Procedures

Lumbar Facet/Medial Branch Block Injection

Lumbar facet joint pain can be caused by the cartilage inside the joint being injured or the connecting ligaments surrounding the joints being injured. Pain can range on a spectrum of pain from muscle tension to severe pain. The pain depends on which joint is affected. Lumbar facet joint pain can occur in an area from your lower back down to your buttocks, groin, and hips.

What are Lumbar Facet Joints?

Lumbar facet joints connect the vertebrae, the bones of the spine. They help guide your spine when you move. The low back area of the spine is called the lumbar region. It contains five vertebrae.

Facet joints are found on both sides of the spine. Each is about the size of a thumbnail. Lumbar facet joints are named for the vertebrae they connect and the side of the spine where they are found. The right 1.4-5 facet joint, for example, joints the 4th and 5th lumbar vertebrae on the right side.

How do I know if I have Lumbar Facet pain?

If you have pain in one or more of these areas and if your pain has lasted longer than two months, you may have lumbar facet pain. Common tests such as x-rays or MRIs may not always show if a facet joint is causing pain.

What is a Lumbar Facet Injection?

A lumbar facet injection is an outpatient procedure for diagnosing and treating low back, buttock, hip and groin pain.

In a lumbar facet injection, a local anesthetic (numbing medicine) and corticosteroid (anti-inflammatory medicine) are injected into one or more of your lumbar facet joints. The injection can be used to diagnose or treat. An anesthetic and steroid may be injected to see if they temporarily lessen your pain. If they do, and if this helps you move better, it tells the doctor which facet joint may be causing the pain. The corticosteroid is used to treat inflammation of the facet joint.

What happens during an injection?

A local anesthetic will be used to numb your skin. The doctor will then insert a thin needle directly in to the facet joint. Fluoroscipy, a type of x-ray, must be used to ensure the safe and proper position of the needle. A dye may also be injected to make sure the needle is at the correct spot. Once the doctor is sure the needle is correctly placed, the medicine will be injected.

What happens after an Injection?

You will be monitored for up to 30 minutes after an injection. When you are ready to leave, the staff will give you discharge instructions. You will also be given a pain diary. It is important to fill this out because it helps the doctor know when your injection is working. It may help to move in ways that hurt before the injection to see if the pain is still there, but do not overdo it. Take it easy for the rest of the day.

You may feel immediate pain relief and numbness in your back for a period of time after the injection. This tells you that the medication has reached the right spot. Your pain may return after this short pain-free period, or may even be a little worse for a day or two. It may be caused by needle irritation or the corticosteroid itself. Corticosteroids usually take two or three days to start working, but can take as long as a week.

You can usually return to work the day after the injection, but always check with your doctor.

How long can I expect pain relief?

The extent and duration of pain relief may depend on the amount of inflammation and how many areas are involved. Other coexisting factors may be responsible for your pain. Sometimes an injection can bring several weeks to months of pain relief, and then more treatment is needed. Other times, particularly if there is no underlying bone or joint problem, one injecting brings long-term pain relief. If your pain is caused by injury to more than one area, only some of your symptoms may be relieved by one injection.

Lumbar Epidural Injection

A lumbar transforaminal epidural steroid injection is an outpatient procedure used to treat low back and leg pain. A corticosteroid (anti-inflammatory medicine) is injected into the epidural space to reduce inflammation. A local anesthetic (numbing medicine) may also be injected.

One technique is from the back of the spine. This is called an interlaminar injection. When it is done from the side where the nerve exits the spine, is is called a transforaminal injection. This technique puts the medicine near the source of the inflammation.                                                                           

What is the Epidural Space?

The dura is a protective covering of the spinal cord and its nerves. The space surrounding the dura is called the epidural space. In the lower back, it is called the lumbar epidural space.

What causes pain in the epidural space?

The lumbar area of the spine has five bones called vertebrae. Soft discs between these vertebrae cushion them, hold them together and control motion. If a disc tears, chemicals inside may leak out. This can inflame nerve roots or the dura and cause pain.

A large disc tear may cause a disc to bulge, inflaming or compressing nerve roots or the dura and cause pain. Bone spurs, called Osteophytes, can also press against nerve roots and cause pain.

How do I know if I have a disc and nerve root pain?

If you have pain in your low back when you bend your back, you may have lumbar disc and dural inflammation. If pain travels to your leg when you bend your back, you may have nerve root inflammation. Common tests such as MRIs can show disc bulges and nerve root compression, but may not show a torn and leaking disc. A lumbar epidural injection may provide relief if disc problems, dural or nerve root inflammation are causing your pain.

What happens during an injection?

