Procedures
Spine and Back
Epidural Steroid Injection
An epidural steroid injection is a procedure in which your physician uses a small needle to inject a steroid (like cortisone) into the epidural space, which is the space that surrounds your spinal cord.
The purpose of an epidural steroid injection is to reduce the swelling and inflammation of irritated nerves as they leave the spinal cord. Irritated nerves can cause symptoms such as pain, tingling, numbness, or loss of strength.
How long does the injection take?
The actual injection only takes a few minutes. You can expect to be in the procedure room for about 15 minutes for positioning, placing monitors, preparation, and the procedure.
What is injected?
The injection usually consists of the corticosteroid (methylprednisolone, decadron, celestone) and a local anesthetic (lidocaine or bupivicaine).
Will the injection hurt?
Most patients tolerate the injection very well. Numbing medicine is placed under the skin that feels like a poke and a burn.
After that, you most likely will only feel pressure. If you feel any pain during the injection, more numbing medicine can be given. If you choose, you may have
intravenous sedation to help you relax.
How is the injection performed?
You will be lying on your stomach on an x-ray table. We will monitor your blood pressure, heart rhythm, and blood oxygen. Your skin will be cleansed with an antiseptic. After the injection, you will be placed on a bed and moved to the recovery area.
What should I expect after the injection?
You may or may not feel better immediately after the injection and your legs or arms may feel slightly heavy or numb. The numbing medicine injected can wear off after several hours. You may have a sore back or neck for several days after the injection. This is due to the needle insertion as well as the chemically irritating effect of the steroid. The steroid is a long and slow acting medication that can take up to 5 days before starting to work and up to 2 weeks before taking full effect.
What can I do after the procedure?
We recommend that you limit strenuous physical activity the day of the injection.
You will bring someone with to drive you home the day of the injection. There is absolutely no driving the day of the injection. You may go about your normal daily activities as tolerated excluding strenuous physical activity.
How long does the effect of the steroid last?
The effect of the steroid can last anywhere from several days to several months. The purpose of the injection is to decrease swelling and inflammation to decrease pain. Over time, your body may heal itself.
How many injections do I need?
If the first injection does not relieve your symptoms after two weeks, a second injection may be recommended. If the second injection doesn’t relieve your symptoms after an additional two weeks, a third injection may be recommended. The effects of the injections are additive if spaced at these time intervals. We generally would not perform more than 3 epidural steroid injections in a 6-month time period. More than this may increase the steroid load in your body increasing the likelihood of suffering from side effects. If 3 injections did not provide a lasting benefit, it is unlikely that any further epidural steroid injections would provide further benefit.
Will the Epidural Steroid Injection help me?
Overall, epidural steroid injections have about a 60% success rate and treating pain. Your chance of improvement will be better if your pain is less than 6 months old, is more in your legs or arms than back, and you have not had previous back surgery.
Side Effects | Risks
Overall, the procedure is very safe. As with any procedure, there are risks. The most common side effect is pain, which is temporary. Any time a needle is punctured through the skin, there is a chance of bleeding or infection that is very rare. Other rare side effects include spinal
headache, nerve damage, worsening of pain, etc., which are extremely unlikely
Who should not have these injections?
If you are allergic to corticosteroids, specific local anesthetics, or ionic contrast, please notify your physician. Also, if you are taking any blood thinners (Coumadin, Plavix, Warfarin, Lovenox, Aspirin) please let your physician know ahead of time to help devise a safe plan for the injection.
Medial Branch Block – Facet Block
Because there are many causes of spinal pain, doctors rely on diagnostic tests to try to pinpoint the source of pain. After a thorough examination, your doctor may determine your pain is caused by the facet joints in your spine. Facet joints are located between each of the vertebrae in the spine; and their function is to help the spine move correctly. Over time, you may develop facet arthritis, which causes inflammation and consequently, spinal pain.
