Cervical Facet Injection  
A cervical facet injection is used in the treatment of chronic neck pain, upper back pain, shoulder pain, and headaches. Facet joints are used to connect the vertebrae, and they help guide your spine as you move. They are found on both sides of the spine and are named for the vertebrae they connect and the side of the spine in which they are found. For example, the left C2-3 facet joins the 2nd and 3rd vertebrae on the left side of the spine.

Cervical facet joint pain can range from simple muscle tension to severe pain, and is dependent upon the injury and the joint which is affected. The injury can include the cartilage inside the joint itself or just the connecting ligaments surrounding the joint, with pain occurring from your head down to your shoulder blade.

In a cervical facet injection, an anesthetic and steroid are injected into one or more of your cervical facet joints. The benefit of this injection can be twofold. The anesthetic and steroid may be injected to see if they temporarily relieve your pain. If they do, it tells the physician which facet joint is causing your pain (a diagnostic benefit). On the other hand, the steroid is used to treat inflammation of the facet joint (a therapeutic benefit).

The procedure may start with an IV to help you relax and a local anesthetic to numb your skin. The physician then inserts a very thin needle directly into the facet joint. Fluoroscopy, a type of x-ray, is used to ensure proper needle placement; and, a dye may also be injected to make sure the needle is in the correct spot. Once the needle is correctly placed, the physician injects the anesthetic and steroid.

What should I expect after the procedure?
You will be monitored for approximately 30 minutes following the injection, at which time you will be given your discharge instructions and be allowed to leave the clinic. You may notice immediate relief and numbness in your neck for a few hours after the injection, which means the medication has reached the correct spot.

It’s normal for your pain to return after this initial pain-free period; and, it may even worsen for a day or two. This is usually caused by needle irritation. The steroid will start working after a couple days, but can sometimes take up to a week. Relief varies from person to person, and depends on the amount of inflammation involved. Sometimes this injection brings several months of pain relief, and sometimes long-term relief is acquired. You may be able to return to work the following day; but always make sure to consult your physician.

Cervical Intralaminar Epidural Steroid Injection  
This simple procedure is used in the treatment of neck, upper back, shoulder, and arm pain. The cervical section of the spine has seven bones, or vertebrae. Soft discs between these vertebrae hold them together, cushion them, and control motion. If a disc tears, chemicals inside may leak out causing an inflamed nerve root or even a disc bulge. Bone spurs can also press against nerve roots and cause pain.

Neck and/or upper back pain when you move your head may mean cervical disc and dural inflammation. If your pain travels down to your arm, you may have nerve root inflammation. Because tests such as MRI’s may not show a torn or leaking disc, a cervical epidural injection helps determine if disc problems, or dural, or nerve root inflammation are causing your pain.

A cervical epidural steroid injection consists of an anesthetic and a steroid being injected into the epidural space in order to reduce inflammation. This Intralaminar injection is done from the back of the spine, and may begin with an IV to help you relax and a local anesthetic to numb your skin. The physician then inserts a thin needle into the epidural space. Fluoroscopy, a type of x-ray, is used to ensure proper needle placement; and, a dye may also be injected to make sure the needle is in the correct spot. Once the needle is correctly placed, the physician injects the anesthetic and steroid.

What should I expect after the procedure?
You will be monitored for approximately 30 minutes following the injection, at which time you will be given your discharge instructions and be allowed to leave the clinic. You may notice immediate relief and numbness in your neck and arm for a few hours after the injection, which means the medication has reached the correct spot.

It’s normal for your pain to return after this initial pain-free period, and it may even worsen for a day or two. This is usually caused by needle irritation. The steroid will start working after a couple days, but can sometimes take up to a week. Relief varies from person to person, and depends on the amount of inflammation involved. Sometimes this injection brings several months of pain relief, and sometimes long-term relief is acquired. You may be able to return to work the following day, but always make sure to consult your physician.

Cervical Radiofrequency Ablation (RFA)  
This procedure is used to treat chronic upper back, shoulder, and neck pain, and can also be called rhizotomy or cervical facet thermal coagulation. Facet joints are used to connect the vertebrae, and they help guide your spine as you move. They are found on both sides of the spine and are named for the vertebrae they connect and the side of the spine in which they are found. For example, the left C2-3 facet joins the 2nd and 3rd vertebrae on the left side of the spine.

An injured cervical facet joint can cause pain ranging from simple muscle tension to sever pain depending on the severity of the injury and the joint that is affected. The cartilage inside the joint can be injured; other times only connecting ligaments around the joint are injured. This pain can occur anywhere from your head down to your shoulder blade, and usually lasts several months. Because common tests like MRI’s or x-rays don’t always show if a facet joint is causing pain, the best way to diagnose this pain is to block the pain signal in a medial branch nerve.

RFA disrupts nerve function using radiofrequency energy. Done to a medial branch nerve, it cannot transmit pain from the injured joint.

