Injection Therapy
There are several types of injections:
- Epidural/Caudal injection
An injection of anesthetic and steroid medication is used to treat back pain, neck pain or sciatica. A spinal needle is inserted into the epidural space of the cervical, thoracic, lumbar, or caudal spine (depending on where the symptoms are) to target the nerve roots in the spinal canal, effectively blocking the nerve from transmitting pain. The procedure can take up to 30 minutes, plus approximately 45 minutes of recovery time. - Selective nerve root injection
A spinal needle is inserted into the area adjacent to the nerve root and medication (anesthetic and steroid) is injected. The procedure can take up to 30 to 45 minutes, plus approximately 45 minutes of recovery time. - Discography/Intradiscal injection
This is a diagnostic test to view and assess the internal structure of a disc and determine if it is a source of pain. Essentially, it is using analogous to “pressing/palpating” on the disc to see if it is painful/inflamed. If so, we may inject medication (anesthetic and steroid) to ease pain and inflammation. So we can identify disc abnormalities using a CT scan, we inject contrast dye into the disc. We look for annular tears, scarring, disc bulges, and other changes to the disc nucleus. The procedure can take up to 30 to 45 minutes, plus 30 minutes if a CT scan is indicated plus approximately 45 minutes of recovery time. - Sacroiliac injection
Used to target the sacroiliac joint in the lower back and buttocks region, a sacroiliac injection delivers an anesthetic and steroid into the sacroiliac joint and its surrounding structures. The procedure can take up to 30 minutes, plus approximately 45 minutes of recovery time. - Zygapophysial (facet) joint injection
A facet joint injection is directed to a pain-producing facet joint, a small stabilizing joint located between and behind the vertebra. A spinal needle is inserted into the facet joint or capsule and its surrounding structures, and an anesthetic or combined anesthetic and corticosteroid mixture is injected to prevent the nerve from transmitting pain. The procedure can take up to 30 minutes, plus approximately 45 minutes of recovery time. - Radiofrequency medial branch neurotomy
This is a therapeutic procedure performed to determine if the facet joint is the pain generator. It involves interrupting the nerve supply to the facet joint, which are called the medial branches. Radiofrequency probes or needles are placed on the two medial branches that innervate each facet joint. The needles are heated to 80 degrees Celsius for 90 seconds, sufficiently heating the nerve to cause denervation. Medication (anesthetic and steroid) is injected afterwards. Pain relief and can last from three to 18 months. The nerve eventually grows back and the procedure can be repeated. The procedure can take up to 30 to 45 minutes, plus approximately 45 minutes to 1 hour of recovery time. - Sympathetic injection
This injection is diagnostic and can be therapeutic. It is performed to determine if there is damage to the sympathetic chain of nerves (that control involuntary reflexes) that may be malfunctioning. A spinal needle is inserted along the sympathetic chain next to the vertebral body. Medication (anesthetic and steroid) is injected. The procedure can take up to 30 minutes plus approximately 45 minutes to one hour of recovery time. For a lumbar sympathetic chain injection, you generally can expect redness and a feeling of warmth in the lower extremities, lasting four to eight hours after the injection. For a cervical sympathetic chain injection, in addition to warmth and redness of the upper extremities, a hoarse voice, eye redness, drooping eyelid, and pupillary constriction can be expected, lasting four to eight hours after injection. - Trigger point injection
A trigger point injection targets a specific spot in the muscles anywhere in the body that is “triggering” the pain. The injection numbs the spot using an anesthetic, which may be combined with a corticosteroid to reduce inflammation, then the needle mechanically breaks up the nodule or “taut band” that forms the trigger point.