This procedure is used to determine if any of the facet joints, the joints between vertebrae, are damaged and causing pain. Two facet joints per vertebra are located on either side of the spine to provide flexibility that allows patients to bend and move. Facet joint blocks are injections of local anesthetic into a particular joint to assess if pain is numbed, and if the pain returns when the medication wears off.

Conditions

• Arthritis
• Traumatic injury

Treatment

• A needle is inserted into the joint using x-ray guidance
• A mixture of local anesthetic and anti-inflammatory steroids are injected
• Nerve activity in one or more joints is blocked
• Evaluation of pain while medication is active, and after it wears off

This procedure is used to evaluate if pain is stemming from the branch nerves, small nerves that originate in the facet joints and feed out into the spine carrying signals. Branch nerve blocks are similar to facet joint blocks in that they block the signaling of nerves to identify whether or not the blocked nerves are causing the patient's pain.

Conditions

• Arthritis
• Traumatic injury

Treatment

• A needle is placed near the suspected nerves using x-ray guidance
• Local anesthetic is then injected into each branch nerve of interest
• Analysis of pain while medication is active, and after it wears off

This procedure is used to determine if the nerve roots are the cause of a patient's pain. A nerve root block is an injection into the sheath that surrounds a nerve root, the base or origin of a root, in the spine. Like other nerve blocks, this procedure use local anesthetics to numb the nerve so that physicians can evaluate if it is the cause of pain.

Conditions

• Cervical Radiculopathy (Pinched Nerve)
• Lumbar Radiculopathy (Sciatica)

Treatment

• A small needle is inserted near the nerve root using x-ray guidance
• Local anesthetic and anti-inflammatory medication are injected
• Dye is injected to confirm needle location
• Evaluation of pain while the medication is in effect, and after it wears off

A caudal steroid injection is used to treat pain in the lower back and leg. Swelling and inflammation are common causes of pain that can be reduced with steroids. Steroids can be administered by a simple injection, and monitored with fluorescent dyes to ensure that the medication reaches the inflamed tissue.

Conditions

• Spinal stenosis
• Foraminal stenosis
• Cervical radiculopathy (Pinched Nerve)
• Lumbar radiculopathy (Sciatica)
• Herniated disc
• Bulging disc
• Torn disc
• Facet Joint Syndrome
• Arthritis

Treatment

• A physician places a needle with x-ray guidance and confirms needles location with contrast dye
• A combination of local anesthetic and anti-inflammatory steroids is injected into the area experiencing pain
• Injections are repeated as needed
• Reduced swelling and inflammation will lessen pain

The cervical region of the spine is the neck. A membrane called the dura covers the spine and nerves in the cervical region. The space directly surrounding the dura membrane is called the epidural space. Nerves travel in and out of the epidural space to reach other parts of the neck, the shoulders, and arms. When these nerves become inflamed a patient may experience pain. An epidural injection uses anti-inflammatory steroids to reduce nerve swelling in the epidural space and subsequent pain.

Conditions

• Herniated disc
• Bulging disc
• Torn disc
• Degenerative disc disease
• Arthritis
• Cervical radiculopathy (Pinched Nerve)

Treatment

• Using x-ray guidance a small needle is inserted into the epidural space
• Fluorescent dye is injected to provide contrast and show the inflamed areas
• Anti-inflammatory steroids and a local anesthetic are then injected into the epidural space
• Treatment can provide permanent relief or temporary relief while the damage heals

The lumbar region of the spine is the lower back. A membrane called the dura covers the spine and nerves in the cervical region. The space directly surrounding the dura membrane is called the epidural space. Nerves travel in and out of the epidural space to reach other parts of the neck, the shoulders, and arms. When these nerves become inflamed a patient may experience pain. An epidural injection uses anti-inflammatory steroids to reduce nerve swelling in the epidural space and subsequent pain.

