Lumbar Procedures

Diagnostic Medial Nerve Branch Nerve Injection

Patients with increasing arthritis in the facet joints and patients with lower back pain can seek diagnosis and treatment with a medial nerve block, administered with an injection of local anesthetic and sometimes a steroid. With a medial nerve branch block, the injection is made outside the joint near the nerve. The results of the treatment can vary. If pain returns, the length of time relief was experienced and how the pain returns can be used in diagnosis to tell the doctor more about how to proceed with further treatment. Blocks are treatments that can be repeated if benefits are derived.

Epidural Steroid Injection

An epidural steroid injection is a common non-surgical treatment option for certain lower back pain and/or leg pain. This choice of treatment is focused on pain relief and the results are temporary. However, combined with a rehabilitation program, short-term pain relief can be beneficial. The steroid that is injected reduces inflammation and therefore reduces painful irritation. This can be a treatment for herniated lumbar discs, degenerative disc disease and lumbar spinal stenosis (or a narrowing of the spinal canal that compresses nerves and the spinal cord).

Facet / Medial Nerve Block

Facet and medial branch blocks are procedures that are typically used in patients who have back pain that is due to arthritic changes in the facet joints or those who have mechanical low back pain.  A facet block is an injection of a local anesthetic along with a steroid into a joint in the spine. Similarly a medial branch block is the introduction of a local anesthetic but it is placed outside the joint space closer to the nerve of the joint known as the medial branch. These injections both have the possibility to be therapeutic as well as diagnostic. There are three possible outcomes to this procedure:
1. The pain does not go away. (Which may indicate that the pain is not coming from the arthritic facet joint.) This outcome serves as providing diagnostic information.
2. The pain goes away for some time, but then the original pain comes back and fails to receive any relief. (This would mean that the pain’s origin is most likely the joint, but the steroid was not providing relief.) This outcome is also diagnostic.
3.The pain goes away following the block. (Which may come back later, but as time passes eventually subsides.) This outcome serves to be therapeutic and may have a long lasting effect on the pain.

Intradiscal Electrothermal Therapy

Intradiscal Electrothermal Therapy (IDET) is a treatment for chronic lower back pain. This is a relatively new, minimally invasive treatment for discogenic low back pain, or pain originating from or in a disc. A flexible catheter is inserted into the disc and is heated causing the contraction of collagen fibers with the intent of enhancing the strength and structure of the disk. Recovery is gradual following this procedure with significant pain relief in 3-4 months.

Lumbar Sympathetic Block

For patients with pain related to their sympathetic nervous system, a lumbar block (also known as a sympathetic block) can diagnose and in some cases relieve pain. This can be properly diagnosed pain in the legs. A lumbar block involves an injection of a local anesthetic into the lower back. From a diagnostic point of view, a lumbar sympathetic block also help in determining if circulation issues can be improved with some diseases. Short-term pain relief will result from the treatment and depending on the patient’s symptoms, long-term relief from the pain may be experienced.

Nerve Root Blocks

A nerve root block is frequently a diagnostic tool to help the doctor diagnose back and neck pain. The injection of steroid and anesthetic can also have therapeutic benefits depending on the patient’s condition. In the procedure, an injection of an anesthetic and a steroid is made into the sheath around the nerve root in the spine to reduce inflammation. This injection will cause a short-term relief from the pain and allow the doctor to specifically isolate the nature of the pain. Depending on the patient’s symptoms, the anti-inflammatory injection may treat the area and offer long-term relief.

Percutaneous Discectomy

A percutaneous discectomy literally translated means the surgical removal of a herniated disc through a small incision in the skin. When a herniated disc causes pain by compressing a nerve on the spinal cord, your doctor may recommend a percutaneous discectomy. With a herniated disc, or a ruptured disc, the viscous cushioning material inside the disc leaks out to surround the nerve or spinal cord causing pressure leading to pain, weakness and/or discomfort.

Prior to the procedure, your doctor will use imaging (MRI or CT scan) to confirm a herniated disk. The percutaneous discectomy procedure is performed under either local or general anesthetic. With a small incision, the surgeon can remove disc tissue with surgical instruments, lasers or by suction. Only herniated materials are removed in this procedure.

Piriformis Block

Pain related to the sciatic nerve is a very common condition. This is due to the compression of the sciatic nerve near the piriformis muscle. This can lead to pain in the leg, foot and buttocks depending on where and to what degree the compression is occurring. A piriformis block is an injection of anesthetic and steroid into the affected area with the goal of reducing irritation and inflammation. The injection is a deep muscle injection and pain from the injection may last a few days.

RadioFrequency Rhizotomy

For pain caused by degenerative facet joints in the spine, radiofrequency rhizotomy is a therapeutic procedure that offers relief. This procedure uses radio frequencies to heat and destroy the nerves that carry the pain signals to the brain from the facet joint experiencing pain. Radio frequencies are a safe and focused method of delivering specific heating treatments to localized areas.

Sacroiliac Joint Injection

Pain related to the sacroiliac joint can cause an intense and localized pain in the buttock, leg, hip, groin and/or abdomen. The sacroiliac joint is a large joint in the lower back. Irritation or inflammation in the sacroiliac joint can cause chronic pain. An injection of steroid, such as cortisone, will reduce inflammation and irritation, alleviating the pain. Initially, this injection can be used to diagnose if the pain is being caused by irritation of the sacroiliac joint, should the pain not be relieved immediately by the injection.

Transforaminal Injections

A transforaminal injection is a steroid injection into an opening at the side of the spine at the exit point of a specific nerve root (also known as a foramen). A small covering of epidural tissue extends just beyond the spine at that point and out over the nerve root. This injection is also known as a root block or transforaminal epidural block. The steroid injection reduces inflammation and irritation of the spinal nerve roots and the surrounding area. This reduces pain and other related symptoms such as numbness or swelling. A transforaminal injection can treat patients with pain radiating into the arms and legs from the spine and those with localized neck or back pain.