The procedure may start with an IV to help you relax and a local anesthetic to numb your skin. The physician then inserts a very thin needle near the facet joint. Fluoroscopy, a type of x-ray, is used to ensure proper needle placement. The physician then checks to make sure it is at the correct nerve by stimulating it. This may cause muscle twitching. When the needle is in the proper place, that area is numbed. Radiofrequency energy is then used to disrupt the medial branch nerve, which is often repeated at multiple levels of the spine.

What should I expect after the procedure?
You will be monitored for approximately 30 minutes following the injection, at which time you will be given your discharge instructions and be allowed to leave the clinic. You may feel sore for a few days, which is absolutely normal and is usually as a result of muscle and/or nerve irritation. A numb or itchy back for a couple weeks is also normal, with full pain relief coming in 2 – 3 weeks. The nerve will regenerate after an RFA and your pain may or may not return. In the event that your pain does eventually return, another RFA can be performed.

Cervical Selective Nerve Root Blocks  
A cervical selective nerve root block is used in the treatment of neck, upper back, shoulder, and arm pain. The cervical section of the spine has seven bones, or vertebrae. Soft discs between these vertebrae hold them together, cushion them, and control motion. If a disc tears, chemicals inside may leak out causing an inflamed nerve root or even a disc bulge. Bone spurs can also press against nerve roots and cause pain.

Neck and/or upper back pain when you move your head may mean cervical disc and dural inflammation. If your pain travels down to your arm, you may have nerve root inflammation. Because tests such as MRI’s may not show a torn or leaking disc, a cervical epidural injection helps determine if disc problems, or dural, or nerve root inflammation are causing your pain.

This procedure consists of an anesthetic and a steroid being injected into the epidural space in order to reduce inflammation. If the needle is positioned next to an individual nerve root, it’s considered a selective nerve root block and places medication directly along an inflamed nerve root. The injection may begin with an IV to help you relax, and a local anesthetic to numb your skin. The physician then inserts a thin needle into the epidural space. Fluoroscopy, a type of x-ray, is used to ensure proper needle placement; and, a dye may also be injected to make sure the needle is in the correct spot. Once the needle is correctly placed, the physician injects the anesthetic and steroid.

What should I expect after the procedure?
You will be monitored for approximately 30 minutes following the injection, at which time you will be given your discharge instructions and be allowed to leave the clinic. You may notice immediate relief and numbness in your neck and arm for a few hours after the injection, which means the medication has reached the correct spot.

It’s normal for your pain to return after this initial pain-free period, and it may even worsen for a day or two. This is usually caused by needle irritation. The steroid will start working after a couple days, but can sometimes take up to a week. Relief varies from person to person, and depends on the amount of inflammation involved. Sometimes this injection brings several months of pain relief, and sometimes long-term relief is acquired. You may be able to return to work the following day, but always make sure to consult your physician.

Cervical Transforaminal Epidural Steroid Injection  
This procedure is used in the treatment of neck, upper back, shoulder, and arm pain. The cervical section of the spine has seven bones, or vertebrae. Soft discs between these vertebrae hold them together, cushion them, and control motion. If a disc tears, chemicals inside may leak out causing an inflamed nerve root or even a disc bulge. Bone spurs can also press against nerve roots and cause pain.

Neck and/or upper back pain when you move your head may mean cervical disc and dural inflammation. If your pain travels down to your arm, you may have nerve root inflammation. Because tests such as MRI’s may not show a torn or leaking disc, a cervical epidural injection helps determine if disc problems, or dural, or nerve root inflammation are causing your pain.

A cervical epidural steroid injection consists of an anesthetic and a steroid being injected into the epidural space in order to reduce inflammation. When it is done from the side it’s considered a transforaminal injection, and it places the medication near the source of inflammation. The injection may begin with an IV to help you relax, and a local anesthetic to numb your skin. The physician then inserts a thin needle into the epidural space. Fluoroscopy, a type of x-ray, is used to ensure proper needle placement; and, a dye may also be injected to make sure the needle is in the correct spot. Once the needle is correctly placed, the physician injects the anesthetic and steroid.

What should I expect after the procedure?
You will be monitored for approximately 30 minutes following the injection, at which time you will be given your discharge instructions and be allowed to leave the clinic. You may notice immediate relief and numbness in your neck and arm for a few hours after the injection, which means the medication has reached the correct spot.

It’s normal for your pain to return after this initial pain-free period, and it may even worsen for a day or two. This is usually caused by needle irritation. The steroid will start working after a couple days, but can sometimes take up to a week. Relief varies from person to person, and depends on the amount of inflammation involved. Sometimes this injection brings several months of pain relief, and sometimes long-term relief is acquired. You may be able to return to work the following day, but always make sure to consult your physician.

