Facet Injections and Nerve Blocks
Facet joint injections
Facet joint injections are performed for facet joint pain. Facet joints can be injected with long acting local anesthetic and anti-inflammatory steroids,which can alleviate facet joint pain for long periods.
Facet joint denervation
This is a straightforward procedure that is normally carried out if you have had a successful result from facet joint injections. Special needles are carefully placed under continuous fluoroscopy so that their tips lie exactly on the nerves that carry pain signals from the facet joints. Radiofrequency energy is then passed through the needles so that that tissue at the tip is heated to about 80 degrees C for about a minute. This coagulates and inactivates the nerves.
Sacroiliac joint steroid injection
In the first instance a solution of long-acting local anesthetic, long acting anti-inflammatory steroid, and sometimes other pain modifying drugs is injected into one or both joints. If this is successful the joint can then be denervated in a similar way to facet joint denervation.
Selective nerve root block (SNRB) for diagnosis or pain management
Another common injection, a selective nerve root block (SNRB), is primarily used to diagnose the specific source of nerve root pain and, secondarily, for therapeutic relief of low back pain and/or leg pain.
Lumbar sympathetic block
Injection needles will be positioned and then there are three main ways to produce the block: injection of a long acting local anesthetic to produce a diagnostic block to safely see if your pain can be treated this way; injection of a neurolytic substance such as phenol or alcohol to destroy the lumbar sympathetic nerves; and the use of radiofrequency energy to similarly destroy the nerves in a highly controlled way.
Radiofrequency ablation of a nerve is an option to provide longer lasting pain relief. While it does not treat the underlying inflammation causing the pain, it can effectively blocks pain signals to the brain by ablating or using extreme heat to the nerve endings. A nerve ablation lasts for approximately one year.
Epidural steroid injection
The word ‘epidural’ simply refers to a layer of supporting tissue outside the spinal cord. In an epidural a solution of long acting local anesthetic, long acting anti-inflammatory steroid, and sometimes other pain modifying drugs is injected into the epidural space in the spine.
Transforaminal epidural injection
This is an important adjunct to epidural steroid injection and the two are normally done together. If you have lumbar radiculopathy or cervical radiculopathy, you will probably also have one or more transforaminal epidural injections.
Trigger point therapy
A trigger point is a tight knot of muscle that forms over time when a muscle is not able to relax. Trigger point injections are used both diagnostically, to determine if implanted hardware (from a previous surgery) is causing pain and needs to be removed, and therapeutically to treat pain.
Vertebral Body Fractures
It involves the insertion of needles into the damaged vertebral body, through which balloons are passed. These are inflated under high pressure, which expands the VCF and corrects the deformity. Once corrected, liquid bone cement is injected into the vertebra to permanently fix the restored shape
NOTE: These procedures require a referral from your primary care doctor or your pain management doctor.