The diagnostic procedures used to confirm inflammation of your facet joints are medial branch blocks and facet injections. The medications used in these injections are anesthetics and steroids, which reduce pain and inflammation. While similar in most ways, the key difference between a medical branch block and a facet joint injection is the location of the actual injection. When administering a medial branch block, your doctor injects medication near the nerve that delivers pain signals from the facet joints to the brain, which is called the medial branch nerve. During a facet injection, your doctor injects medication directly into a facet joint.
What are the benefits?
The medial branch block and facet injection are both used to relieve spinal pain, and are effective diagnostic tools for your doctor to determine the source of your pain. These procedures block the pain signals being sent from nerves in your spinal cord to your brain. If the source of your pain is caused by inflammation in the facet joints, you will feel relief from the procedure.
What can I expect?
Upon arrival, you will meet with one of healthcare professionals to discuss your medical history and to ask any questions you may have about the procedure.
You may receive IV sedation to help relax you. Once the area is sterilized, your doctor numbs the area and then injects a needle containing medications into the intended area. Following the procedure, you will rest in the recovery area. If sedated, you will need a responsible adult to accompany you home.
Radiofrequency Ablation
Radiofrequency ablation is a minimally invasive procedure used to treat pain in the spine. It is a safe and effective technique in which heat is used to disable the nerves in your spine that transfer pain signals to your brain. Radiofrequency ablation is most commonly used to treat pain caused by arthritic joints in the spine, though it is effective in treating other conditions.
How is it beneficial?
Radiofrequency ablation is a viable alternative to invasive surgery and extended use of pain medications. Your doctor may recommend this procedure if other treatment options have been unsuccessful in reducing your pain. Because radiofrequency ablation disables the nerves, the effects last longer than injections or blocks. If the nerves become active again, they are likely to cause less pain than before.
What can I expect?
Upon arrival, you will meet with one of healthcare professionals to discuss your medical history and to ask any questions you may have about the procedure.
You may receive IV sedation to help relax you. Once the area is sterilized, your doctor uses a specialized needle to apply heat directly to the nerves in your spine.
Following the procedure, you will likely have minimal effects. However, you may experience a temporary increase in pain (neuralgia) at the procedure site. This side effect usually resolves itself, and can be managed with rest, ice packs and pain medication. Be sure to follow discharge
instructions and contact your doctor if the pain continues or new symptoms arise.
How soon will I feel relief?
You will likely experience significant pain relief within two weeks following the procedure. The effects may last for several months.
Sacroiliac (SI) Injection
The sacroiliac (SI) injection is used to treat and diagnose lower back pain. It targets the sacroiliac joints, located in the lower back. When these joints become inflamed, you may feel pain in the lower back, buttocks, groin or legs.
How is it beneficial?
The SI injection may provide relief from pain when other treatments have been unsuccessful. It can also be used as a diagnostic tool in determining the source of your pain. The medications used in SI injections are anesthetics and steroids, which reduce pain and inflammation. They also spread to the area surrounding the SI joints, coating inflamed or irritated nerve roots.
What can I expect?
Most likely, you will be instructed to avoid taking pain medication the day of procedure. Upon arrival, you will meet with one of healthcare professionals to discuss your medical history and to ask any questions you may have about the procedure.
You may receive IV sedation to help relax you. Once the area is sterilized, a local anesthetic is applied to the skin. Your doctor then uses an X-ray to guide the placement of a very thin needle to the proper position, and then gradually injects the medication. Following the procedure, you will rest in the recovery area. If sedated, you will need a responsible adult to accompany you home.
Due to the nature of the procedure, recovery time is relatively short. Be sure to follow discharge instructions, and contact your doctor if discomfort continues or new symptoms arise.
How soon will I feel relief?
You may feel immediate relief following the SI injection. The lasting effects of the treatment differs with everyone, ranging from weeks to months. Your doctor may suggest subsequent injections or more permanent procedures to help manage your pain.