Discogram  
A discogram is a diagnostic test performed to view and assess the internal structure of a disc, and is the most effective test to determine if an intervertebral disc is the source of your pain. MRI scans do not always show tears in discs, and it is impossible to diagnose a painful disc without performing a discogram in addition to other tests. This is the most common point of misunderstanding among patients and physicians alike: X-rays alone cannot tell us where pain is coming from. You will be given medication to help you relax, and a local anesthetic is applied to numb the injection area. However, because this procedure is diagnostic in nature as opposed to treatment for pain, a steroid is not injected. During discography, the physician inserts a needle in the patients back into the center of the disc. Radiographic dye is then injected causing pressure within the disc; and, if injecting the dye recreates the patient’s normal pain, it is then inferred that the specific disc is the source of pain for the patient. If the pain is unlike their normal pain it can be inferred that even though the disc may look degenerative on an MRI scan, it is in fact not the source of the patient’s pain. The discogram can show if a disc is degenerative, if a disc has begun to rupture, or if it has tears in the annulus (outer ring). It is a very valuable diagnostic tool because it increases the success rate of treatments for painful discs by ensuring that only the disc(s) causing pain will be treated.

Will I be “put out” for this procedure?
No. This procedure is performed under local anesthesia. Many patients receive additional sedation, but it’s important that you remain awake during the test in order to tell the doctor what you are feeling.

What should I expect after the procedure?
You will need to arrange for a ride home the day of your procedure. We advise patients to take it easy for a day or so after the test. Perform activities as tolerated by you.

Can I go to work the next day?
We usually recommend taking a couple days off work after the injection.

Who shouldn’t have this injection?
If you are allergic to any of the medications being injected, if you are on a blood thinning medication (Coumadin, Heparin, Plavix), if you are pregnant, or if you have an active infection you should not have this procedure. If you have not responded to local anesthesia you may not be a candidate for this procedure. You should also not have a discogram if you have not already tried simpler treatments such as activity restriction or anti-inflammatory medications.

Epidural Lysis of Adhesion (RACZ procedure)  
Named after Dr. Gabor Racz, the RACZ procedure consists of the physician passing an epidural catheter into the epidural space and injecting medicine directly at the site of the nerve injury in order to decrease pain. Scar tissue formation within the epidural space at any level can become chronic sources of pain generation in patients. This procedure is used to dissolve some of the scar tissue from around entrapped nerves in the epidural space of the spine so medications, such as cortisone, can reach the affected areas. This scarring is most commonly caused from bleeding in the epidural space following back surgery and the subsequent healing process, which is a natural occurrence following surgical intervention. The occurrence and frequency of this scar tissue and the pain that it causes increase with the number of surgical interventions in the same region of a particular patient. After the medications are put into the epidural catheter, the patient is required to exercise daily for the next 4 weeks to prevent reoccurrence of adhesion. Patients must arrange to have a driver escort them home on the day of the procedure.

Will I be “put out” for this procedure?
No. This procedure is done under local anesthesia, as it’s necessary for you to be awake enough to communicate easily during the procedure. The patient may also receive intravenous sedation, making the procedure easy to tolerate.

How is the procedure performed?
It’s done with the patient lying on their stomach. The patient is monitored with an EKG, blood pressure cuff, and blood oxygen monitoring device. The skin on the back is cleaned with antiseptic solution and the procedure is then carried out. Fluoroscopy (x-ray) is used to assist in the placement of the catheter and perform the epidurogram. After the procedure, you are placed on your back or side.

What should I expect after the procedure?
Immediately following the injection, your legs may feel slightly heavy or numb. You may also notice that your pain is gone or significantly diminished. This is due to the local anesthetic and will only last for a few hours.

Can I go to work the next day?
Unless there are complications or you are otherwise informed by the physician, you should be able to return to work the next day. A mildly sore back at this point is normal.

Will the injection need to be repeated?
If the first procedure does not relieve your pain symptoms within a couple weeks, you may be recommended for another procedure. If you respond well to the second procedure and still experience residual pain, you may be recommended for a third. We generally do not perform more than three procedures in any six-month period since the medication injected typically lasts that long. If three procedures have not helped you much, you will not get further benefit from additional RACZ procedures.

Who shouldn’t have this injection?
If you are allergic to any of the medications being injected, if you are on a blood thinning medication (Coumadin, Heparin, Plavix), if you are pregnant, or if you have an active infection you should not have this procedure. If you have not responded to local anesthesia you may not be a candidate for this procedure.

Lumbar Caudal Epidural Steroid Injection  
This procedure is for treating low back and leg pain. The spinal cord and its nerves are protected by a covering called the dura. The space around the dura is called the epidural space. In the lower back, it’s called the lumbar epidural space.

The lumbar section of the spine has five bones, or vertebrae. Soft discs between these vertebrae hold them together, cushion them, and control motion. If a disc tears, chemicals inside may leak out causing an inflamed nerve root or even a disc bulge. Bone spurs can also press against nerve roots and cause pain.

Lower back pain when you bend your back may mean lumbar disc and dural inflammation. If your pain travels to your leg when you move your back, you may have nerve root inflammation. Because tests such as MRI’s may not show a torn or leaking disc, a cervical epidural injection helps determine if disc problems, or dural, or nerve root inflammation are causing your pain.

