Epidural and Facet Injections

Questions About Epidural and Facet Injections

What is radiofrequency?

Radiofrequency is a safe and effective technique used in pain management to desensitize specific nerves and reduce pain impulses using radio waves. It is used to treat certain neck, arm, back or leg pain problems after the cause of the pain has been identified.


What is a Medial Branch Block?

Facet joints are innervated by nerves called “medial branches”, which carry pain sensations. Medial Branch Block is a diagnostic test to confirm facet joint pathology.


How is the injection performed?

Facet injections are safely performed on an outpatient basis. After sterilizing the area, a small amount of local anesthetic is used to numb the skin. Needles are then placed through the numb area to the desired locations using real-time x-ray (fluoroscopy) to ensure precise placement. A small amount of local anesthetic is injected and the needle is withdrawn. The procedure itself typically takes 15 minutes followed by a short observation period.


Who is a candidate for facet injections?

Anyone with persistent neck or back pain, who has not responded to epidural steroid injections or conservative therapies (i.e. chiropractor, anti-inflammatory medications, physical therapy).


What is an epidural?

An epidural is a potent steroid injection that helps decrease the inflammation of compressed spinal nerves to relieve pain in the back, neck, arms or legs. Cortisone is injected directly into the spinal canal for pain relief from conditions such as herniated disks, spinal stenosis, or radiculopathy. Some patients may need only one injection, but it usually takes two or three injections, given two weeks apart, to provide significant pain relief.


What is a cortisone/corticosteroid injection?

Cortisone is a steroid that is produced naturally in the body. Synthetically-produced cortisone can also be injected into soft tissues and joints to help decrease inflammation. In Pain Management, cortisone injections are commonly used as a treatment for chronic conditions such as bursitis, tendinitis, and arthritis. cortisone is not a pain reliever; pain may diminish as part of the treatment.


How are epidural injections done?

Epidural steroid injections are safely performed on an outpatient basis. All of our procedures are done under continuous x-ray (fluoroscopy) to ensure exact placement of the medication. The skin is always numbed with local anesthetic before careful placement of specially designed small gauge needles. First, contrast (dye) is injected to better visualize the anatomy and confirm proper location. The therapeutic steroid mixture is then injected and the needle is removed. The procedure typically lasts about 15 minutes followed by an hour recovery period.


Who may benefit from an epidural injection?

People with neck, arm, back or leg pain (sciatica) due to irritation of the spinal nerves. Causes of the nerve inflammation are mechanical (direct pressure) or chemical (irritating substance) and result from either herniated or damaged spinal discs, a tight spinal canal (spinal stenosis) or severe arthritis of the spine.


Is there a limit to the number of injections you can have in a lifetime or in a year?

The number of injections is deliberately limited based on the experience of the medical profession since the 1960’s. Generally speaking, if we don’t get very good relief in two to three weeks with two to three injections, the patient will most likely not get substantial relief just from epidural injections. There are occasions however where we can vary the type of injection which is given and we will go to a fourth or fifth injection. Generally speaking it is the total dose of steroid a patient receives that actually limits the number of injections the patient can receive. When steroids are delivered to the body, we can develop some side effects from the steroids. This is a complex problem of endocrinology, which can cause increased blood sugar or retention of fluids to name a few.


What is the most common use and when are epidural steroid injections indicated for back pain?

Steroids are anti-inflammatory drugs, so they are only indicated where there are conditions of inflammation. The steroid medication is injected percutaneously into the epidural space in a wide variety of fashions under fluoroscopic guidance. This is a fancy X-ray machine in an operating room where the medication can be placed exactly where the inflammation is believed to be. This fluoroscope also minimizes any of the complications that can occur by placing the needle blindly into the spine. The advantage of delivering epidural steroids is that the physician can deliver a high enough concentration in and around the inflamed area much greater than we could have obtained if the medication was given orally. Epidural steroid injections have been in use since the early 1960’s and have been well studied and well published in the medical literature. They have been proven effective since that time.

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