Spinal Cord Stimulator
A spinal cord stimulator (SCS) is an innovative mechanism used to manage chronic pain by
blocking pain signals before they reach your brain. The small device has thin wires, or leads, that are placed into the epidural space in your back. The leads deliver low-voltage electrical pulses from a generator. The pulses interrupt the transmission of pain signals to your brain, which results in a reduction of pain or even a feeling of gentle massaging or pleasant sensations. The pulses can be regulated, and the system turned off and on, based on your specifications.
How is it beneficial?
The SCS may provide relief from chronic pain in your back, neck, arms or legs, when other treatments have been unsuccessful. It is especially beneficial because you may try out the system with a temporary device for 5 to 7 days. If you feel significant relief during the trial, you may choose to have a permanent system implanted. Many patients experience pain relief years after implantation, and experience a greater quality of life.
What can I expect?
For this short procedure, you receive a local anesthetic (or possibly light sedation), and the procedure site is numbed. The doctor inserts the leads into your back using a needle, and then positions them to the specific location of your pain. After the leads are in place, the doctor connects them to an external generator, which is taped to your back.
Following the procedure, there may be mild discomfort at the procedure site. While the procedure site heals, keep it dry and clean. Be sure to follow discharge instructions, and contact your doctor if drainage or redness occurs.
How soon will I feel relief?
Many patients feel relief shortly after the trial implementation procedure. If the trial SCS relieves your pain, you may choose to have a SCS permanently implanted. This must take place at a hospital or surgery center. This procedure involves implanting the generator in the abdomen or the buttocks, and adjusting the leads to provide the best pain relief and most coverage of the painful area. The system can be removed at a later time if necessary. Studies have shown that many patients experience pain relief for years after the original implant.
Sympathetic Block
A sympathetic block is an interventional pain management technique used to provide relief from pain caused from a number of conditions. It involves injecting medication into the groups of sympathetic nerves near the spine. A sympathetic block may be used to treat pain from conditions, such as reflex sympathetic dystrophy, neuropathy, phantom limb pain, circulatory insufficiency and post-herpetic neuralgia.
How is it beneficial?
The sympathetic nerves run along the spinal column, and are part of the autonomic nervous system. An imbalance to this system of nerves may cause chronic pain in the extremities. By injecting the medication around the sympathetic nerves, they are blocked from sending pain signals to the brain.
What can I expect?
Upon arrival, you will meet with one of healthcare professionals to discuss your medical history and to ask any questions you may have about the procedure.
You may receive IV sedation to help relax you. Once the area is sterilized, your doctor numbs the area and then uses fluoroscopy (real-time X-ray technology), along with contrast dye, to determine proper needle placement. Once confirmed, a needle containing medications is injected into groups of sympathetic nerves.
Following the procedure, you will rest in the recovery area. If sedated, you will need a responsible adult to accompany you home. Recovery time is relatively short due to the nature of the procedure. You may feel slight discomfort at the injection site. Be sure to follow discharge instructions, and contact your doctor if discomfort continues or new symptoms arise.
How soon will I feel relief?
You may feel relief from a sympathetic block within hours of the procedure. The length of pain relief varies with each patient.
Head and Neck
Occipital Nerve Block
An occipital nerve block is an important therapy used to treat acute and chronic headache pain, most often caused by occipital neuralgia and trigeminal autonomic cephalalgias. Occipital neuralgia is characterized by pain or throbbing in the occipital region (back of the head) and radiates along the course of the occipital nerves. The cause of occipital neuralgia is uncertain, though it may be related to an injury or impact of the head. Headaches caused by occipital neuralgia are often confused with migraines because symptoms are similar.
Trigeminal autonomic cephalalgias are a group of headache disorders, typically characterized by severe pain on one side of the head. Symptoms include sweating, tearing up and a runny nose on the affected side.
What are the benefits?