A lumbar epidural steroid injection consists of an anesthetic and a steroid being injected into the epidural space in order to reduce inflammation. A caudal injection is done from the opening in your tailbone, and is the safest and easiest of the epidural injections. It may begin with an IV to help you relax and a local anesthetic to numb your skin. The physician then inserts a thin needle into the epidural space. Fluoroscopy, a type of x-ray, is used to ensure proper needle placement; and, a dye may also be injected to make sure the needle is in the correct spot. Once the needle is correctly placed, the physician injects the anesthetic and steroid.

What should I expect after the procedure?
You will be monitored for approximately 30 minutes following the injection, at which time you will be given your discharge instructions and be allowed to leave the clinic. You may notice immediate relief and numbness in your back and leg for a few hours after the injection, which means the medication has reached the correct spot.

It’s normal for your pain to return after this initial pain-free period, and it may even worsen for a day or two. This is usually caused by needle irritation. The steroid will start working after a couple days, but can sometimes take up to a week. Relief varies from person to person, and depends on the amount of inflammation involved. Sometimes this injection brings several months of pain relief, and sometimes long-term relief is acquired. You may be able to return to work the following day, but always make sure to consult your physician.

Lumbar Facet Injection  
This procedure is done to treat low back, buttock, groin, and hip pain. Facet joints are used to connect the vertebrae, and they help guide your spine as you move. The lumbar region of the spine is your lower back; and, it contains five vertebrae, each roughly the size of a thumbnail. Lumbar facet joints are found on both sides of the spine and are named for the vertebrae they connect and the side of the spine in which they are found. For example, the left L4-5 joins the 4th and 5th vertebrae on the left side of the spine.

A lumbar joint injury can feel like simple muscle tension or even sever pain. The cause could be an injury to ligaments around the joint or cartilage inside the joint itself. Lumbar facet joint pain occurs from your low back to your buttocks, varies depending on the affected joint or joints, and usually lasts longer than a couple months. Typical diagnostic tests such as MRI’s and x-rays may not show if a facet joint is causing your pain.

The procedure may start with an IV to help you relax and a local anesthetic to numb your skin. The physician then inserts a very thin needle directly into the facet joint. Fluoroscopy, a type of x-ray, is used to ensure proper needle placement; and, a dye may also be injected to make sure the needle is in the correct spot. Once the needle is correctly placed, the physician injects the anesthetic and steroid.

What should I expect after the procedure?
You will be monitored for approximately 30 minutes following the injection, at which time you will be given your discharge instructions and be allowed to leave the clinic. You may notice immediate relief and numbness in your back for a few hours after the injection, which means the medication has reached the correct spot.

It’s normal for your pain to return after this initial pain-free period, and it may even worsen for a day or two. This is usually caused by needle irritation. The steroid will start working after a couple days, but can sometimes take up to a week. Relief varies from person to person, and depends on the amount of inflammation involved. Sometimes this injection brings several months of pain relief, and sometimes long-term relief is acquired. If your pain is caused by injury to multiple areas, it’s possible that only some of the symptoms may respond. You may be able to return to work the following day, but always make sure to consult your physician.

Lumbar Intralaminar Epidural Steroid Injection  
This simple procedure is used in the treatment of lower back and leg pain. The lumbar section of the spine has five bones, or vertebrae. Soft discs between these vertebrae hold them together, cushion them, and control motion. If a disc tears, chemicals inside may leak out causing an inflamed nerve root or even a disc bulge. Bone spurs can also press against nerve roots and cause pain.

Lower back pain when you move you bend may mean cervical disc and dural inflammation. If your pain travels to your leg, you may have nerve root inflammation. Because tests such as MRI’s may not show a torn or leaking disc, a cervical epidural injection helps determine if disc problems, or dural, or nerve root inflammation are causing your pain.

A lumbar epidural steroid injection consists of an anesthetic and a steroid being injected into the epidural space in order to reduce inflammation. This Intralaminar injection is done from the back of the spine, and may begin with an IV to help you relax and a local anesthetic to numb your skin. The physician then inserts a thin needle into the epidural space. Fluoroscopy, a type of x-ray, is used to ensure proper needle placement; and, a dye may also be injected to make sure the needle is in the correct spot. Once the needle is correctly placed, the physician injects the anesthetic and steroid.

What should I expect after the procedure?
You will be monitored for approximately 30 minutes following the injection, at which time you will be given your discharge instructions and be allowed to leave the clinic. You may notice immediate relief and numbness in your neck and arm for a few hours after the injection, which means the medication has reached the correct spot.

It’s normal for your pain to return after this initial pain-free period, and it may even worsen for a day or two. This is usually caused by needle irritation. The steroid will start working after a couple days, but can sometimes take up to a week. Relief varies from person to person, and depends on the amount of inflammation involved. Sometimes this injection brings several months of pain relief, and sometimes long-term relief is acquired. You may be able to return to work the following day, but always make sure to consult your physician.

