rationale

Due to the irreversible nature and the historically high potential for surgical failure, patients and physicians alike have always searched for less invasive and risky alternatives to surgical management of pain. Interventional pain dates back to as early as 1901 when the first epidural was performed to treat sciatic pain. Recently, with the explosion of technologic advancements in imaging techniques and pain treatment systems, there now exists a host of minimally invasive outpatient procedures that may effectively manage your pain.

Traditionally, the ability to accurately diagnose pain-generating structures was as low as 15%. With advancements in diagnostic interventional pain techniques, physicians  may definitively pinpoint your pain to its exact source by temporarily blocking nerve roots, ligaments, joints, muscles or discs. This allows precise localization of painful structures in up to 85% of patients treated, which undoubtedly leads to more a focused treatment plan.

Dr. Smigel specializes in supplementing exercise, physical therapy and medication with minimally invasive procedures to effectively diagnose and manage your pain. She  offers a wide array of treatments options including epidural blocks, selective nerve root blocks, SI and facet joint injections,  nerve blocks,  proliferative therapy,  joint injections, trigger point injections, lysis of scar tissue, and Botox injections.

Read below to learn more about any specific procedure that may have been ordered by your doctor to help you more effectively manage your pain and maximize your active lifestyle.
Pain Relief / Pain Management - Spinal Injections
People who suffer from chronic spinal pain can often be helped with various types of spinal injections for pain management as well as to help make a diagnosis. Done correctly, spinal injections are safe and very effective.

For relief of pressure and inflammation on a nerve root, usually caused by a disc protrusion, narrowing of the nerve canal, or by scarring after back surgery.

This procedure involves placing a needle under fluoroscopic guidance either into the foramen, or hole, where a specific nerve comes out of the spine or into the center of the spine where the nerves run together down the spinal canal. A combination of local anesthetic, such as lidocaine, and a cortisone like drug, such as triamcinolone, that decreases the inflammation and swelling around the nerve is injected. This combination is very effective in relieving the pain and can also help diagnose the cause of the pain when it's selectively injected in the area of specific nerve roots.

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