Epidural Steroid Injection

Facet Joint Injection

Radiofrequency Ablation

Sacroiliac Joint Injection

Discography

Epidural Steroid Injections

An epidural injection is one of many methods doctors use to relieve pain, along with physical therapy, nerve blocks, oral medications and surgery.
An epidural injection may be performed to alleviate pain caused by:

• A herniated or bulging disk
• Spinal stenosis
• Other injuries to spinal nerves, vertebrae and surrounding tissues

The injection is delivered into the epidural space of the spine to provide temporary or prolonged relief from pain or inflammation. Steroids, anesthetics and anti-inflammatory medications are typically delivered in an epidural injection. The injection may reduce pain and swelling in and around the spinal nerve roots, as well as around damaged nerves which in time may heal.
Our interventional radiologist utilizes guided imagery by fluoroscopy or computed tomography (CT or "CAT" scan) to help target the exact location of pain so the patient can receive the maximum benefit from the injection.
Click here for an informational video on Epidural Steroid Injections:

Epidural Steroid Injection FAQ’s

Facet Joint Injection

Lumbar facet joints are small joints located in pairs in your lower back. They help guide motion and provide stability.  Facet joint pain can result from arthritis, injury, or mechanical stress, and cause pain in various areas
in your lower back, hip, buttock, or leg.
A facet joint injection serves dual purposes. First, by placing numbing medicine into the joint, the amount of immediate pain relief you experience will help confirm or deny the joint as a source of your pain. That is, if you obtain complete relief of your main pain while the facet joints are numb, then these joints are likely your pain source. Furthermore, time-release cortisone will be injected into these joints to reduce any presumed inflammation, which can, on many occasions, provide long-term pain relief.
Click here for an informational video on Facet Joint Injections:

Facet Joint Injection FAQ’s

Radiofrequency Ablation

Radio Frequency Ablation is a pain management procedure our clinic can use to interrupt nerve conduction on a semi-permanent basis. Using a specialized machine, the procedure disrupts nerve conduction (such as conduction of pain signals), and may in turn reduce pain, and other related symptoms. The nerves are usually blocked for 6-9 months (but can be as short as 3 months or as long at 18 months). Approximately 70-80% of patients will get good block of the intended nerve. This should help relieve that part of the pain that the blocked nerve controls. Sometimes after a nerve is blocked, it becomes clear that there is pain from the other areas as well.

Radio Frequency Ablation FAQ’s: 

• How long does the procedure take?
  Depending upon the areas to be treated, the procedure can take from about twenty minutes to a couple of hours.

• Where is the procedure performed?
  The procedure is usually performed in an operating room, sometimes in a fluoroscopy (x-ray) room.

• How is it actually performed?
  Since nerves cannot be seen on x-ray, the needles are positioned using bony landmarks that indicate where the nerves usually are. Fluoroscopy (x-ray) is used to identify those bony landmarks. A local anesthetic (like Novocaine) is injected to minimize the discomfort. After confirmation of the needle tip position, a special needle tip is inserted.

When the needle is in good position, as confirmed by x-ray, electrical stimulation is done before any lesioning. This stimulation may produce a buzzing or tingling or pressure sensation or may be like hitting your "funny bone". You may also feel your muscles jump. You need to be awake during this part of the procedure so you can report what you’re feeling. The tissues surrounding the needle tip are then heated when electronic current is passed using the Radio Frequency machine, for a few seconds. This "numbs" the nerves semi-permanently.

• Will the procedure hurt?
  Nerves are protected by layers of muscle and soft tissues. The procedure involves inserting a needle through skin and those layers of muscle and soft tissues, so there is some discomfort involved. However, we numb the skin and deeper tissues with a local anesthetic using a very thin needle prior to inserting the needle.  There is moderate discomfort involved for a few weeks after. You may have numb areas with increased sensitivity (like a deep sun-burn).

• Will I be "put out" for this procedure?
  No. This procedure is done under local anesthesia. Most of the patients also receive intravenous sedation and analgesia, which makes the procedure easier to tolerate. The amount of sedation given generally depends upon the patient tolerance. It is necessary for you to be awake enough to communicate easily during the procedure.
   
• How is the procedure performed?
  It is done either with the patient lying on the stomach when working on the facet joints, low back for lumbar sympathetic nerves, and in sitting position when lesioning the cervical (neck) area. The patients are monitored with EKG, blood pressure cuff, and blood oxygen-monitoring device. The skin on the back is cleaned with antiseptic solution and then the procedure is carried out. X-ray (fluoroscopy) is used to guide the needles.
   