An occipital nerve block is usually performed when other treatment options have unsuccessfully reduced pain. It is an interventional nerve block, which works to stop, or “block,” pain signals from traveling through the occipital nerve to the brain.
During the procedure, medication consisting of an anesthetic and a steroid is injected into the region where the nerve crosses the skull. The anesthetic alleviates pain, and the steroid helps to reduce inflammation. The occipital nerve block is deemed one of the safest and easiest nerve blocks to perform.
What can I expect?
A local anesthetic is applied to the skin. Then your doctor feels for the protrusion of the occipital bone of the skull, behind your ear, and identifies the specific area where he/she then injects the medication.
Recovery time is relatively short due to the nature of the procedure. You may feel slight discomfort at the injection site, but should feel relief within 24 hours. Be sure to follow discharge instructions, and contact your doctor if discomfort continues or new symptoms arise.
How soon will I feel relief?
You may feel immediate relief, though it may take up to 48 hours to feel the full benefits of this treatment. Your relief may last up to a month.
Stellate Ganglion Block
A stellate ganglion block is an injection of anesthetic medication into the nerves of the stellate ganglion, in the front of your neck on either side of your trachea and esophagus (not performed on both sides at one visit). The purpose is to attain relief from pain in your head, neck, upper arm or upper chest. The block is used to treat conditions such as reflex sympathetic dystrophy, complex regional pain syndrome, shingles and phantom limb pain.
What can I expect?
Upon arrival, you will meet with one of healthcare professionals to discuss your medical history and to ask any questions you may have about the procedure.
You may receive an IV sedative to help relax you. Most patients tolerate the injection very well.
During the procedure, you will lie on your back. Once the area is sterilized, a local anesthetic is applied to the skin (feels like a poke and a burn). After that, you most likely will only feel pressure. Your doctor then uses an X-ray to guide the placement of a very thin needle to the proper position. Once in place, your doctor then gradually injects the medication.
How long will the effect of the medication last?
You may start feeling relief immediately, though it may take longer to feel the full effects of the procedure. The lasting effects of the treatment differs with everyone, ranging from days to weeks. A series of injections is usually required for treatment with a progressive increase in relief with each injection.
What should I expect after the injection?
Following the procedure, you will rest in the recovery area. If sedated, you will need a responsible adult to accompany you home. After the injection, you may notice that your pain has lessened. You may also temporarily feel warmth in your arm, and/or experience a hoarse voice, a feeling of a lump in the neck, red or a droopy eye, a stuffy nose on the side of the injection, or soreness in the neck at the injection site. You may go for immediate physical therapy. Otherwise, you will perform activity as tolerated.
Can I go to work the next day?
You should be able to return to work the next day unless otherwise directed by your doctor.
Side Effects | Risks
Overall, the procedure is very safe. As with any procedure, there are risks. The most common side effect is pain, which is temporary. Any time a needle is punctured through the skin, there is a chance of bleeding or infection, though it is very rare. Other rare side effects include spinal headache, nerve damage, worsening of pain, etc., which are extremely unlikely.
Stabilink
Stabilink is a procedure that uses small implants to fixate the lumbar spine. Incisions in the skin between 2 and 4 cm are made to place the small titanium implants. The implants are then set between spinous processes, which are located outside the spinal canal and away from nerves.
How is it done?
A particular tool inserts and links the interspinous implants together. It is performed as an outpatient procedure.
What is it used for?
This procedure can be used to treat a variety of back pain issues including degenerative disc disease, spondylolisthesis, lumbar spinal stenosis, facet syndrome, trauma, and disc herniations. These fixated implants protect the body from bending too far backward, and limits twisting range of motion as well as lateral bending.
Hip and Pelvic
Hip Injection
A hip injection is used to provide relief from hip pain and to help your doctor diagnose the source of pain. It may be used to treat hip pain from inflammation caused by osteoarthritis, disease or injury.
How is it beneficial?
