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Non-Operative Treatment: Therapeutic Injections The physicians at the San Diego Center for Spinal Disorders (SDCSD) understand that pain management is a high priority for most patients with spinal disorders. To help manage your pain, your physician may prescribe a therapeutic injection, such as nerve blocks, epidural steroid injections, and radiofrequency nerve ablation. These procedures may help to relieve and control pain from degenerative disc disease, injury, osteoarthritis and other disorders of the spine.
A nerve block is an injection of medication onto or near nerves. The injected medication may include a local anesthetic, steroid or narcotic.
- Facet Joint Block and Medial Blocks
Joint inflammation between the spinal bones can cause back pain. A facet joint block is an injection of local anesthetic and steroid medication into the joint. A medial block uses similar medication injected outside the joint space near the nerve that feeds that joint.
- Peripheral Nerve Block
Paresthesias are sensations described as numbness, tingling, or a 'pins and needles' feeling. These sensations may be caused by a disturbance in the peripheral nervous system. A nerve block to the peripheral nerves, which are outside of the brain and spinal cord, may help with paresthesias.
- Selective Nerve Root Block (SNRB)
Pain and discomfort from cervical or lumbar radiculopathy may be relieved by a SNRB. A radiculopathy is irritation and inflammation of a nerve root that serves a particular body part (e.g. arm, leg).
- Sympathetic Nerve Block
This type of nerve block can help address chronic pain. Sympathetic nerves regulate part of the autonomic (involuntary) nervous system. This includes such bodily functions as sweating and blood flow.
Epidural Steroid Injections
The epidural space is the space surrounding the membrane that covers the spinal cord and nerve roots. Disorders such as spinal stenosis and herniated disc can cause nerve irritation, inflammation, and pain. An epidural injection places anti-inflammatory medication (e.g. steroids) into the epidural space. Epidural injections are performed in the cervical, thoracic and lumbar spine.
Sacroiliac Joint Injection
The sacroiliac joint is the largest joint. It is located in the lower spine above the tailbone, and normally has very little motion. Inflammation of the sacroiliac joint can cause low back and buttock pain. An injection of an anesthetic and steroid may help relieve joint pain.
Radiofrequency Nerve Ablation
Facet joints are one source of back pain. Radiofrequency nerve ablation uses radio waves to produce heat focused at a specific facet joint nerve. The heat destroys the nerve and relieves pain.
The ablation procedure is similar to a nerve block or spinal joint injection except two needles are inserted; each facet joint has two nerves. Fluoroscopic guidance is used to correctly position each needle. Then radiofrequency "radio waves" are directed through each needle. The ablation process takes about two minutes. The entire procedure takes about 2 hours.
For safety, some patients are not allowed to undergo a spinal injection for the following reasons:
- Allergy to the drugs to be injected
- Bleeding problems
- Kidney disease
- Severe spinal abnormality
If therapeutic injections for pain management are not an option for you, our staff will discuss other pain management strategies such as medication or physical therapy.
Patient Preparation: At Home
The staff at SDCSD will thoroughly prepare you for any injection therapy, and it is important to follow all pre-test instructions. These instructions generally include:
- Stop blood thinning medication 2 days prior to the test
- Do not take any aspirin product 5 days prior to the test
- Stop anti-inflammatory medication 5 days prior to the test
- Stop pain medication 8 hours prior to the test
- Do not eat or drink 6 hours prior to the test
- Arrange for someone to provide transportation home
Patient Preparation: At the Medical Facility
- All therapeutic injections can be performed on-site at SDCSD or an adjoining facility.
- The medical staff at SDCSD will review your history, condition, medications taken on a daily basis, food and/or drug allergies, and other information.
- You'll be asked to change into a gown and lie down in a hospital bed. We provide a secure place for your personal items.
- You'll be hooked up to an EKG monitor (heart monitor), automatic blood pressure cuff (blood pressure monitor), and oximeter (measures blood-oxygen levels). This equipment enables us to consistently monitor your vital signs before, during and after the procedure.
- We'll administer medication via injection to relax you. In some cases, light intravenous sedation may be given.
What to Expect During the Procedure
- The procedure is performed in a sterile setting similar to an operating room.
- The injection site is cleaned and draped. Skin numbing medication is injected into and around the procedure site.
- Before proceeding, the fluoroscopy C-arm is positioned over the patient. Fluoroscopic guidance is used during the procedure to guide the needle into the proper position.
- After the needle is placed, an anesthetic and steroid are injected. An antibiotic may be included in the injection to prevent infection.
After the Procedure
- Our medical staff will continue to monitor your vital signs in the recovery area.
- Most patients are discharged home when stable with written instructions.
- The area around the injection site will feel numb.
- Steroids may cause side effects that include blurred vision, frequent urination, increased thirst and change in blood sugar levels. If these side effects become bothersome or worsen, seek medical attention.
- If fever, chills, increased pain, weakness or loss of bowel/bladder function occurs, seek immediate medical attention.
- As always, follow-up with your treating physician after the injection.
Spinal injections, like other medical procedures, have risks. Complications include risk of infection, low blood pressure, headache, and injury to nerve tissue. These risks are low.
We perform the full range of injection therapies to provide the best possible pain management for your condition. The skilled medical team at SDCSD will carefully discuss the options with you, and we'll give you detailed instructions for before and after the procedure so that you are well prepared.