Lumbar Medial Branch Block  
A lumbar medial branch block is used in diagnosing and treating low back, hip, buttock, and groin pain. Facet joints are used to connect the vertebrae, and they help guide your spine as you move. They are found on both sides of the spine and are named for the vertebrae they connect and the side of the spine in which they are found. For example, the left L4-5 facet joins the 4th and 5th lumbar vertebrae on the left side of the spine.

Medial branch nerves are found near facet joints, and transmit pain signals from the facet joints to the brain.

Lumbar facet joint pain can range from simple muscle tension to severe pain, and is dependent upon the injury and the joint which is affected. The injury can include the cartilage inside the joint itself or just the connecting ligaments surrounding the joint, with pain occurring from your lower back down to your buttocks.

In a lumbar medial branch block, an anesthetic is injected near the medial branch nerve. This stops the transmission of pain signals from the facet joint. If this relieves or reduces your pain and helps you move your back normally, it tells the physician which facet joint is causing your pain.

The procedure may start with an IV to help you relax and a local anesthetic to numb your skin. The physician then inserts a very thin needle near the facet joint. Fluoroscopy, a type of x-ray, is used to ensure proper needle placement; and, a dye may also be injected to make sure the needle is in the correct spot. Once the needle is correctly placed, the physician injects the anesthetic.

What should I expect after the procedure?
You will be monitored for approximately 30 minutes following the injection, at which time you will be given your discharge instructions and be allowed to leave the clinic. You may notice immediate relief and numbness in your back for a few hours after the injection, which means the medication has reached the correct spot.

Relief varies from person to person, and depends on the amount of inflammation involved, as well as the number of injured areas. If your pain subsides for a short time only to return, you may be a good candidate for radiofrequency ablation (RFA) to the medial branch nerve, which can provide a more permanent disruption of pain signals.

Lumbar Radiofrequency Ablation (RFA)  
This procedure is used to treat chronic low back pain, and can also be called rhizotomy or lumbar facet thermal coagulation. Facet joints are used to connect the vertebrae, and they help guide your spine as you move. They are found on both sides of the spine and are named for the vertebrae they connect and the side of the spine in which they are found. For example, the left C2-3 facet joins the 2nd and 3rd vertebrae on the left side of the spine.

An injured lumbar facet joint can cause pain ranging from simple muscle tension to sever pain depending on the severity of the injury and the joint that is affected. The cartilage inside the joint can be injured; other times only connecting ligaments around the joint are injured. This pain can occur anywhere from your lower back down to your buttocks, and usually lasts several months. Because common tests like MRI’s or x-rays don’t always show if a facet joint is causing pain, the best way to diagnose this pain is to block the pain signal in a medial branch nerve.

RFA disrupts nerve function using radiofrequency energy. Done to a lumbar medial branch nerve, it cannot transmit pain from the injured joint.

The procedure may start with an IV to help you relax and a local anesthetic to numb your skin. The physician then inserts a very thin needle near the facet joint. Fluoroscopy, a type of x-ray, is used to ensure proper needle placement. The physician then checks to make sure it is at the correct nerve by stimulating it. This may cause muscle twitching. When the needle is in the proper place, that area is numbed. Radiofrequency energy is then used to disrupt the medial branch nerve, which is often repeated at multiple levels of the spine.

What should I expect after the procedure?
You will be monitored for approximately 30 minutes following the injection, at which time you will be given your discharge instructions and be allowed to leave the clinic. You may feel sore for a few days, which is absolutely normal and is usually as a result of muscle and/or nerve irritation. A numb or itchy back for a couple weeks is also normal, with full pain relief coming in 2 – 3 weeks. The nerve will regenerate after an RFA and your pain may or may not return. In the event that your pain does eventually return, another RFA can be performed.

Lumbar Selective Nerve Root Block  
A lumbar selective nerve root block is used in the treatment of lower back and leg pain. The lumbar section of the spine has five bones, or vertebrae. Soft discs between these vertebrae hold them together, cushion them, and control motion. If a disc tears, chemicals inside may leak out causing an inflamed nerve root or even a disc bulge. Bone spurs can also press against nerve roots and cause pain.

Lower back pain when you bend your back may mean lumbar disc and dural inflammation. If your pain travels to your leg, you may have nerve root inflammation. Because tests such as MRI’s may not show a torn or leaking disc, a cervical epidural injection helps determine if disc problems, or dural, or nerve root inflammation are causing your pain.

This procedure consists of an anesthetic and a steroid being injected into the epidural space in order to reduce inflammation. If the needle is positioned next to an individual nerve root, it’s considered a selective nerve root block and places medication directly along an inflamed nerve root. The injection may begin with an IV to help you relax, and a local anesthetic to numb your skin. The physician then inserts a thin needle into the epidural space. Fluoroscopy, a type of x-ray, is used to ensure proper needle placement; and, a dye may also be injected to make sure the needle is in the correct spot. Once the needle is correctly placed, the physician injects the anesthetic and steroid.