Conditions

• Herniated disc
• Bulging disc
• Torn disc
• Degenerative disc disease
• Arthritis
• Cervical radiculopathy (Pinched Nerve)

Treatment

• Using x-ray guidance a small needle is inserted into the epidural space
• Fluorescent dye is injected to provide contrast and show the inflamed areas
• Anti-inflammatory steroids and a local anesthetic are then injected into the epidural space
• Treatment can provide permanent relief or temporary relief while the damage heals

Spinal discography can be used to diagnose and treat pain associated with damage to the intravertebral discs, the soft jelly-like cushions located between the vertebrae in the spine. Spinal discography is an injection of fluorescent dyes that provide contrast to the damaged tissue and help physician's locate the problem. A physician can use this procedure to establish which discs are damaged and which are healthy, and whether or not the patient's pain is related to disc disease.

Conditions

• Arthritis
• Herniated disc
• Bulging disc
• Torn disc
• Degenerative disc disease

Treatment

• Using x-ray guidance a small needle will be inserted into the center of the disc
• Contrast dye will be injected into the discs
• Patients are then asked to describe if the contrast dye causes any pain
• Evaluation of the pain levels with the contrast will show if the disc is the source of pain
• The visual provided by the contrast dye will enable physicians to see disc damage

This treatment is used to eliminate scar tissue that develops in the epidural space, the space directly outside of the membrane that encloses the spine. Nerves run through the epidural space and can become inflamed by rubbing against other tissues.

Conditions

• Arthritis
• Traumatic injury
• Lumber spine surgery

Treatment

• A needle is inserted into the epidural space to administer a local anesthetic
• A catheter is then inserted into the epidural space
• Anti-inflammatory steroids are then inserted through the catheter
• Manipulation of the catheter is used to disrupt adhesions and scar tissue
• Reduced inflammation and scar tissue relieves pain

An injection into the sacroiliac joint, a large joint in the lower back, can be used to relieve pain in the lumber spine and thigh. Inflammation in the joint can cause the tissue to rub together causing pain and discomfort. A steroid injection can reduce this swelling and irritation.

Conditions

• Arthritis
• Traumatic injury

Treatment

• A needle is inserted into the joint using x-ray guidance
• Dye is injected to provide contrast that can help identify the injured tissue
• Steroids and a local anesthetic are then injected into the joint
• The steroids provide relief for pain associated with inflammation and swelling
• Relief can be long-term or temporary as the injury heals

This treatment blocks the signaling of the sympathetic nerve to reduce pain in a patient's arms. An anesthetic is injected into the sympathetic nervous tissue located in the cervical spine (neck) on either side of a patient's voice box. This can provide temporary relief from pain symptoms while the anesthetic is active.

Conditions

• Shingles
• Postherpetic neuralgia
• Local nerve pain
• Traumatic injury

Treatment

• A small needle is inserted into the cervical spine using x-ray guided fluoroscopy
• An anesthetic is administered through the injection
• The anesthetic will numb the area providing relief from pain
• Duration of relief will vary, and may be assessed over the first 3-4 hours

This treatment blocks the signaling of the sympathetic nerves in the lower back to relieve pain in the back and legs. The sympathetic nerves run along the outer surface of the spinal column, instead of within the spinal canal itself. These nerves control blood flow and regulate body temperature in the extremities. When these nerves are irritated it can cause pain in the back and legs that can be blocked with an anesthetic.

Conditions

• Reflex sympathetic dystrophy
• Local nerve pain
• Traumatic injury

Treatment

• A small needle is inserted into the lumbar spine using x-ray guided fluoroscopy
• A contrast dye will be injected to confirm which nerves are affected by the treatment
• An anesthetic will then be administered through an injection
• Duration of relief will vary, and may be assessed over the first 20-30 minutes

Electrodiagnostic testing is a state of the art method for diagnosing and treating illnesses of the nerves and muscles, including those in the spine. It can be difficult to pinpoint the exact cause of symptoms, but electrodiagnostic tests can determine with certainty what nerves and muscles are affected by symptoms including numbness, tingling, cramping, weakness, pain, and swelling.

