Epidural Steroid Injection (ESI)
An epidural steroid injection is a minimally invasive procedure performed for the relief of arm, thorax or leg pain. The epidural space is the area between the spinal cord and vertebrae (bone) and is where the spinal nerve roots are found. These nerve roots can be irritated by local pathology such as disc tears, disc herniation and facet joint changes.
During an ESI, two medications are placed around the nerve root, including Lidocaine and a long-acting steroid to reduce inflammation around the nerve root, thus decreasing pain in the arm, thorax or leg. An alternative to steroid is to place platelet-rich fibrin (PRF) around the nerve root. PRF has powerful anti-inflammatory effects that last longer than steroid with fewer potential side effects.
Facet Joint Injection
The facet joints are small synovial joints that occur on both sides of the spine at every vertebral level of the cervical, thoracic and lumbar spine. Facet syndrome is an irritation of part of the facet joint, leading to local pain and decreased range of motion.
Facet joints can be treated using three different techniques, including facet joint injections, medial branch blocks or radiofrequency neurotomy.
During a facet joint injection, the painful facet joints are injected with a mixture of two different medications, including Lidocaine and a long-acting steroid with the goal of decreasing inflammation within the joint and providing pain relief. An alternative to steroid is placing either platelet-rich fibrin (PRF) or stem cells into the facet joints. These products give longer-lasting pain relief and have fewer potential side effects than steroid therapy.
Medial Branch Blocks (MBB)
The medial branches are nerves that connect the facet joints to the brain and allow us to perceive pain from our facet joints. In placing a strong short or long-acting anesthetic medication such as Lidocaine or Marcaine over the medial branch, the pain signal can be temporarily interrupted. MBBs serve as a strictly diagnostic approach to treating facet syndrome. If following MBBs a significant amount of pain relief is noted, then you are probably a good candidate to undergo a more lasting treatment option, radiofrequency neurotomy.
Radiofrequency Neurotomy (RFN)
For patients who have been definitively diagnosed with facet syndrome via history, physical exam and facet joint injections/medial branch blocks, radiofrequency neurotomy is a reasonable next treatment option. This procedure provides more lasting relief for facet syndrome sufferers and can be repeated if necessary.
RFN consists of using special neurotomy needles that are positioned directly over the medial branches of the painful facet levels. An electrode is then placed into the needle, with the opposite end of the electrode being connected by a cord to a radiofrequency generator. Following testing of the nerve to ensure accurate needle placement, the radiofrequency generator is used to heat up the tip of the electrode and ablate the medial branch. After the ablation, a long-acting steroid is placed over the lesion site to decrease inflammation.
Sacroiliac Joint Injection
The sacroiliac joint is a large, stable joint that connects the sacrum to the pelvis. The joint can become inflamed and cause pain and dysfunction.
A sacroiliac joint injection may be appropriate for those who have not gained adequate relief from more conservative measures. This injection can be performed in the office under ultrasound guidance. A mixture of two medications is placed into the joint, including Lidocaine and a long-acting steroid. An alternative to placing steroid into the joint includes placing platelet-rich fibrin (PRF) or stem cells into the joint. These treatments give longer lasting relief with fewer side effects than steroid therapy.
What To Expect From Your Spine Injection
Why Is This Injection Being Performed?
A spine injection is performed to decrease inflammation around a painful region of your spine. The injection is performed in a surgical center using fluoroscopy, an x-ray machine that helps your physician to guide the needle into the proper location. Contrast dye is also used to assure your physician of correct needle placement. The medication injected is a mixture of long-acting steroid and local anesthetic. Conscious sedation is offered to decrease anxiety and any discomfort associated with the injection. For more information on the type of injection that is being performed and the anatomy of the region, please refer to www.SpineUniverse.com.
What Should I Do Before My Injection?
Please discontinue any blood-thinning medications prior to the injection. NSAIDs such as Ibuprofen and Naproxen will need to be stopped three days prior to the procedure. Aspirin will need to be stopped for seven days prior to the procedure. If you are taking a prescription blood thinner, contact the prescribing provider and ask when to stop the medication and whether you need a bridging medication during that time period. Do not eat or drink for eight hours prior to the injection. Sips of water with your medications are permitted, and please continue taking all of your normal medications that are not blood-thinning. Plan for someone to come to the procedure with you, as you will not be allowed to drive yourself home.
What Can I Expect During The Injection?
The procedure will be performed in a sterile procedure room where your physician, a nurse and a radiology technician will be present. You will be lying on a table and a small x-ray machine will hover over you, controlled by the radiology technician. If you choose to undergo conscious sedation, a certified nurse will monitor your vitals during the sedation period, and oxygen will be provided. Once the injection site is confirmed, your physician will clean the site with soap and create a sterile field. Local anesthetic will be used to numb the injection site and decrease discomfort. You will likely feel pressure as the needle is guided into the correct region. Please know that you will be alert throughout the entire procedure, even with sedation, so that your physician can communicate with you and keep you safe.
What Can I Expect After The Injection?
You may have some discomfort in the areas where the needle entered the skin. Ice to this region can help decrease any discomfort. If an epidural steroid injection is performed, you may experience slight arm/leg weakness for a few hours due to the anesthetic injected. This is normal and will resolve four to six hours following the procedure. Some people experience a condition called a “steroid flare” following treatment with a steroid. Symptoms from a steroid flare usually begin about 12-24 hours following the injection. Symptoms can include headache, flushing of the face and chest, feeling hot, sweating, and increased or decreased energy level. This is normal and will usually resolve completely within one to two days. Any individual who elects to have conscious sedation may also experience nausea and fatigue for several hours after the sedation is given.