What should I expect after the procedure?
You will be monitored for approximately 30 minutes following the injection, at which time you will be given your discharge instructions and be allowed to leave the clinic. You may notice immediate relief and numbness in your back and leg for a few hours after the injection, which means the medication has reached the correct spot.

It’s normal for your pain to return after this initial pain-free period, and it may even worsen for a day or two. This is usually caused by needle irritation. The steroid will start working after a couple days, but can sometimes take up to a week. Relief varies from person to person, and depends on the amount of inflammation involved. Sometimes this injection brings several months of pain relief, and sometimes long-term relief is acquired. You may be able to return to work the following day, but always make sure to consult your physician.

Lumbar Transforaminal Epidural Steroid Injection  
A lumbar transforaminal epidural steroid injection is used to treat pain in lower back and leg. The spinal cord and its nerves are protected by a covering called the dura. The space around the dura is called the epidural space. The thoracic area of the spine has twelve bones, or vertebrae. Soft discs between these vertebrae hold them together, cushion them, and control motion. If a disc tears, chemicals inside may leak out causing an inflamed nerve root or even a disc bulge. Bone spurs can also press against nerve roots and cause pain.

Lower back pain when you bend your back may mean lumbar disc and dural inflammation. If your pain travels to your leg when you bend, you may have nerve root inflammation. Because tests such as MRI’s may not show a torn or leaking disc, a thoracic epidural injection helps determine if disc problems, or dural, or nerve root inflammation are causing your pain.

A lumbar epidural steroid injection consists of an anesthetic and a steroid being injected into the epidural space in order to reduce inflammation. When it is done from the side it’s considered a transforaminal injection, and it places the medication near the source of inflammation. The injection may begin with an IV to help you relax, and a local anesthetic to numb your skin. The physician then inserts a thin needle into the epidural space. Fluoroscopy, a type of x-ray, is used to ensure proper needle placement; and, a dye may also be injected to make sure the needle is in the correct spot. Once the needle is correctly placed, the physician injects the anesthetic and steroid.

What should I expect after the procedure?
You will be monitored for approximately 30 minutes following the injection, at which time you will be given your discharge instructions and be allowed to leave the clinic. You may notice immediate relief and numbness in your back and leg for a few hours after the injection, which means the medication has reached the correct spot.

It’s normal for your pain to return after this initial pain-free period, and it may even worsen for a day or two. This is usually caused by needle irritation. The steroid will start working after a couple days, but can sometimes take up to a week. Relief varies from person to person, and depends on the amount of inflammation involved. Sometimes this injection brings several months of pain relief, and sometimes long-term relief is acquired. You may be able to return to work the following day, but always make sure to consult your physician.

Spinal Cord Stimulation  
Spinal Cord Stimulation is an advanced treatment for chronic pain where pain is being blocked from effectively reaching the brain through interference with the spinal transmission of pain signals. It uses low-level electrical impulses to stimulate targeted nerves along the spine. When successful, painful sensations are replaced with what some patients describe as a more pleasing sensation—called parasthesia. Spinal Cord Stimulation requires a minor surgical procedure to implant the system components. During the procedure, one or more leads are placed in the epidural space (the space just above the spinal cord). The leads contain electrodes that produce the electrical signals that result in stimulation. The leads are then connected to a small electronic device placed just under the skin.

Thoracic Facet Injection  
This procedure is done to treat middle and upper back pain. Facet joints are used to connect the vertebrae, and they help guide your spine as you move. The thoracic region of the spine is between your neck and lower back, and it contains twelve vertebrae, each roughly the size of a thumbnail. Thoracic facet joints are found on both sides of the spine and are named for the vertebrae they connect and the side of the spine in which they are found. For example, the left T-4-5 joins the 4th and 5th vertebrae on the left side of the spine.

A thoracic joint injury can feel like simple muscle tension or even sever pain. The cause could be an injury to ligaments around the joint or cartilage inside the joint itself. Thoracic facet joint pain occurs from the upper back and shoulders to the hips, varies depending on the affected joint or joints, and usually lasts longer than a couple months. Typical diagnostic tests such as MRI’s and x-rays may not show if a facet joint is causing your pain.

The procedure may start with an IV to help you relax and a local anesthetic to numb your skin. The physician then inserts a very thin needle directly into the facet joint. Fluoroscopy, a type of x-ray, is used to ensure proper needle placement; and, a dye may also be injected to make sure the needle is in the correct spot. Once the needle is correctly placed, the physician injects the anesthetic and steroid.

What should I expect after the procedure?
You will be monitored for approximately 30 minutes following the injection, at which time you will be given your discharge instructions and be allowed to leave the clinic. You may notice immediate relief and numbness in your back for a few hours after the injection, which means the medication has reached the correct spot.