• What should I expect after the procedure and what are the side effects?
  Initially there will be muscle soreness for up to a week afterward. Ice packs will usually control this discomfort. After the first two weeks are over, your pain may be gone or quite less.  Some patients may have some "deep sun-burn" type feeling.  Some may develop hypersensitivity or burning pain or numb areas for a few weeks.  After lesioning of the 3rd Occipital nerve (for headaches), some of the patients may develop dizziness or vertigo for a few days.  The relief of pain is noticed in about 2 to 3 weeks, not right away.
   
• What should I do after the procedure?
  You should have a ride home. We advise the patients to take it easy for a day or so after the procedure. You may want to apply ice to the affected area. Perform the activities as tolerated by you.

• Can I go to work to work the next day?
  You should be able to return to your work the next day. Sometimes soreness at the injection site causes you to be off work for a day or two.

• How long will the effects of the procedure last?
  If successful, the effects of the procedure can last from 3-18 months, usually 6-9 months.

• How many procedures do I need to have?
  If the first procedure does not relieve your symptoms completely, you may be recommended to have a repeat procedure after re-evaluation. Because these are not permanent procedures, they may need to be repeated when the numbness wears off (often 6-12 months).

• Will the Radio Frequency Lesioning help me?
  It is very difficult to predict if the procedure will indeed help you or not. Generally speaking, the patients who have responded to repeated local anesthetic blocks will have better results.

• What are the risks ?
  Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects, and the possibility of complications. The risks and complications are dependent upon the sites that are lesioned. Any time there is an injection through the skin, there is a risk of infection. This is why sterile conditions are used for these blocks. The needles have to go through skin and soft tissues, which will cause soreness. The nerves to be lesioned may be near blood vessels or other nerves which can be potentially damaged. Great care is taken when placing the radio frequency needles, but sometimes complications occur. Please discuss your specific concerns with your physician.

• Who should not have this procedure?
  If you are on a blood thinning medication (e.g. Coumadin®, Plavix®), or if you have an active infection going on, you should not have the procedure. If you have not responded to local anesthetic blocks, you may not be a candidate for this procedure.

Sacroiliac Joint Injection

Sacroiliac Joint Injection is an injection of long lasting steroid ("cortisone") into the Sacroiliac joints – which are located in the low back area. The injection consists of a mixture of local anesthetic (like lidocaine or bupivacaine) and the steroid medication (triamcinolone – Aristocort® or methylprednisolone – Depo-medrol®). The actual injection takes only a few minutes.
The steroid injected reduces the inflammation and/or swelling of tissue in the joint space. This may in turn reduce pain, and other symptoms caused by inflammation / irritation of the joint and surrounding structures.

Sacroliac Joint Injection FAQ’s:

• Will I be "put out" for this procedure?
  No. This procedure is done under local anesthesia. Most of the patients also receive intravenous sedation and analgesia, which makes the procedure easy to tolerate. The amount of sedation given generally depends upon the patient tolerance.

• Will the injection hurt?

The procedure involves inserting a needle through skin and deeper tissues (like a "tetanus shot"). So, there is some discomfort involved. However, we numb the skin and deeper tissues with a local anesthetic using a very thin needle prior to inserting the needle into the joint. Most of the patients also receive intravenous sedation and analgesia, which makes the procedure easy to tolerate.

• How is the injection performed?

It is done with the patient lying on the stomach, under x-ray control. The patients are monitored with EKG, blood pressure cuff and blood oxygen-monitoring device. The skin in the back is cleaned with antiseptic solution and then the injection is carried out. After the injection, you are placed on your back or on your side.

• What should I expect after the injection?

Immediately after the injection, you may feel that your pain may be gone or quite less. This is due to the local anesthetic injected. This will last only for a few hours. Your pain will return and you may have a "sore back" for a day or two. This is due to the mechanical process of needle insertion as well as initial irritation form the steroid itself. You should start noticing pain relief starting the 5th day or so.

• What should I do after the procedure?

You should have a ride home. We advise the patients to take it easy for a day or so after the procedure. You may want to apply ice to the affected area. Perform the activities as tolerated by you.

• Can I go to work to work the next day?

Unless there are complications, you should be able to return to your work the next day. The most common thing you may feel is sore back.

• How long the effect of the medication lasts?