Conditions

• Carpal Tunnel Syndrome
• Wrist/Foot Drop
• Pinched Nerves
• Neuropathy (nerve disease)
• Myopathy (muscle disease)
• Sciatica
• Disc Herniation
• Slipped Discs
• Spinal Stenosis

Types of electrodiagnostic tests:
Electromyography (EMG) - an EMG test used to test the function of nerves and muscles. Physicians insert a tiny, sterile, disposable needle beneath the surface of the skin, into the muscle to record signals that are generated. Physicians then analyze these signals and determine if the muscle or nerves supplying this muscle, are working properly.

Nerve Conduction Studies (NCS) - this test is used to assess the function of nerves, and identifies nerves that may not be working properly. Physicians stimulate the nerves then use surface electrodes to record the speed and size of the nerve potential generated. These impulses pass over the nerve while recording the nerve's response at a different location.

Cervical Radiculopathy occurs due to damage sustained by the root of the spinal nerves in the neck. These nerve root injuries are commonly referred to as "pinched nerves" and cause pain and numbness in the neck that radiates down the shoulder and into the arm.

Symptoms

• Sharp pain or a pins and needles sensation
• Numbness
• Muscle weakness

Treatment

• Physical therapy
• Anti-inflammatory medication
• Pain Medication
• Steroid injections

Lumbar Radiculopathy, commonly known as sciatica, is pain in the lower extremities that radiates from the lumbar spine (lower back). Pain is caused by compression at the roots of the spinal nerves, and generally causes discomfort in the lower back, hips, thighs, and travels down the legs. Compression most often occurs when the jelly-like substance in the intravertebral discs puts pressure on the nerves either by bulging out or by leaking out through a tear in the disc membrane.

Symptoms

• Pain radiating through the lower extremities
• A "popping sound" when moving the lower back
• Tingling
• Numbness
• Difficulty moving the lower extremities

Treatment

• Pain Medication
• Cortisone injections
• Physical therapy
• Anti-inflammatory medication

The facet joints are the areas in the spine that connect the vertebrae (bony segments that make up the spine). Like all joints, these structures enable bending, twisting, and flexing motions. Inflammation in these joints causes pain and stiffness that makes it difficult to move. This disorder most often affects the cervical spine (neck) and lumbar spine (lower back).

Symptoms

• Pain localized to one side of the body
• Pain in the neck, shoulders, and upper back or pain in the lower back or hips
• Difficulty walking, or walking hunched over

Treatment

• Painkillers
• Steroid injections

Arthritis is inflammation of the joints that causes pain and restricts movement. Arthritis occurs due to the breakdown of cartilage that normally protects joints, facilitating smooth movement. Without cartilage, bones rub together, which creates inflammation, pain, and stiffness. There are a variety of different types of arthritis that affect different parts of the body.

Symptoms

• Pain
• Joint swelling
• Reduced ability to move the joint
• Redness of the skin
• Stiffness

Treatment

• Low-impact aerobic activity
• Range of motion exercises for flexibility
• Strength training for muscle tone
• Avoid placing extra stress on your affected joints
• Modify your home to make activities easier
• Medication

Failed back syndrome (post-laminectomy syndrome) is persistent pain that occurs following a surgical procedure on the back. Also called failed back surgery syndrome (FBSS), it is chronic pain in the back or leg.

Symptoms

• Dull, aching pain in the back or legs
• Sharp pricks of pain in the extremities
• Constant or persistent pain

Treatment

• Physical therapy
• Pain medication
• Electrical nerve stimulation
• Anti-inflammatory medications
• Steroid injections

A herniated or "slipped" disc is a common spine injury that occurs when the jelly-like substance inside the intravertebral discs is forced outward either creating a bulge in the disc's membrane or leaking out through a tear in the membrane. The movement of the jelly-like substance places pressure on nearby nerves, which can cause pain and discomfort. There are two areas of the spine that can experience a herniated disc, the lumbar spine (lower back) and cervical spine (neck).

Symptoms

• Pain isolated to one side of the body
• Pain that get worse after standing or sitting
• Numbness
• Muscle weakness

Treatment

• Anti-inflammatory medication
• Pain medication
• Physical therapy
• Steroid injections