It’s normal for your pain to return after this initial pain-free period, and it may even worsen for a day or two. This is usually caused by needle irritation. The steroid will start working after a couple days, but can sometimes take up to a week. Relief varies from person to person, and depends on the amount of inflammation involved. Sometimes this injection brings several months of pain relief, and sometimes long-term relief is acquired. If your pain is caused by injury to multiple areas, it’s possible that only some of the symptoms may respond. You may be able to return to work the following day, but always make sure to consult your physician.

Thoracic Intralaminar Epidural Steroid Injection  
This procedure is used to treat chronic upper and middle back pain, and can also be called rhizotomy or thoracic facet thermal coagulation. Facet joints are used to connect the vertebrae, and they help guide your spine as you move. They are found on both sides of the spine and are named for the vertebrae they connect and the side of the spine in which they are found. For example, the left C2-3 facet joins the 2nd and 3rd vertebrae on the left side of the spine.

An injured thoracic facet joint can cause pain ranging from simple muscle tension to sever pain depending on the severity of the injury and the joint that is affected. The cartilage inside the joint can be injured; other times only connecting ligaments around the joint are injured. This pain can occur anywhere from your upper back and shoulder down to your hips, and usually lasts several months. Because common tests like MRI’s or x-rays don’t always show if a facet joint is causing pain, the best way to diagnose this pain is to block the pain signal in a medial branch nerve.

RFA disrupts nerve function using radiofrequency energy. Done to a medial branch nerve, it cannot transmit pain from the injured joint.

The procedure may start with an IV to help you relax and a local anesthetic to numb your skin. The physician then inserts a very thin needle near the facet joint. Fluoroscopy, a type of x-ray, is used to ensure proper needle placement. The physician then checks to make sure it is at the correct nerve by stimulating it. This may cause muscle twitching. When the needle is in the proper place, that area is numbed. Radiofrequency energy is then used to disrupt the medial branch nerve, which is often repeated at multiple levels of the spine.

What should I expect after the procedure?
You will be monitored for approximately 30 minutes following the injection, at which time you will be given your discharge instructions and be allowed to leave the clinic. You may feel sore for a few days, which is absolutely normal and is usually as a result of muscle and/or nerve irritation. A numb or itchy back for a couple weeks is also normal, with full pain relief coming in 2 – 3 weeks. The nerve will regenerate after an RFA and your pain may or may not return. In the event that your pain does eventually return, another RFA can be performed.

Thoracic Medial Branch Block  
A thoracic medial branch block is used in diagnosing and treating upper and middle back pain. Facet joints are used to connect the vertebrae, and they help guide your spine as you move. They are found on both sides of the spine and are named for the vertebrae they connect and the side of the spine in which they are found. For example, the left T4-5 facet joins the 4th and 5th thoracic vertebrae on the left side of the spine.

Medial branch nerves are found near facet joints, and transmit pain signals from the facet joints to the brain.

Thoracic facet joint pain can range from simple muscle tension to severe pain, and is dependent upon the injury and the joint which is affected. The injury can include the cartilage inside the joint itself or just the connecting ligaments surrounding the joint, with pain occurring from your head down to your shoulder blade.

In a thoracic medial branch block, an anesthetic is injected near the medial branch nerve. This stops the transmission of pain signals from the facet joint. If this relieves or reduces your pain and improves your necks mobility, it tells the physician which facet joint is causing your pain.

The procedure may start with an IV to help you relax and a local anesthetic to numb your skin. The physician then inserts a very thin needle directly into the facet joint. Fluoroscopy, a type of x-ray, is used to ensure proper needle placement; and, a dye may also be injected to make sure the needle is in the correct spot. Once the needle is correctly placed, the physician injects the anesthetic.

What should I expect after the procedure?
You will be monitored for approximately 30 minutes following the injection, at which time you will be given your discharge instructions and be allowed to leave the clinic. You may notice immediate relief and numbness in your back for a few hours after the injection, which means the medication has reached the correct spot.

Relief varies from person to person, and depends on the amount of inflammation involved, as well as the number of injured areas. If your pain subsides for a short time only to return, you may be a good candidate for radiofrequency ablation (RFA) to the medial branch nerve, which can provide a more permanent disruption of pain signals.

Thoracic Radiofrequency Ablation (RFA)  
This procedure is used to treat chronic upper and middle back pain, and can also be called rhizotomy or thoracic facet thermal coagulation. Facet joints are used to connect the vertebrae, and they help guide your spine as you move. They are found on both sides of the spine and are named for the vertebrae they connect and the side of the spine in which they are found. For example, the left C2-3 facet joins the 2nd and 3rd vertebrae on the left side of the spine.

An injured thoracic facet joint can cause pain ranging from simple muscle tension to sever pain depending on the severity of the injury and the joint that is affected. The cartilage inside the joint can be injured; other times only connecting ligaments around the joint are injured. This pain can occur anywhere from your upper back and shoulder down to your hips, and usually lasts several months. Because common tests like MRI’s or x-rays don’t always show if a facet joint is causing pain, the best way to diagnose this pain is to block the pain signal in a medial branch nerve.

