Spinal injections can be very helpful for patients looking for pain relief without surgery. All of our spinal injections are performed by my partners who are both anesthesiologists. They have advanced training in spinal injections and are very experienced. Modern spinal injections are performed with IV sedation to reduce patient anxiety. We also use fluoroscopy (X-Ray) to see the spine clearly and confirm that the injection is completed safely.
If you undergo a spinal injection our nurse will place a small IV in your hand and the injection doctor will give you a mild sedative to make you relaxed. He then confirms the target area for your injection with a fluoroscopy or x-ray picture. He then numbs the skin and deep tissue with lidocaine and proceeds to place a combination of both local anesthetic and a small amount of cortisone around the spinal area of concern. We keep you in our recovery area for 30-60 minutes to make sure you are comfortable before going home.
Epidural/ Selective Nerve Root Block
An epidural injection is usually most effective for nerve pain that radiates into either your arm (cervical/neck) or leg (lumbar/low back). A herniated disc or nerve compression from spinal stenosis can be treated with an epidural injection prior to considering surgery. Even if it provides temporary relief it can help me confirm the location of your pain (since we do them with X-ray confirmation of the spinal level).
Facet Joint Injection/ Medial Branch Block
The facet joints are located along the side of the spine from neck to low back. These are joints that chiropractors often adjust and can be a source of pain. They are frequently injured in the neck after car accidents and can be a contributing source of whiplash symptoms. The medial branch nerve supplies the facet joint so we frequently inject both the joint itself and block the nerve to treat injury and inflammation of the facet joints.
Facet Joint Neurotomy/ Rhizotomy
A neurotomy is a more permanent blockade of the facet joint. Once we confirm the exact location of the painful joints with Medial Branch Blocks or Facet Joint Injections, we can offer you a neurotomy or rhizotomy. The injection doctor performs the same targeted localization as was done for the injection but instead of injecting cortisone he uses a needle with a special tip which can heat up. With the tip against the Medial Branch nerve to the joint he energizes the needle (remember you have local anesthetic and IV sedation!) and it cauterizes the nerve to deaden it. Good results from a facet rhizotomy can often last 6 months or longer.