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.

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) into the facet joints. These products give longer-lasting pain relief and have fewer potential side effects than steroid therapy.

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.

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.

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) into the joint. These treatments give longer lasting relief with fewer side effects than steroid therapy.