RFA disrupts nerve function using radiofrequency energy. Done to a medial branch nerve, it cannot transmit pain from the injured joint.

The procedure may start with an IV to help you relax and a local anesthetic to numb your skin. The physician then inserts a very thin needle near the facet joint. Fluoroscopy, a type of x-ray, is used to ensure proper needle placement. The physician then checks to make sure it is at the correct nerve by stimulating it. This may cause muscle twitching. When the needle is in the proper place, that area is numbed. Radiofrequency energy is then used to disrupt the medial branch nerve, which is often repeated at multiple levels of the spine.

What should I expect after the procedure?
You will be monitored for approximately 30 minutes following the injection, at which time you will be given your discharge instructions and be allowed to leave the clinic. You may feel sore for a few days, which is absolutely normal and is usually as a result of muscle and/or nerve irritation. A numb or itchy back for a couple weeks is also normal, with full pain relief coming in 2 – 3 weeks. The nerve will regenerate after an RFA and your pain may or may not return. In the event that your pain does eventually return, another RFA can be performed.

Thoracic Selective Nerve Root Block  
A thoracic selective nerve root block is used in the treatment of neck, upper back, shoulder, and arm pain. The thoracic section of the spine has twelve bones, or vertebrae. Soft discs between these vertebrae hold them together, cushion them, and control motion. If a disc tears, chemicals inside may leak out causing an inflamed nerve root or even a disc bulge. Bone spurs can also press against nerve roots and cause pain.

Upper back pain when you move your head may mean thoracic disc and dural inflammation. If your pain travels to the front of your chest, you may have nerve root inflammation. Because tests such as MRI’s may not show a torn or leaking disc, a cervical epidural injection helps determine if disc problems, or dural, or nerve root inflammation are causing your pain.

This procedure consists of an anesthetic and a steroid being injected into the epidural space in order to reduce inflammation. If the needle is positioned next to an individual nerve root, it’s considered a selective nerve root block and places medication directly along an inflamed nerve root. The injection may begin with an IV to help you relax, and a local anesthetic to numb your skin. The physician then inserts a thin needle into the epidural space. Fluoroscopy, a type of x-ray, is used to ensure proper needle placement; and, a dye may also be injected to make sure the needle is in the correct spot. Once the needle is correctly placed, the physician injects the anesthetic and steroid.

What should I expect after the procedure?
You will be monitored for approximately 30 minutes following the injection, at which time you will be given your discharge instructions and be allowed to leave the clinic. You may notice immediate relief and numbness in your neck and arm for a few hours after the injection, which means the medication has reached the correct spot.

It’s normal for your pain to return after this initial pain-free period, and it may even worsen for a day or two. This is usually caused by needle irritation. The steroid will start working after a couple days, but can sometimes take up to a week. Relief varies from person to person, and depends on the amount of inflammation involved. Sometimes this injection brings several months of pain relief, and sometimes long-term relief is acquired. You may be able to return to work the following day, but always make sure to consult your physician.

Thoracic Transforaminal Epidural Steroid Injection  
A thoracic transforaminal epidural steroid injection is used to treat pain in the upper and middle back. The spinal cord and its nerves are protected by a covering called the dura. The space around the dura is called the epidural space. The thoracic area of the spine has twelve bones, or vertebrae. Soft discs between these vertebrae hold them together, cushion them, and control motion. If a disc tears, chemicals inside may leak out causing an inflamed nerve root or even a disc bulge. Bone spurs can also press against nerve roots and cause pain.

Upper back pain when you move your head may mean thoracic disc and dural inflammation. If your pain travels to the front of your chest, you may have nerve root inflammation. Because tests such as MRI’s may not show a torn or leaking disc, a thoracic epidural injection helps determine if disc problems, or dural, or nerve root inflammation are causing your pain.

A thoracic epidural steroid injection consists of an anesthetic and a steroid being injected into the epidural space in order to reduce inflammation. When it is done from the side it’s considered a transforaminal injection, and it places the medication near the source of inflammation. The injection may begin with an IV to help you relax, and a local anesthetic to numb your skin. The physician then inserts a thin needle into the epidural space. Fluoroscopy, a type of x-ray, is used to ensure proper needle placement; and, a dye may also be injected to make sure the needle is in the correct spot. Once the needle is correctly placed, the physician injects the anesthetic and steroid.

What should I expect after the procedure?
You will be monitored for approximately 30 minutes following the injection, at which time you will be given your discharge instructions and be allowed to leave the clinic. You may notice immediate relief and numbness in your neck and arm for a few hours after the injection, which means the medication has reached the correct spot.

It’s normal for your pain to return after this initial pain-free period, and it may even worsen for a day or two. This is usually caused by needle irritation. The steroid will start working after a couple days, but can sometimes take up to a week. Relief varies from person to person, and depends on the amount of inflammation involved. Sometimes this injection brings several months of pain relief, and sometimes long-term relief is acquired. You may be able to return to work the following day, but always make sure to consult your physician.