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.
Selective Nerve Blocks
Selective nerve root blocks, or SNRBs, are steroid injections that help doctors diagnose the exact source of low back and leg pain arising from the compression and inflammation of one of the spine's many nerve roots. Nerve root damage is often associated with a far lateral disc herniation. SNRBs can temporarily relieve nerve root pain if the injection is delivered directly to the damaged area.
Radiofrequency Rhizotomy for Sacroilliac Pain
Radiofrequency rhizotomy is a minimally-invasive procedure for treating pain due to sacroiliac joint dysfunction. This pain typically originates from inflammation in one or both of the sacroiliac joints, which link the pelvis and lower spine. Sacroiliac joint pain can affect the buttocks and lower back and often worsens when running or standing for extended periods of time. Radiofrequency rhizotomy relieves pain by sending pulses of energy to the associated nerves, stopping them from processing pain messages from injured sacroiliac joints.
Local anesthesia is used for radiofrequency rhizotomy. Once the anesthetic has numbed your skin, an imaging technique known as fluoroscopy will be used to insert a small needle into your spine near the sacroiliac joint. The nerve will be numbed as soon as the needle is positioned properly. Depending on your individual condition, the needle may be inserted into more than one portion of your spine.
Patients return home the same day as their radiofrequency rhizotomy, and work can usually be resumed the very next day. Your lower back may feel sore for the first few days, and you may experience numbness, itchiness or weakness in the region for a few weeks. Full pain relief is usually achieved about three weeks after radiofrequency rhizotomy.
The axial joint is at the top of the cervical vertebrae in the neck area. Problems within this joint may result in scalp tenderness, neck pain and headaches. It may be the result of an injury to either the cartilage in the joint or its surrounding tissues. A diagnostic axial injection may be performed to determine the cause of the pain in the region.
The injection is a combination of anesthetic and corticosteroid. The anesthetic provides immediate relief from pain, while the corticosteroid works to decrease inflammation and offer longer term pain reduction. If the axial injection is effective in relieving pain and increasing motion in the joint, it can be used as a treatment method.
Local anesthesia is used for axial injections. Once the anesthetic has numbed your skin, an imaging technique known as fluoroscopy will be used to insert a small needle into your spine near the axial joint. The medication will be injected as soon as the needle is positioned properly. Some patients experience permanent relief, with no further injections necessary. Others may only experience relief for a few weeks or months, requiring additional treatment.
The MILD procedure is a new, minimally invasive technique for treating lumbar spinal stenosis (LSS). By attending to the causes of LSS symptoms, MILD can provide pain relief as well as improve mobility in patients. This treatment has been FDA-cleared for decompression of the lumbar spine.
The MILD procedure offers several benefits over traditional surgical approaches, including:
- Only a tiny incision needs to be made, so no stitches are required
- It's an outpatient procedure, typically performed in one hour using only local anesthetic and light sedation
- Complications are rare
- No implants are used
- Recovery time is minimal, with patients generally returning to work and light activity just a few days later
The MILD procedure is ideal for patients whose LSS is the result of excess ligament. Using imaging technology to guide the procedure, your doctor will insert specialized instruments through the small incision to remove the ligament and bone putting pressure on your spinal canal. It has been proven effective in clinical studies for 79 percent of patients who have undergone this treatment.
Schedule an appointment with our office to find out whether you are a good candidate for the MILD procedure.
MILD Procedure Patient Education Video
Discography, or a discogram, is an injection that helps doctors locate a painful disc before performing lumbar fusion surgery in patients whose pain has not responded to conservative treatments. A discogram may be ordered when other diagnostic injections have failed to pinpoint the source of the pain, which may affect the back, legs, groin or hips.
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.
Patients return home the same day as their epidural blood patch, and most return to work the next day. Your doctor may provide you with additional instructions regarding work and other activities after your procedure; please follow them closely. An epidural blood patch is usually permanent, with no subsequent injections required.
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.
Intercostal Nerve Blocks
The intercostal nerves are located underneath the lower edge of each rib. An intercostal nerve block is an injection to relieve pain originating from the intercostal nerves. The injection itself only takes a few minutes, although patients should expect to remain at our office for about an hour; this includes consulting with your doctor before the procedure and recovery room observation afterwards.
An intercostal nerve block can be performed with only a local anesthetic, although sedation is an option for anxious patients. During the procedure, you will be lying down on your stomach. Once the local anesthetic has taken effect, the skin surrounding the affected rib(s) will be cleaned. With the assistance of x-ray and contrast dye, a needle is inserted under the rib. Once the needle is situated properly, the medicine is injected.
The exact effectiveness of an intercostal nerve block varies from patient to patient. Typically, patients whose pain has begun recently are more likely to experience relief from this procedure than patients who have been in pain for a longer period of time. If the initial injection relieves your pain for a reasonable amount of time, you may qualify for an additional intercostal nerve block. Your doctor will monitor your progress and determine whether another injection is right for you.
To learn more about our Pain Management Services, please contact us at (215) 725-7600 today to schedule an appointment.