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Injections

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Injections

Our physicians are experts in the placement of medications at specific locations of the spine, nervous system, joints, peripheral nerves, and soft tissues. This is done to treat pain syndromes, or to diagnose the problem that might be causing pain. Injections are performed in the office, and some at an outpatient surgical facility. Many of the procedures are performed with fluoroscopy, a type of x-ray, so that the needle can be directed specifically to the site in question. If the patient desires, a mild sedative can be given for maximum comfort and relaxation. The patient should expect a discussion of the purpose, risks, side effects, complications, and desired results of injection procedures. When indicated, the following procedures are expertly performed by our physicians.

Diagnostic Discography



Discography, also called discogram, is a diagnostic procedure used to determine if back pain is caused by one or more discs. The procedure involves pressurizing discs with an injection of sterile liquid to induce pain in the affected discs. Discography helps the pain specialist plan a course of treatment. Patient’s lie either on their side or stomach on a table equipped with a fluoroscopic (x-ray) unit. An intravenous (IV) line administers medication that relaxes the patient. It is important for patients to be awake enough to tell the doctor what they are feeling. A local anesthetic numbs the skin and all the tissue down to the disc area. Using fluoroscopy to identify the correct location, the doctor inserts a guide needle through the anesthetized track to the outer edge of the disc. A smaller needle is inserted through the guide needle into the center of the disc. This may be repeated for more than one disc. Once all the needles are placed, the discs are pressurized one at a time with injections of contrast dye. With each injection, patients feel either pressure or pain. If pain is felt, it is important for patients to compare it to the pain they had been experiencing. If it is the same, this may indicate a diseased disc. After each disc is tested, images are taken with the fluoroscopic unit. The needles are removed. Patients may be taken for a CT scan to obtain additional images of the inside of the discs. (www.viewmedica.com)

Epidural Steroid Injections

CERVICAL (neck)


LUMBAR (back)



Epidural steroid injections can be performed in the cervical, thoracic, and lumbar regions in order to alleviate neck pain, arm pain, back pain, and leg pain due to pinched nerve(s) in the spine. The medication used in the injection decreases inflammation associated with spinal stenosis or herniated discs. The patient is brought to the procedure room and sedated, typically with a combination of a pain reliever and relaxant. The area to be injected is numbed with local anesthetic. X-ray is used to guide needle placement in order to ensure proper delivery of the medication. A midline (translaminar) approach is always used in the cervical region, but a lumbar injection can be done either midline or from the sides (transforaminal). Contrast dye is used to ensure needle placement on X-ray and a mixture of steroid and local anesthetic is injected near the nerve root. Once the procedure is completed, the patient is brought into the recovery room for 30 minutes, provided with food and drink, and given post-treatment instructions. Typically, the injections occur in a series of three with each injection separated by 2 weeks. Results may last a few weeks, months, or years, depending on the severity of the underlying problem. The goal of the injection is to reduce the pain to allow the patient to remain active and perform all necessary functions.

Sympathetic Ganglion Block : Stellate and Lumbar



The stellate ganglion is a collection of nerve cell bodies in the sympathetic nervous system located in the neck while the lumbar sympathetic ganglion is located in the low back. When activated, the sympathetic nervous system can constrict blood vessels, increase sweat production, and halt digestion, to just name a few. These nerves can become affected, as in Complex Regional Pain Syndrome (CRPS, also known as Reflex Sympathetic Dystrophy), or Herpes Zoster (also known as Shingles). The patient is brought to the procedure room and sedated, typically with a combination of a pain reliever and a relaxant. The area to be injected is numbed with local anesthetic. X-ray is used to guide needle placement in order to ensure proper delivery of the medication. Contrast dye is used to ensure needle placement on X-ray and a mixture of steroid and local anesthetic is injected near the nerves. Once the procedure is completed, the patient is brought into the recovery room for 30 minutes, provided with food and drink, and given post-treatment instructions.

Sympathetic Plexus Blocks – Celiac and Hypogastric


Trigger Point Injections



A trigger point is a “knot” within a muscle that forms when a muscle contracts or spasms for an extended period of time. Trigger points can cause pain in the exact location where they are located or refer pain to another area of the body. On most occasions, they can be felt as a bump underneath the skin. In addition to stretching, massage, and physical therapy, the trigger points can be injected with either local anesthetic alone or with the addition of steroid. The combination of medication as well as “needling” (moving the needle in different directions around the trigger point) help allow the muscle to relax and the trigger point to resolve. These injections can be done in the office exam room without sedation. Once injected, the patient is instructed to stretch while the anesthetic is in effect as well as to ice the areas injected to prevent any soreness that may develop the following day.

