Our physiatrists offer a variety of diagnostic and non-operative pain management options, including ultrasound-guided injections, generative medicine, therapeutic neural blockade and acupuncture. These may be prescribed in combination or alone. Our physicians also work in partnership with local physical therapists and other professionals to offer comprehensive pain management treatment.
While spinal injections can be used to diagnose the source of back, leg, neck or arm pain, they are most often performed as part of a comprehensive treatment program, which usually includes an exercise program to improve or maintain spinal mobility and stability. Spinal injections are performed under x-ray guidance (fluoroscopy) to confirm correct medication placement and improve safety.
What are the most common types of injections available?
- Epidural injections
- Facet joint injections
- Sacroiliac joint injections
What are epidural injections used to treat?
Epidural injections are used to treat pain that starts in the spine and radiates to an arm or leg. Arm or leg pain often occur when a nerve is inflamed or compressed (pinched nerve).
Epidural injections involve injecting an anesthetic and an anti-inflammatory medication, such as a steroid (cortisone), near the affected nerve. This reduces inflammation and lessens or resolves the pain. This type of epidural injection is a therapeutic one.
For diagnostic purposes, an epidural spinal injection can be done at a very specific, isolated nerve site to determine if that particular nerve is the pain source. Sometimes only an anesthetic is injected. The immediate response to the injection is closely monitored. If the pain is completely or nearly completely relieved, then that specific nerve is the primary cause of the pain symptoms. If there is little pain relief, then another source of pain exists.
What are facet joint injections used to treat?
Facet joint injections can be done for diagnostic and therapeutic reasons and are often used when pain is caused by degenerative/arthritic conditions or injury. They are generally used to treat neck, middle back or lower back pain. The pain does not have to be exclusively limited to the midline spine as these problems can cause pain to radiate into the shoulders, buttocks or upper legs.
For diagnostic purposes, facet joints can be injected with an anesthetic directly into the joint or by anesthetizing the nerves carrying the pain signals away from the joint (medial branches of the nerve). If the majority of pain is relieved with anesthetic into the joint, then a therapeutic steroid injection may provide lasting neck or low back pain relief.
If anesthetic injections indicate that the nerve is the source of pain, the next step is to block the pain signals more permanently. This is done with radio frequency ablation (damaging the nerves that supply the joint with a “burning” technique).
How are sacroiliac joint injections used?
The SI joints are located between the sacrum and ilium (pelvic) bones. Problems in the SI joints have been shown to cause pain in the low back, buttock and leg. Typically, one joint is painful and causes pain on one side of the lower body. Less often, both SI joints are painful at the same time.
Similar to facet joint injections, the sacroiliac (SI) joint can also be injected for diagnostic and therapeutic purposes. Anesthetizing the SI joint by injection under x-ray guidance is considered the gold standard for diagnosing SI joint pain. A diagnostic injection of the sacroiliac joint with anesthetic should markedly diminish the amount of pain in a specific location of the low back, buttock or upper leg.
A therapeutic injection usually includes a steroid medication with the goal of providing longer pain relief.
When should spinal injections be avoided?
Some people are not good candidates for spinal injections, including people with:
- Skin infection at the site of needle puncture
- Bleeding disorder or anticoagulation
- Uncontrolled high blood pressure or diabetes
- An allergy to contrast, anesthetics or steroids
More information (http://orthoinfo.aaos.org/topic.cfm?topic=A00560)
The nerves and muscles in your body create electrical signals that deliver messages to and from your brain. Sensory nerves deliver information about your surroundings to the brain. Motor nerves deliver signals from the brain to activate your muscles.
Injuries or diseases that affect nerves and muscles can slow or halt the movement of these electrical signals. If you have pain, weakness or numbness in your back, neck or hands, measuring the speed and degree of electrical activity in your muscles and nerves can help your doctor make a proper diagnosis. This process is called electrodiagnostic testing.
What are the most commonly tests used?
Two of the most commonly used tests are:
- Electromyography (EMG) – An EMG records and analyzes the electrical activity in your muscles. It is used to learn more about the functioning of nerves in the arms and legs. When a normal muscle is at rest, it is electrically silent. During an EMG, small, thin needles are placed in the muscle to record the electrical activity. Your doctor will listen and watch a TV-like screen that broadcasts the electrical signals.
- Nerve conduction studies (NCS) are used to find damage to the peripheral nervous system, which includes all the nerves that lead away from the brain and spinal cord and the smaller nerves that branch out from those nerves. This test is often used to help find nerve problems such as carpal tunnel syndrome or Guillain-Barré syndrome.
Radiofrequency ablation is a minimally invasive procedure that can provide lasting relief to those suffering from facet joint pain, a well-recognized source of persistent back pain. It is usually performed with a local anesthetic and mild sedation.
As with many spinal injections, radio frequency ablation is best performed under fluoroscopy (live x-ray), which our physiatrist uses to guide him in properly targeting and placing the needle. During the procedure, our physiatrist numbs the targeted nerves to minimize pain uses radiofrequency waves to heat the tip of the needle, which he then uses to create a lesion that disrupts the nerve’s ability to send pain signals.