You're currently on:

Interventional Spine Procedures

 

Learn more about Interventional Spine Procedures:

Epidural Steroid Injections
Medial Branch Blocks
Radiofrequency Neurolysis

 

 

 

Epidural Steroid Injections 

 

General Overview:

 

Epidural injections can provide diagnostic information and pain relief by delivering two medications (local anesthetics and corticosteroids) into the spinal canal. These injections are done under x-ray guidance for safety and to better enable your doctor to target the direct source of your pain.

An epidural injection may be ordered by your provider as a way to confirm a specific diagnosis and/or to decrease pain and inflammation. Epidural injections are recommended to provide pain relief and allow patients to progress with their rehabilitation. They may be an effective nonsurgical option to treat common conditions such as lumbar disc herniations, lumbar spinal stenosis and degenerative disc disease.

 

Steroids:

 

Medically used steroids are strong anti-inflammatory agents which are used in epidural steroid injections. They are useful in treating patients with low back and leg pain caused by local inflammation due to disc injury or degenerative changes.

Steroids do have possible risks associated with them, although most adverse effects are associated with long-term use. When steroids are used locally as they are in epidural steroid injections, the associated risks are much less.

 

What To Expect During and After Your Procedure:

 

The typical procedure for an epidural steroid injection involves having an appointment at an outpatient surgery center. You may be given the option of receiving light conscious sedation intravenously, which should help you relax and be more comfortable during the procedure. If sedation is used, you will be monitored closely with an EKG monitor, blood pressure cuff and blood oxygen monitoring device. Local anesthetic will be used prior to the actual injection to decrease discomfort. Your doctor will then locate the area to be injected under x-ray guidance. Contrast is usually injected to confirm proper placement of the needle prior to injection of the medications (typically local anesthetic and steroid).

You will typically be at the surgery center for one to two hours. You are required to arrive prior to the procedure and be monitored for a short time following the procedure. The actual procedure time is usually around fifteen minutes. You will then be taken to the recovery room for a short time prior to being discharged.

Because the procedure involves an injection, you may feel some discomfort. You may also experience reproduction of your typical pain. Most patients tolerate the procedure without difficulty and complications are rare.

You may experience numbness and relief from your typical pain for up to six hours after the injection. This is due to the local anesthetic injected. Your usual symptoms may then return and may possibly increase for the next few days. The beneficial effects of the steroid part of the injection usually begin two to three days after the injection and may take as long as a week.

It is difficult to determine if additional injections would be recommended. If the first injection provided a certain amount of pain relief, a second injection may be offered to provide additional benefit. If the pain resolves completely but returns at a later date, additional injections may be an option.

 

Risks of the Procedure:

 

These procedures are generally very safe and complications are rare. However, as with any procedure, there are potential risks of side effects and complications. Some people experience a transient increase in pain for a few days after the procedure. Risks also include infection, nerve injury or reactions to the medications which may cause breathing difficulties and/or cardiac difficulties. However, serious risks or complications are extremely rare.

 

The Different Types of Epidural Steroid Injections:

 

Transforaminal Epidural Steroid Injection – This procedure is performed for both diagnostic and therapeutic purposes for pain, numbness, tingling or weakness. In this procedure, a needle is directed under x-ray guidance through the opening where the spinal nerve exits. The level chosen is usually where a disc and/or nerve injury is suspected to have occurred. Contrast is usually used to confirm proper needle placement. The medications (anesthetic and steroid) are delivered between the disc and nerve interface along the course of the nerve which seems to be causing the majority of the symptoms.

 

Caudal Epidural Steroid Injection – For this procedure, the spinal needle is introduced through a portion of the sacrum (near the tailbone) at a small bony opening called the sacral hiatus. This area is entered with a spinal needle under x-ray guidance. This is a relatively safe, easy procedure to perform and can provide significant anatomical coverage of the injected medications. It is not one of the more specific, localizable procedures.

 

Interlaminar Epidural Steroid Injection – The approach in this procedure involves a needle being advanced to a site specific to the level of injury. The level of injury is viewed under fluoroscopy, and the needle is advanced between two vertebrae to a depth that allows it to reach the epidural space. Contrast is usually injected to confirm placement in the epidural space prior to the injection of medication.

 

Selective Nerve Root Block - This procedure is performed for diagnostic and sometimes therapeutic purposes. In this procedure, a needle is directed under x-ray guidance to a spot overlying the nerve root in the spine where nerve injury is suspected to have occurred. Contrast is usually used to confirm proper placement. A small amount of local anesthetic, and sometimes steroid, is then administered to bathe the nerve root which seems to be causing the majority of the symptoms. A pain log will usually be given in which you should record your pain level before and immediately following the procedure.

