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Cervical Epidural Steroid Injection

A cervical epidural steroid injection (ESIs) is an effective treatment option to temporarily relieve pain in patients with neck, upper back, shoulder and arm pain.  Medication and an anesthetic are injected into the epidural space to help reduce inflammation and relieve pain.  This pain is commonly caused by:

  • Herniated disc
  • Degenerative disc disease
  • Spinal stenosis
  • Vertebral compression fractures
  • Facet joint or nerve root cysts
  • Bone spurs

Comprised of cortisone and a local anesthetic or saline solution, ESIs work by reducing inflammation and flushing out the particles that cause swelling and pain. Medication is delivered directly to the source of the pain rather than dispersing it throughout the body, as oral painkillers and steroids do. 

ESIs can be used alone to provide pain relief or given as part of a rehabilitation program to help the patient perform his/her exercises with less discomfort. Relief from a single injection typically lasts from one week up to one year.

Cervical Transforaminal Epidural Steroid Injection

A transforaminal injection is a long acting steroid that is injected into a nerve root exit in the cervical spine known as a foramen. The injection helps to reduce inflammation and swelling in the spinal cord nerve roots and relieves pain and numbness symptoms. A transforaminal injection consists of a very small dosage of steroid medication mixed with saline and local anesthesia. The anesthesia numbs the area so the actual injection often feels like just pinching and pressure.

Immediate pain relief is found because of the injection of anesthesia, but this wears off quickly. Effective relief is usually noticeable by the third day after the injection and can last for several months. This treatment is most successful for patients with back pain that radiates through the arms rather than pain that is focused just in the neck or back. Complications from this procedure are rare and usually mild.

Discography

A provocative discography (PD), also known as disc stimulation, is a diagnostic test to determine whether or not an intervertebral disc is internally damaged. While these discs often may “slip” or herniate and apply pressure to nerve roots in the spine, they may also have an in growth of nerves and blood vessels that cause pain in the lower back.

A provocative discography is the only test to diagnose disc injuries by responding to patients' reactions. During the test, a needle is placed in the center of the disc while the patient is under sedation. Once the needle is in place, the sedation is discontinued and X-ray contrast fluid is injected into the disc. In a disrupted disc, this injection will produce the pain that the patient has been suffering from. The patient will identify this pain and will be questioned about it after the procedure. This procedure is performed to help determine the best treatment option for the patient's pain.

Facet Joint Injections

A facet injection is a minimally invasive treatment option for back pain caused by inflamed facet joints. Facet joint pain is often related to spinal stenosis, sciatica or arthritis and is characterized by neck, arm, low back or leg pain. Each vertebra has four facet joints that connect it to the vertebra above and below. The injection may also be used as a diagnostic test to determine if facet joint inflammation is the source of a patient's pain.

A facet injection is a combination of a long-lasting steroid and a local anesthetic that are injected either into the joint capsule or its surrounding tissue. The steroid reduces inflammation and can relieve pain for a few days to a few years. This procedure can be repeated up to 3 times a year for those who experienced successful but short-term pain relief.

Lumbar Transforaminal Epidural Steroid Injection

An epidural steroid injection is an effective treatment option for relieving back pain by injecting an anesthetic and steroid directly into the epidural space, the space surrounding the protective covering of the spinal cord and nerves.

This type of treatment is ideal for patients with lower back and leg pain as a result of:

  • Herniated disc
  • Spinal stenosis
  • Bone spurs
  • Degenerative disc disease
  • Vertebral compression fractures

Patients usually experience immediate pain relief from the anesthetic, which will fade after about six hours. Steroid pain relief is usually noticeable two to three days after the injection, and can last for several months or longer, depending on the individual patient.

Trigger Point Injections

Trigger point injections are a treatment option for pain in areas that contain trigger points, or knots of muscle that form when muscles do not relax. These points can also irritate nerves around them and therefore cause pain in other areas of the body. A needle containing a local anesthetic (and sometimes a steroid as well) is inserted into the trigger point to make it inactive and therefore alleviate the pain.

The procedure takes just a few minutes and is done in the doctor's office. It is very safe and has minimal side effects. Trigger point injections not only relieve pain, but also loosen the muscles which are causing the pain to therefore help with the rehabilitation process.