Transforaminal Epidural Steroid Injection
A transforaminal injection is a long acting steroid delivered into a nerve root exit in the spine known as a foramen. The injection helps to reduce inflammation and swelling in the spinal cord nerve roots and relieves pain and numbness. A transforaminal injection consists of a small dosage of steroid medication mixed with saline and local anesthesia. The anesthesia numbs the area so the 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 pain that radiates through the arms or legs rather than just back or neck pain.
Interlaminar Epidural Steroid Injection
Epidural steroid injections, or ESIs, are a minimally invasive treatment that has been used for decades to temporarily relieve low back and leg pain (sciatica). They have been shown to be effective for pain in the neck (cervical) and mid-spine (thoracic) as well. While they do not treat serious underlying spinal conditions, ESIs are often effective in relieving the chronic pain these conditions often cause.
Comprised of cortisone and a local anesthetic or saline solution, ESIs work by reducing inflammation and flushing out 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. They are injected into the epidural space, the area between the dura (a membrane covering the brain and spinal cord) and the actual cord itself.
Epidural steroid injections can be used to relieve pain within the lower back, arms, legs and neck, which may be caused by conditions such as:
- Lumbar disc herniation
- Degenerative disc disease
- Lumbar spinal stenosis
- Vertebral compression fractures
- Facet joint or nerve root cysts
- Annular tear
Epidural steroid injections 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. These injections can also be of diagnostic value to determine the cause and severity of pain and develop an appropriate treatment plan.
Epidural Blood Patch
An epidural blood patch is an injection of your own blood into the epidural space, which surrounds the spinal cord. It is done for patients experiencing severe headaches after receiving a spinal injection. These headaches occur as a result of spinal fluid leaking into the epidural space. An epidural blood patch stops the leak, making the headache go away.
An epidural blood patch only requires local anesthetic, although sedation is an option for anxious patients. During the procedure, you will be lying down on your stomach. The skin on your back, as well as the skin surrounding one of your veins, is cleaned with an antiseptic solution. Then, a small intravenous catheter is inserted into your vein. Once the needle has been properly positioned over the epidural space, your doctor will draw about 20-25cc of blood from your vein and inject it into the epidural space. While an epidural blood patch only takes a few minutes to perform, you will remain at our office for about an hour and a half; this includes consulting with your doctor before the procedure and recovery room observation afterwards.
Medial Branch Blocks
A medial branch block is a minimally-invasive procedure to diagnose and treat neck or back pain. This procedure can determine whether a facet joint-which connects the bones of your spine, providing support as you move-is the source of your pain. Next to the facet joints are the medial branch nerves, which transmit pain signals from these joints to your brain.
Before undergoing a medial branch block, you will be given intravenous medication to help you relax. With the assistance of imaging technologies, a small needle will be inserted near your medial branch nerve. Once it is situated properly, an anesthetic will be injected through it.
The effectiveness of a medial branch block varies depending on your individual condition. Patients whose pain returns after a short period of time may require a different form of treatment if it is confirmed that the facet joint is not the source of the pain.