Epidural Steroid Injections
Steroids help reduce inflammation. Epidural steroid injections are used to deliver medication close to the injury in the spine. Often used to delay surgery, epidural steroid injections can treat issues such as nerve root irritation, radiculopathy (sciatica), degenerative disc disease, spine arthritis, post-surgical pain and post-herpetic neuralgia. They can also help alleviate pain in the neck, shoulder, arm, buttock, hip and/or leg.
Under the guidance of X-ray imaging, interventional radiologists are able to locate areas of pain and accurately deliver an injection. A local anesthetic is often injected with the steroid to provide short-term pain relief and diagnostic information. Patients may feel as if their spine is slightly weak, numb or odd for a few hours after the injection. Some notice a slight increase in pain that lasts for several days, as the pain medication wears off before the anti-inflammatory medicine takes effect.
Facet Joint Injections (intra-articular, medical branch block)
Common sources of pain, the facet joints play a part in supporting the spine and are often are affected by degenerative arthritis or acute injuries such as whiplash. These joints can cause low back, buttock or thigh and leg pain.
During intra-articular injections, the joints are penetrated with a needle followed by injection of contrast to confirm placement. A combination of local anesthetic and steroid are then injected. Medial branch blocks involve the injection of a small amount of local anesthetic at the two small nerves that supply each facet joint. This highly specific procedure is diagnostic and often used with radiofrequency ablation.
Sacroiliac Joint Injections
The sacroiliac joints are located where the spine and pelvis meet and are susceptible to stress, injury and arthritis causing low back pain. They often respond to steroid injections under fluroscopic guidance.
Provocative discography is used to diagnose internal disc disruption and resultant discogenic pain. This procedure is divided into provocative and morphological components. The provocative portion is an attempt to reproduce the patient's "typical" pain. Abnormal discs are identified and injected; adjacent control (normal) discs are also injected. Concordant pain is elicited when an abnormal disc is injected, replicating the patient's typical pain. Disc morphology often can also be noted with an injection of contrast material and confirmed via a CT scan immediately following the procedure. The combination of the information gleaned from these two components of the study can be useful in identifying the cause of disc-related low back pain.
Sympathetic Nerve Interventions
The sympathetic nervous system, which controls nonvoluntary activities such as pupil dilation, digestion and heart rate, can contribute to various pain syndromes. Interventions targeting this system involve the injection of local anesthetic at the sympathetic ganglia in the cervical or lumbar spine. Radiofrequency ablation, chemical neurolysis and spinal cord stimulation are other procedures that target this system.
Epidural Lysis of Adhesions
In rare situations following neck or low back surgery, scar tissue (adhesions) develops around a nerve root, causing compression and severe pain. With a steerable catheter placed through an introducer needle, these adhesions are destroyed or "broken up." Epidural lysis is recommended for patients who have not had success with conservative treatments such as medications and epidural injections.
Percutaneous Lumbar Disc Decompression (DEKOMPRESSOR®, ACUTHERM®)
Disc decompression can be effective for the treatment of small, contained disc herniations primarily causing lower extremity pain. This procedure involves the removal of nuclear material from the disc to reduce pressure on the nerve roots and to potentially resolve the disc protrusion. In this procedure, a small extraction device enters the disc through a needle.
Intradiscal Anuloplasty (IDET®, TRANSDISCAL BIACULOPLASTY)
These procedures are used for the treatment of disc-related low back pain. Thermal energy is delivered to the posterior aspect of the disc, resulting in collagen formation that "seals" the disc and reduces aberrant nerve growth into the disc. In IDET, a catheter enters the disc via an introducer needle. Transdiscal biaculoplasty is performed via a bipolar method, producing a field between two introducer needles.
Trigger Point Injections
In some instances, the source of pain is a specific muscle that develops taut bands either as a primary process or as a result of an underlying trigger. These trigger points can be treated with injections of local anesthetic, often with steroids, as one portion of a treatment plan that also includes physical therapy, stretching and other modalities.
Botolunim Toxion Injections (BOTOX®, MYOBLOC®)
Growing evidence suggests that botulinum toxin injections can help stop muscle spasms when injected directly into the muscle and might be beneficial in treating musculoskeletal conditions such as plantar fasciitis, lateral epicondylitis and myofascial pain syndrome. These muscle-specific targeted treatment modalities often are used after conservative therapies have failed. Combining these injections with a course of intensive physical therapy is often beneficial. While botulinum toxin consists of bacterium that causes food poisoning, but typically does not cause harm when given in small dose injections.