All procedures are done either under fluoroscopy or ultrasound guidance to reassure precision and safety.
Epidural Steroid Injections: Cervical, Thoracic, Lumbar and Caudal
Epidural steroid injections (ESIs) are a common method of treating inflammation associated with low back-related leg pain and/or neck related arm pain. In both of these conditions, the spinal nerves become inflamed due to narrowing of the passages where the nerves travel as they pass down or out of the spine.
A variety of conditions can cause the spinal passages to narrow, including disc herniations, bone spurs, thickening of the ligaments in the spine, joint cysts or abnormal alignment of the vertebrae (spondylolisthesis, which is also referred to as ‘slipped vertebrae’). The epidural space is a fat filled ‘sleeve’ that surrounds the spinal sac and provides cushioning for the nerves and spinal cord. Steroids (‘cortisone’) placed into the epidural space have a very potent anti-inflammatory effect that can decrease pain and improve function. Although steroids do not change the underlying condition, they can break the cycle of pain and inflammation, which allows the body to compensate for the condition. The injections can provide benefits that outlast the effects of the steroid.
ESIs, may not provide pain relief for everyone, but the injections may provide improvement in pain and function that lasts several months or longer. The injections can be safely repeated periodically to maintain the improvements. Injections are also commonly combined with physical therapy and other treatments to either maximize the benefit or prolong the effects.
Facet Joint Injections
Facet joints (Zygapophysial joints or z-joints) are located on the back of the spine on each side where two adjacent vertebrae meet. The facet joints provide stability and allow the spine to bend and twist. The facet joint contains cartilage between bones and is surrounded by a sac-like capsule that is filled with a lubricating liquid (synovial fluid) that reduces the friction between bony surfaces when movement occurs.
A facet joint injection will determine either the source of pain or it will be used as a therapeutic treatment of an abnormality that has been detected. Facet joint injections combine a local anesthetic and a corticosteroid anti-inflammatory medication. This mixture relieves both pain and inflammation coming from the involved joint.
Sacroiliac Joint Injection
Sacroiliac (SI) joint dysfunction is a common source of pain in the lower back, buttocks, groin, and legs. These general symptoms can be easily confused with other causes of back pain.
Sacroiliac joints connect the pelvic bones to the spine. They are small and don’t move much, but absorb all the forces of the upper body before balancing and transferring the weight to the hips and legs. When one or both of these joints become irritated or injured, they can cause chronic discomfort and pain.
A sacroiliac (SI) joint injection(also called a sacroiliac joint block) is primarily used either to diagnose or treat sacroiliac back pain and/or sciatica symptoms associated with sacroiliac joint dysfunction, although often the two are combined into one injection.
Intradiscal injections are performed for both diagnostic and therapeutic purposes. For diagnostic reasons, a local anesthetic is used to temporarily block pain within a disc and determine if the pain is coming from that particular disc. For therapeutic reasons, a steroid is injected to decrease inflammation within a disc. The steroid usually takes two to three days to relieve pain. Intradiscal injection of corticosteroids can be an efficient short term treatment for degenerative chronic discogenic low back pain.
Spinal chemonucleolysis is a treatment for herniated or bulging discs to relieve pain symptoms without surgery. If the disc is bulging and has not ruptured, chemonucleolysis can be considered as an option.
An enzyme is injected into a bulging spinal disc, with the goal of reducing the disc’s size and taking the pressure off nerve roots. The enzyme speeds up the breakdown of the jellylike substance inside the disc (nucleus), releasing water. As a result, the bulging disc may shrink and relieve pressure on the nerve root.
Occasionally chemonucleosysis is performed when there are signs of serious nerve damage in the leg that may be getting worse. The signs can include severe weakness, loss of coordination, or loss of feeling, although surgery may be considered in the case of severe symptoms.
Spinal disc degeneration occurs in all adults as they age. Degeneration is associated with the loss of disc fluid and decreased disc height. These changes may or may not be painful. Typical symptoms related to disc degeneration are neck or back pain and possibly pain in the lower limbs. Severe degeneration may cause pain when the spine presses on nerve roots or forces more load onto the facet joints in the back of the spine.
Discography is a procedure in which an injection into the disc space helps determine the integrity of the intervertebral disc. It can help identify the source of pain and is used to determine a specific cause of pain so a new treatment plan, such as surgery, can be developed.
Cervical Epidural Steroid Injection
Lumbar Transforaminal Epidural Steroid Injection
Lumbar Epidural Steroid Injection
Platelet Rich Plasma (PRP) Injection Treatment for Whiplash
Epidurolysis for Post-Laminectomy Conditions
A laminectomy is a surgical procedure that removes a portion of the vertebral bone called the lamina. Epidurolysis allows medications to reach affected nerves in the spine so that pain and other symptoms may be diminished.
Following back surgery, scarring is most commonly caused from bleeding into the epidural space as a result of back surgery and the subsequent healing process. It is a natural occurrence following surgical intervention and scarring can also occur when a disc ruptures and the fluid leaks out.
Epidurolysis dissolves scar tissue that forms around entrapped nerves in the epidural space of the spine. The procedure allows pain relief medications such as cortisone to reach the affected areas.
Including conventional thermal and pulsed for peripheral and spinal nerves
Radiofrequency ablation (RFA) uses radiofrequency energy to heat and destroy nerves to reduce pain. When a nerve is heated in this manner, it can no longer send pain signals. RFA can reduce pain such as chronic low-back and neck pain and pain related to the degeneration of joints from arthritis. The degree of pain relief varies, depending on the cause and location of the pain. Pain relief from RFA can last from six to 12 months and in some cases, relief can last for years.
Transcutaneous Electrical Nerve Stimulation (TENS units)
TENS is a non-invasive, low-risk nerve stimulation intended to reduce both acute and chronic pain. TENS devices produce electrical current to therapeutically stimulate the nerves. The unit is usually connected to the skin using two or more electrodes and a typical battery-operated TENS unit is able to modulate pulse width, frequency and intensity. Portable TENS devices are available for home use.
TENS units have successfully treated various types of conditions, such as low back pain (LBP), myofascial and arthritic pain, sympathetically mediated pain, neurogenic pain, visceral pain and post-surgical pain.
Spinal Cord Stimulation Trials for Spinal and Peripheral Conditions
Neuropathic pain is generated by nervous tissue and it is an adaptive response to nerve injury caused by either the peripheral or central nervous system. Spinal cord stimulation has been used successfully to treat neuropathic pain originating from the peripheral nervous system.
Spinal cord stimulation always involves a short trial conducted with a temporary stimulator to determine whether or not spinal cord stimulation will provide adequate pain relief. The spinal cord stimulator for the trial period is implanted for approximately a week during which:
Leads are placed under the skin and attached to a small device that the patient carries (similar to a cell phone). Using pre-set programs, electrical currents are emitted in a pattern to target the areas of pain, with the goal of giving the best pain relief possible. Preset programs are used to emit electrical currents in a pattern designed to target the areas of pain.
If the patient receives significant relief from pain during the trial, a complete system with a generator device can then be implanted.
A microdiscectomy is typically performed for a herniated lumbar disc and is particularly effective for treating leg pain (radiculopathy).
Compression or impingement on the nerve root can cause substantial leg pain. Microdiscectomy is a minimally invasive procedure in which a small portion of the bone over the nerve root and/or disc material from under the nerve root is removed to relieve neural impingement and provide more room for the nerve to heal.
Although it may take weeks or months for the nerve root to fully heal and any numbness or weakness to improve, patients typically feel leg pain relief almost immediately after a microdiscectomy procedure.