The immediate effect is usually from the local anesthetic injected. This wears off in a few hours. The cortisone starts working in about 5 to 7 days and its effect can last for several days to a few months.

• How many injections do I need to have?

If the first injection does not relieve your symptoms in about a week to two weeks, you may be recommended to have one more injection. If you respond to the injections and still have residual pain, you may be recommended for a third injection.

• Can I have more than three injections?

In a six-month period, we generally do not perform more than three injections. This is because the medication injected lasts for about six months. If three injections have not helped you much, it is very unlikely that you will get any further benefit from more injections. Also, giving more injections will increase the likelihood of side effects from cortisone.

• Will the Sacro-Iliac Joint Injection help me?

It is very difficult to predict if the injection will indeed help you or not. Generally speaking, the patients who have recent onset of pain may respond much better than the ones with a long standing pain.

• What are the risks and side effects?

Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects, and possibility of complications. The most common side effect is pain – which is temporary. The other risks involve, infection, bleeding, worsening of symptoms etc. The other risks are related to the side effects of cortisone: These include weight gain, increase in blood sugar (mainly in diabetics), water retention, suppression of body’s own natural production of cortisone etc. Fortunately, the serious side effects and complications are uncommon.

• Who should not have this injection?

If you are allergic to any of the medications to be injected, if you are on a blood thinning medication (e.g. Coumadin®), or if you have an active infection going on, you should not have the injection.
Sacro-Iliac Joint Injection is an injection of long lasting steroid ("cortisone") in the Sacro-Iliac joints – which are located in the low back area.

• What is the purpose of it?

The steroid injected reduces the inflammation and/or swelling of tissue in the joint space. This may in turn reduce pain, and other symptoms caused by inflammation / irritation of the joint and surrounding structures.

• How long does the injection take?

The actual injection takes only a few minutes.

• What is actually injected?

The injection consists of a mixture of local anesthetic (like lidocaine or bupivacaine) and the steroid medication (triamcinolone – Kenalog or methylprednisolone – Depo-medrol®).

• Will the injection hurt?

The procedure involves inserting a needle through skin and deeper tissues (like a "tetanus shot"). So, there is some discomfort involved. However, we numb the skin and deeper tissues with a local anesthetic using a very thin needle prior to inserting the needle into the joint. Most of the patients also receive intravenous sedation and analgesia, which makes the procedure easy to tolerate.

• Will I be "put out" for this procedure?

No. This procedure is done under local anesthesia. Most of the patients also receive intravenous sedation and analgesia, which makes the procedure easy to tolerate. The amount of sedation given generally depends upon the patient tolerance.

• How is the injection performed?

It is done with the patient lying on the stomach, under x-ray control. The patients are monitored with EKG, blood pressure cuff and blood oxygen-monitoring device. The skin in the back is cleaned with antiseptic solution and then the injection is carried out. After the injection, you are placed on your back or on your side.

• What should I expect after the injection?

Immediately after the injection, you may feel that your pain may be gone or quite less. This is due to the local anesthetic injected. This will last only for a few hours. Your pain will return and you may have a "sore back" for a day or two. This is due to the mechanical process of needle insertion as well as initial irritation form the steroid itself. You should start noticing pain relief starting the 5th day or so.

• What should I do after the procedure?

You should have a ride home. We advise the patients to take it easy for a day or so after the procedure. You may want to apply ice to the affected area. Perform the activities as tolerated by you.

• Can I go to work to work the next day?

Unless there are complications, you should be able to return to your work the next day. The most common thing you may feel is sore back.

• How long the effect of the medication lasts?

The immediate effect is usually from the local anesthetic injected. This wears off in a few hours. The cortisone starts working in about 5 to 7 days and its effect can last for several days to a few months.

• How many injections do I need to have?

If the first injection does not relieve your symptoms in about a week to two weeks, you may be recommended to have one more injection. If you respond to the injections and still have residual pain, you may be recommended for a third injection

• Can I have more than three injections?

In a six-month period, we generally do not perform more than three injections. This is because the medication injected lasts for about six months. If three injections have not helped you much, it is very unlikely that you will get any further benefit from more injections. Also, giving more injections will increase the likelihood of side effects from cortisone.

• Will the Sacro-Iliac Joint Injection help me?

It is very difficult to predict if the injection will indeed help you or not. Generally speaking, the patients who have recent onset of pain may respond much better than the ones with a long standing pain.

• What are the risks and side effects?

Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects, and possibility of complications. The most common side effect is pain – which is temporary. The other risks involve, infection, bleeding, worsening of symptoms etc. The other risks are related to the side effects of cortisone: These include weight gain, increase in blood sugar (mainly in diabetics), water retention, suppression of body’s own natural production of cortisone etc. Fortunately, the serious side effects and complications are uncommon.

• Who should not have this injection?

If you are allergic to any of the medications to be injected, if you are on a blood thinning medication (e.g. Coumadin®), or if you have an active infection going on, you should not have the injection.

Discography

• 
  Discography FAQ’s here:
•  
• How do I know if my pain is from a damaged disc?
  
  With age or from an injury, the wall of the spinal discs can get cracks or tears (fissures). This condition is called Internal Disc Disruption or Degenerative Disc Disease. Also, the wall of the disc can weaken and bulge out (a herniated disc). When the disc causes pain, the pain is usually felt as a deep, aching pain in the back and sometimes in the buttocks and into the thigh. However, pain from facet joints in the back and from the sacroiliac joints (SI joints) can be in the same location and feel the same. The best way to tell if the pain is from a damaged disc is with discography.
• How is Discography performed?
  
  The procedure is done in a special room with fluoroscopic (x-ray) guidance. For lumbar discography (discs in the low back), it is done with you lying on your stomach. For cervical discography (discs in the neck), it is usually done with you lying on your back.

There will be a nurse present during the procedure to monitor you and administer intravenous sedation to help you be comfortable and relaxed. You are watched closely with an EKG monitor, blood pressure cuff and blood oxygen-monitoring device. The skin over the injection site(s) is cleaned with an antiseptic solution and then the injections are carried out. After the injection, you are placed on your back or on your side.

• What will I feel during the injection?
  
  When a normal disc is injected, you will feel a sense of pressure, but not pain. When an abnormal disc is injected, you will feel pain. It is important to try to tell if the pain you are feeling is your usual pain or different. With each disc injected, you will be asked if it is painful, where you feel the pain and whether it is in the same area as your usual pain.
• How many discs will be injected?
  
  Based on your symptoms and your MRI, we will identify which discs we suspect are causing your pain. These discs will be injected. In addition, we inject a normal disc to serve as a reference point.
   
• How long does Discography take?
  
  Discography takes about 30 to 45 minutes, depending on how many levels are injected.
   
• What is actually injected?
  
  The injection consists of x-ray dye (x-ray contrast). It is usually mixed with some antibiotics to prevent infection.
   
• Will the injections hurt?
  
  The procedure involves inserting a needle through skin and deeper tissues (like a "tetanus shot"), so there is some discomfort involved. However, your doctor will numb the skin and deeper tissues with a local anesthetic using a very thin needle prior to inserting the needle into the disc. Most of the patients also receive intravenous sedation and analgesia, which makes the procedure easy to tolerate.
  
  You may have a flare-up of your back pain after the injection, but this gets better in a day or two and can usually be managed with ice packs and oral pain medication.
   
• Will I be "put out" for this procedure?
  
  No. This procedure is done under local anesthesia.  Injection of a medicine like Novocaine-Lidocaine is performed to numb the skin. Most of the patients also receive intravenous sedation and analgesia, to help them relax and make the procedure easier to tolerate. The amount of sedation given depends upon the patient. You can be sleepy while the needles are placed, but during the discogram injections, you need to be awake enough to tell the doctor what you are feeling.
   
• Will my pain be better after the injection?
  
  No. Discography does not treat your condition. It is a diagnostic test that allows your doctors to plan your therapy.
   
• What should I do after the procedure?
  
  You will need a ride home. We advise the patients to take it easy for a day or so after the procedure. You may need to apply ice to the affected area for 20-30 minutes at a time for the next day. Perform the activities as tolerated by you.
   
• Can I go to work to work the next day?
  
  We usually recommend taking 2-3 days off work after the injection.
   
• What are the risks and side effects of discography?
  
  Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects, and possibility of complications. The most common side effect is pain ­, which is temporary. Sometimes, the discogram needle brushes past a nerve root and the nerve root is irritated. This pain almost always gets better quickly. The other risks involve infection, bleeding, and worsening of symptoms. Fortunately, the serious side effects and complications are uncommon.
   
• Who should not have this procedure?
  
  If you are allergic to any of the medications to be injected, if you are on a blood thinning medication (e.g. Coumadin®, Plavix®), or if you have an active infection going on, you should not have the procedure. You should not have discography if you have not tried simpler treatments such as activity restriction and anti-inflammatory medications.