Epidural Injections

Epidural steroid injections (ESIs) are a commonly used treatment for chronic pain in the back, neck, and legs. ESIs involve the injection of a steroid medication and a local anesthetic into the epidural space, which is the area outside the protective covering of the spinal cord. The goal of ESIs is to reduce inflammation and swelling in the area, which in turn can help to relieve pain.

There are two main types of ESIs: interlaminar epidural injections and transforaminal epidural injections.

Interlaminar epidural injections are given into the middle layer of the epidural space and are typically used to treat pain in the lower back and legs. This type of injection is delivered using a larger needle and covers a broader area, which makes it well-suited for treating widespread pain in the lower back and legs.

Transforaminal epidural injections are delivered into a specific nerve root that is causing pain, typically in the neck or lower back. The needle used for this type of injection is smaller, which allows for more precise targeting of the affected nerve root. Transforaminal epidural injections are often used for more specific pain patterns, such as sciatica, or for individuals who have failed to respond to other types of treatment.

Both interlaminar and transforaminal epidural injections have similar risks and side effects, including headaches, infection, and nerve damage. However, transforaminal epidural injections have a slightly higher risk of nerve damage, as the needle is inserted closer to the nerve roots.

It is important to discuss the benefits and risks of ESIs with your healthcare provider to determine if this type of treatment is appropriate for you. Factors such as the severity and location of pain, your overall health, and the effectiveness of other treatments will be taken into consideration when making this decision.

Epidural Steroid Injection Video

Lumbar Facet Injections and Lumbar Medial Branch Blocks

Lumbar Facet Injection

Lumbar facet injection is a procedure that involves injecting medication into the lumbar facet joints of the spine. The facet joints are located between the vertebrae and provide stability to the spine. These injections can be used to diagnose the source of low back pain, as well as provide relief from pain and inflammation.

The procedure starts with the patient lying on their stomach or side. The skin over the injection site is cleaned, and a local anesthetic is applied to numb the area. The healthcare provider will then use x-ray guidance to direct a needle to the facet joint. A contrast dye is usually injected to confirm proper placement of the needle. The medication, typically a combination of a corticosteroid and an anesthetic, is then injected into the joint.

Lumbar Medial Branch Block

A lumbar medial branch block is a diagnostic procedure used to determine the source of low back pain. This procedure involves injecting a local anesthetic into the medial branch nerves, which are responsible for transmitting pain signals from the lumbar facet joints.

The procedure starts with the patient lying on their stomach or side. The skin over the injection site is cleaned, and a local anesthetic is applied to numb the area. The healthcare provider will then use x-ray guidance to direct a needle to the medial branch nerve. A contrast dye is usually injected to confirm proper placement of the needle. The local anesthetic is then injected into the nerve to block the transmission of pain signals.

If the patient experiences relief from the pain following the injection, it is considered evidence that the lumbar facet joints are the source of the pain. This information can then be used to develop a more specific treatment plan for the patient's low back pain. 

Once the facet joint is identified as a source of low back pain, a specific treatment modality called Radiofrequency Ablation (RFA) can be applied to provider longer term relief. This procedure targets and lesions the medial branch nerve which innervates the facet joint.

Radiofrequency ablation (RFA)

Radiofrequency ablation (RFA) is a minimally invasive procedure used to treat chronic pain. The procedure uses heat generated by radio waves to destroy nerve tissue, reducing the transmission of pain signals to the brain. RFA can be used to treat low back pain, neck pain, headaches, and knee pain.

For low back pain and neck pain, the procedure is typically performed using x-ray guidance to direct the RFA needle to the affected nerve. The patient may be given a local anesthetic or sedative to reduce discomfort during the procedure. The RFA needle is then inserted into the nerve and radiofrequency energy is applied to destroy the nerve tissue.

For headaches, the RFA procedure is usually performed on the nerves responsible for transmitting pain signals from the head and neck. The procedure may be performed on the occipital nerves, which are located at the back of the head, or the trigeminal nerves, which are located near the temples.

For knee pain, the RFA procedure is typically performed on the nerves responsible for transmitting pain signals from the knee joint. The procedure may be performed using x-ray guidance to direct the RFA needle to the affected nerve.

After the procedure, the patient can usually return home the same day. Pain relief from RFA can take several days to several weeks to take effect. Most patients experience significant pain relief for several months to a year after the procedure. Repeat RFA procedures may be needed to maintain pain relief.

It is important to discuss the risks and benefits of RFA with a healthcare provider to determine if it is an appropriate treatment option for your pain.

Corticosteroid Injections (CSI)

Corticosteroid injections, also known as steroid injections, are a common treatment option for a variety of conditions that involve inflammation and pain. These injections deliver a powerful anti-inflammatory medication directly to the affected area, providing fast and effective relief from symptoms.

Corticosteroid injections are often used to treat conditions such as arthritis, tendinitis, bursitis, and certain types of back and joint pain. They can also be used to treat inflammatory conditions such as carpal tunnel syndrome, tennis elbow and other types of peripheral nerve entrapment.

The procedure for a corticosteroid injection is usually quick and relatively simple. Your healthcare provider will clean the skin over the injection site and numb the area with a local anesthetic. They will then use a fine needle to inject the medication into the affected joint or tissue.

Corticosteroid injections are generally safe and well-tolerated, with a low risk of serious side effects. However, as with any medical procedure, there are potential risks, including infection, bleeding, and nerve damage.

It's important to keep in mind that corticosteroid injections are not a permanent cure, and its effects may wear off over time. It's important to follow-up with the healthcare provider to assess the results of the injection and to determine if further treatments are needed.

If you are experiencing pain or inflammation caused by a chronic condition, it is important to speak with a healthcare professional to determine if a corticosteroid injection is the right treatment option for you. They can help you understand the potential risks and benefits and suggest the most appropriate course of action.