Hip injections are very effective in treating pain from inflammation. Most often the medications used in hip injections are anesthetics and steroids, which reduce pain and inflammation. You may also feel relief from the release of fluid buildup or pressure that sometimes occurs during the procedure. A hip injection is also useful for your doctor to determine if your pain is originating from within the hip.
What can I expect?
During the procedure, you will lie on your side, with the affected hip facing upwards.
Once the area has been sanitized, your doctor injects a needle containing medications into your hip joint.
Following the procedure, you will rest in the recovery area while being monitored.
Recovery time is relatively short due to the nature of the procedure. You may feel slight discomfort at the injection site. Be sure to follow discharge instructions, and contact your doctor if discomfort continues or new symptoms arise.
How soon will I feel relief?
You will most likely feel relief within a week to 10 days, and it can last for a few months.
As your pain subsides, your doctor may advise you to engage in moderate exercise.
While a hip injection is not a permanent solution, it will make your pain more manageable as your doctor develops a long-term treatment plan. If you do not feel relief from the injection, then your doctor will perform additional diagnostic tests to determine the source of your hip pain.
Superior Hypogastric Plexus Block
What can I expect?
Upon arrival, you will meet with one of healthcare professionals to discuss your medical history and to ask any questions you may have about the procedure.
You may receive an IV sedation to help relax you. During the procedure, you will lie on your stomach. A local anesthetic is applied to the skin. Most patients tolerate the injection very well. Numbing medicine is placed under the skin that feels like a poke and a burn. After that, you most likely will only feel pressure. Your doctor then uses an X-ray to guide the placement of a very thin needle to the proper position. Once in place, a test dose of dye is used to confirm the injected medication will reach the intended area, and not in a blood vessel. The doctor then gradually injects the local anesthetic (numbing) medication.
How soon will I feel relief?
You may start feeling relief within 24 hours, though it may take a few days to feel the full effects of the procedure. The lasting effects of the treatment differs with everyone, ranging from weeks to years. Your doctor may recommend subsequent injections to continue the pain relief or that can be used to manage your pain long term for recurrent pain.
What should I expect after the injection?
Following the procedure, you will rest in the recovery area. If sedated, you will need a
responsible adult to accompany you home. After the injection, you may notice that your pain has lessened. Often patients will feel soreness in the back at the injection site. You will perform activity as tolerated. You should be able to return to work the next day unless otherwise directed by your doctor.
Side Effects | Risks
Overall, the procedure is very safe, but there is always risk with any penetration of skin and soft tissue. Risks include infection, bleeding, bladder problems, nerve injury and/or paralysis, puncture of surrounding organs, puncture of adjacent vessels, drug allergy, seizure, and leg ischemia. Secondary risks include drug allergy, seizure and infection.
Who should not have these injections?
Notify your doctor if you are allergic to specific local anesthetics or ionic contrast. Also, if you take any blood thinners (Coumadin, Plavix, Warfarin, Lovenox, Pradaxa, Eliquis) notify your doctor ahead of time to help devise a safe plan for the injection.
Orthopedic
Arthroscopy
Arthroscopy is a procedure that allows your physician to visualize the inside of your joint without the trauma of major surgery. Arthroscopy is most typically performed on the knee, and shoulder, but other joints like hip, ankle, elbow and wrist can also be scoped.
How is it done?
Small incisions are made in the skin and a tool called an arthroscope is inserted. The arthroscope allows the physician to visualize bone structures, ligaments, and muscles. The physician can also insert tools through the other small incisions and repair tissue when necessary.
Will it hurt?
You will most likely not feel anything as you will be given anesthetics for this procedure. General anesthetic will make you unconscious during the procedure. A local anesthetics will make your appendage numb during the procedure.
What should I expect after?
After the procedure, you may experience some soreness and pain. Your physician will discuss pain management such as applying ice to the site, which helps reduce both pain and swelling. Your physician may also prescribe something for post-procedure discomfort.