A local anesthetic will be used to numb your skin. The doctor will then insert a thin needle directly in to the facet joint. Fluoroscipy, a type of x-ray, must be used to ensure the safe and proper position of the needle. A dye may also be injected to make sure the needle is at the correct spot. Once the doctor is sure the needle is correctly placed, the medicine will be injected.

What happens after an Injection?

You will be monitored for up to 30 minutes after an injection. When you are ready to leave, the staff will give you discharge instructions. You will also be given a pain diary. It is important to fill this out because it helps the doctor know when your injection is working. It may help to move in ways that hurt before the injection to see if the pain is still there, but do not overdo it. Take it easy for the rest of the day.

You may feel immediate pain relief and numbness in your back for a period of time after the injection. This tells you that the medication has reached the right spot. Your pain may return after this short pain-free period, or may even be a little worse for a day or two. It may be caused by needle irritation or the corticosteroid itself. Corticosteroids usually take two or three days to start working, but can take as long as a week.

You can usually return to work the day after the injection, but always check with your doctor.

How long can I expect pain relief?

The extent and duration of pain relief may depend on the amount of inflammation and how many areas are involved. Other coexisting factors may be responsible for your pain. Sometimes an injection can bring several weeks to months of pain relief, and then more treatment is needed. Other times, particularly if there is no underlying bone or joint problem, one injecting brings long-term pain relief. If your pain is caused by injury to more than one area, only some of your symptoms may be relieved by one injection.

Cervical Epidural Injection

A cervical interlaminar epidural steroid injection is an outpatient procedure used to treat neck, upper back, shoulder and arm pain. A corticosteroid (anti-inflammatory medicine) is injected into the epidural space to reduce inflammation. A local anesthetic (numbing medicine) may also be injected. The simplest way is from the back of the spine. This is called an interlaminar injection.

What is the Epidural Space?

The dura is a protective covering of the spinal cord and its nerves. The space surrounding the dura is called the epidural space. In the lower back, it is called the lumbar epidural space.

What causes pain in the epidural space?

The lumbar area of the spine has five bones called vertebrae. Soft discs between these vertebrae cushion them, hold them together and control motion. If a disc tears, chemicals inside may leak out. This can inflame nerve roots or the dura and cause pain.

A large disc tear may cause a disc to bulge, inflaming or compressing nerve roots or the dura and cause pain. Bone spurs, called Osteophytes, can also press against nerve roots and cause pain.

How do I know if I have a disc and nerve root pain?

If you have pain in your low back when you bend your back, you may have lumbar disc and dural inflammation. If pain travels to your leg when you bend your back, you may have nerve root inflammation. Common tests such as MRIs can show disc bulges and nerve root compression, but may not show a torn and leaking disc. A lumbar epidural injection may provide relief if disc problems, dural or nerve root inflammation are causing your pain.

What happens during an injection?

A local anesthetic will be used to numb your skin. The doctor will then insert a thin needle directly in to the facet joint. Fluoroscipy, a type of x-ray, must be used to ensure the safe and proper position of the needle. A dye may also be injected to make sure the needle is at the correct spot. Once the doctor is sure the needle is correctly placed, the medicine will be injected.

What happens after an Injection?

You will be monitored for up to 30 minutes after an injection. When you are ready to leave, the staff will give you discharge instructions. You will also be given a pain diary. It is important to fill this out because it helps the doctor know when your injection is working. It may help to move in ways that hurt before the injection to see if the pain is still there, but do not overdo it. Take it easy for the rest of the day.

You may feel immediate pain relief and numbness in your back for a period of time after the injection. This tells you that the medication has reached the right spot. Your pain may return after this short pain-free period, or may even be a little worse for a day or two. It may be caused by needle irritation or the corticosteroid itself. Corticosteroids usually take two or three days to start working, but can take as long as a week.

You can usually return to work the day after the injection, but always check with your doctor.

How long can I expect pain relief?

The extent and duration of pain relief may depend on the amount of inflammation and how many areas are involved. Other coexisting factors may be responsible for your pain. Sometimes an injection can bring several weeks to months of pain relief, and then more treatment is needed. Other times, particularly if there is no underlying bone or joint problem, one injecting brings long-term pain relief. If your pain is caused by injury to more than one area, only some of your symptoms may be relieved by one injection.

Radio Frequency Ablation

Radio Frequency Ablation is a non-surgical knee pain treatment that offers extended-term pain relief. The procedure involves local anesthetic, either flouroscopy and/or ultrasound guidance. An electrical current produced by a radio wave is used to heat up a small area of nerves that are believed to be the source of the patient’s pain. Treatment can be done before surgery or after a failed surgery.