Common Treatments

Epidural Steroid Injection

Steroid injections are minimally invasive procedures. Using fluoroscopy, a steroid is administered into the epidural space to target the area with increased inflammation. After 3-10 days the inflammation will be reduced, thus opening the pathway for nerves which ultimately relieves radicular pain.

Medial Branch Block

Medial Branch Blocks (MBB) targets pain at facet joints along the spine. It is done for diagnostic purposes to locate where the pain is coming from. An anesthetic is placed at the nerves in specific areas. The medication only lasts about 2-3 hours. If pain is relieved, the Radiofrequency Ablation is recommended for longer-lasting treatment.

SI Joint Injection

The Sacroiliac (SI) Joints are the connections between the sacrum and ilium of the pelvis. Although this joint is not built for mobility, it is subject to degenerative arthritis. Using fluoroscopy, a steroid is administered into this space to decrease the inflammation, thus relieving pain.

Selective Nerve Root Block

This block is a targeted injection used to diagnose and possibly treat the cause of pain. Under fluoroscopy, a steroid and numbing medication are distributed over selected nerves. If relief of pain follows, the patient should undergo RFL (Radiofrequency Ablation) for longer-lasting treatment.

Intra-Articular Joint Injection

With age, all joints are susceptible to degenerative arthritis. This can lead to decrease in stability, mobility, balance and increase in pain. Using fluoroscopy or ultrasound for visualization, a steroid and numbing medication is used to decrease inflammation, relieve pain and increase function.

Sympathetic Nerve Block

This block is a targeted injection used to diagnose and possibly treat the cause of pain. Under fluoroscopy, a steroid and numbing medication are distributed over selected nerves. If relief of pain follows, the patient should undergo RFL (Radiofrequency Ablation) for longer-lasting treatment.

Piriformis Injection

The piriformis muscle assists with rotation of the thighbone. At times, this muscle can compress the sciatic nerve resulting in piriformis syndrome. Using fluoroscopy to see real-time images, a steroid is placed into the piriformis muscle to decrease pressure on the nerves and lessen the pain.

Trigger Point Injections

Trigger point injections (TPI) use ultrasound to advance a small needle directly into the constricted muscle. Relief of pain is used with this technique alone also called dry-needling, or with administration of a local steroid or numbing medication.

Intercostal Nerve Blocks

These blocks numb up the nerves underneath the lower edge of each rib. They are typically used when a nerve injury or associated rib injury has occurred. This is most frequently in the setting of rib fractures or chest surgery but may also be used in the treatment of pain after shingles.

Spinal Cord Stimulator

This “pacemaker for pain” is an implantable device that interrupts pain signals traveling through the spinal cord to the brain. Under fluoroscopic guidance, the SCS leads are placed into the epidural space. If a week-long trial is deemed successful, your doctor will perform a permanent surgery by implanting a permanent generator.

Vertebral Augmentation

This novel and minimally invasive treatment is for patients with lumbar spinal stenosis that do not have misalignment of their spine. A small wedge is placed to keep the spine “open” and block painful extension at one or two levels.

Radiofrequency Ablation

Once two successful MBBs have been performed, a Radiofrequency Ablation (RFL) should be performed. A specialized needle is placed in the targeted area. Once well positioned, a heat-generating electrical current burns the nerves in the area. The nerves will die over the next 6-8 weeks which is when pain relief is most expected.