Facet Joint Injections



Facet joints, also known as hypoapophysesal joints, connect the vertebrae together and are located on each side of the spine so that a vertebrae above is connected to the one directly below. These joints are frequently prone to arthritis, can enlarge, and cause significant pain in the neck, thorax, or low back. Steroid can be injected directly into the joint to help decrease inflammation associated with arthritis. Another option to alleviate pain originating from the facet joints would be Medial Branch Blocks. The medial branch nerves give sensation to the joint and can be blocked by injecting local anesthetic onto them. This second procedure can be therapeutic, allowing long lasting pain relief, or diagnostic to confirm that the patient’s pain is from the facet joints. The patient is brought to the procedure room and sedated, typically with a combination of a pain reliever and relaxant. The area to be injected is numbed with local anesthetic. X-ray is used to guide needle placement in order to ensure proper delivery of the medication. Contrast dye is used to ensure needle placement on X-ray and a mixture of steroid and local anesthetic is injected near the nerve root. Once the procedure is completed, the patient is brought into the recovery room for 30 minutes, provided with food and drink, and given post-treatment instructions.

Video for Cervical Nerve Block


Peripheral Nerve Blocks

A peripheral nerve block consists of injecting a mixture of corticosteroid and local anesthetic on a nerve to help reduce inflammation and alleviate pain. It can also be used as a diagnostic study to determine the source of a patient’s pain. This form of treatment is typically used to treat pain from Herpes Zoster (Shingles), Reflex Sympathetic Dystrophy (also known as Complex Regional Pain Syndrome), and meralgia paresthetica to name a few. The patient is brought to the procedure room and sedated, typically with a combination of a pain reliever and relaxant. The area to be injected is numbed with local anesthetic. X-ray is used to guide needle placement in order to ensure proper delivery of the medication. Contrast dye is used to ensure needle placement on X-ray and a mixture of steroid and local anesthetic is injected near the nerve root. Once the procedure is completed, the patient is brought into the recovery room for 30 minutes, provided with food and drink, and given post-treatment instructions.

Occipital Nerve Blocks

The occipital nerves consist of the greater and lesser occipital nerves that exit out of the spinal cord near the second occipital vertebrae. These nerves provide sensation to the back of the head, also known as the occipital region, and up to the top of the head, or the vertex. When arthritis occurs to the second vertebrae or there is trauma to the back of the head, the nerves can become irritated and inflamed causing headaches to the back and top of the head. An occipital nerve block consists of an injection with a mixture of corticosteroid and local anesthetic to reduce inflammation and alleviate pain. The patient is brought to the procedure room and sedated, typically with a combination of a pain reliever and relaxant. The area to be injected is numbed with local anesthetic. X-ray is used to guide needle placement in order to ensure proper delivery of the medication. Contrast dye is used to ensure needle placement on X-ray and a mixture of steroid and local anesthetic is injected near the nerve root. Once the procedure is completed, the patient is brought into the recovery room for 30 minutes, provided with food and drink, and given post-treatment instructions.

Major Joint or Bursal Injections

Major joints in the body (i.e., shoulder, hip, knee) are frequently prone to arthritis as we age. Arthritic joints become inflamed, painful, and stiff. In addition to oral medications like nonsteroidal anti-inflammatories (NSAIDs) or topical ointments, the joints can be injected with corticosteroid to decrease inflammation and allow for greater ease of movement without pain. Typically, joints can be injected without the use of dye, X-ray, or ultrasound for needle guidance, but imaging techniques may be used to ensure proper needle placement. The area around the joint is sterilized and the joint is injected with either corticosteroid alone or with the addition of local anesthetic. Patients are free to resume normal activity following the injection. Typically, a major joint can only be injected with steroid 3-4 times in a year.

Bursa are fluid filled sacs that line the inside of joints, acting as a lubricant. Bursitis is when the bursa become inflamed, which typically occurs with arthritis. Bursa injections are similar to joint injections and occur in the same manner. Typically, bursa can be injected without the use of dye, X-ray, or ultrasound for needle guidance, but imaging techniques may be used to ensure proper needle placement. The area around the bursa is sterilized and the bursa is injected with either corticosteroid alone or with the addition of local anesthetic. Patients are free to resume normal activity following the injection. Typically, a bursa can only be injected with steroid 3-4 times in a year.