 

Medial Branch Blocks 

 

General Overview:

 

Medial branch blocks are part of a procedure used to diagnose pain coming from the facet joints of the spine. Medial branch nerves are located on the back of the spine on each side next to the facet joints. They send sensory signals to the brain from the facet joints, which can be a source of spinal pain. Medial branch blocks stop these sensory signals by injecting local anesthetic around the nerves. Medial branch blocks are performed to help diagnose and treat pain related to disease or injury to the posterior joints of the spine (facet joints). Injecting local anesthetic around these medial branch nerves is an accurate way of diagnosing facet joint pain because certain joints may appear abnormal but not cause pain and problem joints may appear normal.

 

Facet Joint Syndrome:

 

Facet joint syndrome is a group of symptoms which result in diffuse pain which does not fit a clear nerve root pattern. Pain from facet joint syndrome is typically worse with movement of the spine such as standing, walking and turning in bed. The pain does not typically radiate into the extremities and is located in the spine.

 

What To Expect During and After Your Procedure:

 

The typical procedure for medial branch blocks involves having an appointment at an outpatient surgery center. You will be asked to lie flat on your stomach for the procedure. X-ray guidance will be used during the procedure. Local anesthetic will be used prior to the actual injections. A small needle will be positioned along the medial branch nerves. Injection of dye may be used to check positioning. Anesthetic medication is then injected. Multiple levels on either one or both sides of the spine may be performed in the same session depending on your symptoms. The entire procedure usually takes around 15 minutes although you will be at the surgery center for one to two hours including the check-in and post-procedure monitoring. During the procedure you may feel some slight pressure or discomfort. You may experience numbness and relief from your usual spinal pain for several hours after the injection. Your usual symptoms may then return, although this is not always the case. A pain log will be given to you at the procedure to record your pain levels prior to the procedure, immediately after and for several hours during the rest of the day of the procedure. If the injection blocked your pain effectively, but only for a short time, your provider may suggest additional injections including a procedure which offers more permanent relief, such as radiofrequency neurolysis. This option will be discussed at your follow up appointment.

 

Risks of the Procedure:

 

There are some inherent risks from medial branch blocks, as with any procedure, but most of these are minimal. Common risks include, but are not limited to, bruising, bleeding, headaches, irritation of a nerve or nerve injury, numbness and weakness. Risks also include infection or reactions to the medications which may cause breathing difficulties and/or cardiac difficulties. However, serious risks or complications are extremely rare.

 

Radiofrequency Neurolysis 

 

General Overview:

 

Radiofrequency neurolysis is a safe and proven technique to interrupt pain signals from the spine. In this procedure, special radiofrequency needles are directed under x-ray guidance to the location of specific nerves (medial branch nerves) which supply joints in the spine. A radiofrequency current is then used to heat up a small volume of nerve tissue, therby interrupting pain signals from traveling from painful joints to the brain. The procedures can be performed with little discomfort using local anesthesia and IV conscious sedation if necessary. Some common medical conditions which respond to radiofrequency techniques include chronic low back pain, thoracic pain, cervical pain and sacroiliac joint dysfunction.

 

What To Expect During and After Your Procedure:

 

The radiofrequency neurolysis procedure involves having an appointment at an outpatient surgery center. For the procedure you will be asked to lie flat on your stomach. After the local anesthetic and IV medication for sedation (if used) are administered, the doctor will insert a small needle into the area where you experience pain. Local anesthetic will be used prior to insertion of the procedure needle. The doctor will first administer a local anesthetic to minimize discomfort. Then, radiofrequency needles will be advanced under x-ray guidance to the target sites. A microelectrode then will be inserted through the needle to begin the stimulation process. During this process the doctor will ask you if and where you feel the stimulation. The object of the stimulation is to help the doctor ensure that the electrode is in the optimal area for treatment. Local anesthetic is applied to the area before the treatment begins. Once the needle electrode placement is verified, treatment can begin. A small radiofrequency current will then travel through the electrode into the surrounding tissue, causing the local tissue to heat and eliminate pain pathways. You should alert the doctor if at any time during the procedure you experience discomfort, especially in the extremities.

 

Risks of the Procedure:

 

Although there are inherent risks with this procedure, as with any procedure, they are minimal. Common risks include, but are not limited to bruising, bleeding, headaches, nerve irritation or nerve injury, numbness and weakness. Risks also include infection or allergic reactions to the medications which may cause breathing difficulties and cardiac difficulties. Serious risks and complicates are extremely rare.