Injections & Nerve Blocks


Cervical Epidural Steroid Injection

A cervical epidural steroid injection (CESI) is an injection of anti-inflammatory medication into the space just outside the covering (the dura) of the spinal cord in the lower back. These injections are meant to relieve the pain caused by spinal nerve inflammation which can manifest in such conditions as neck pain, headaches, herniated discs, degenerative disc disease, radiculopathy or radiculitis, and spinal stenosis.

This procedure is done lying face-down on an X-ray table and under local anesthesia with the guidance of a fluoroscopy (which provides live x-ray imaging of the body). A needle is inserted into the epidural space, and small amounts of long-lasting steroids are administered around the inflamed spinal nerve.

Epidural Steroid Injections

Epidural Steroid Injections (ESIs) are a common method of treating inflammation causing leg, neck or arm pain relating to the lower back. This is due to the spinal nerves which become inflamed at the narrowing of the passages where the nerves travel as they pass down or out of the spine. Narrowing of the spinal passages can occur from a variety of causes, including disc herniations, bone spurs, thickened ligaments, cysts in the joints or spondylolisthesis (‘slipped vertebrae’).

This injection, which is done by use of a fluoroscopy (which provides live x-ray imaging of the body) can break the cycle of pain and inflammation and allow the body to compensate for the painful condition.

Medical Branch Block

This procedure treats the cervical facet joint, which is formed in the back of the spine where the bones in the spine contact each other. Facet injections are used for patients with low back pain and leg pain stemming from inflammation or irritation of the facet joints.

Facet blocks, which are meant to reduce the inflammation of tissue in the joint space, are used to diagnose and treat a number of painful conditions, including work or sports injuries caused by twisting motions, low back pain without disc conditions, facet arthritis, and pain following back surgery.

A short-acting anesthetic temporarily numbs nerves to relieve pain and added medication reduces swelling and inflammation, to provide more lasting pain relief. The injection is performed while the patient is lying face down on a table, and under local anesthesia with the guidance of a fluoroscopy (which provides live x-ray imaging of the body).

Nerve Root Injections

The nerve root injection, for pinched spinal nerves that cause pain in the spine, arms or legs, is a procedure in which a local anesthetic and steroid solution are administered near the nerve where it exits the spinal canal. This is done under fluoroscopy (which provides live x-ray/imaging of the body) to deliver the drug to the precise location. Injections are performed under local anesthesia while lying face down on an x-ray table.

Sacroiliac Joint Injections

A sacroiliac joint injection (SI) – also called a sacroiliac joint block – is used to either diagnose or treat low back pain and/or sciatica symptoms. The sacroiliac joint is located next to the spine and connects the sacrum with the hip on both sides. Joint inflammation and/or dysfunction in this area can cause pain. During the procedure, the skin is numbed with anesthetic. Then, using a fluoroscopy, an X-ray is used to guide a small needle into the joint. A small mixture of numbing medication (anesthetic) and anti-inflammatory medication are then injected. This 20-30 minute procedure is very effective in reducing inflammation of the joint and providing substantial to complete pain relief for an extended period of time.

Selective Nerve Block

A selective nerve root block (SNRB) is an injection primarily used to diagnose spinal nerve root pain. It is used diagnostically in the event that an imaging procedure, such as an MRI, does not clearly indicate which nerve is the source of pain. Secondarily, the medication provides relief from back, leg or other pain caused by the irritated spinal nerves. An SNRB can also be used to treat certain types of herniated discs.

The patient lies down on an x-ray table. Using a fluoroscopy, a type of X-ray that provides live imaging of the body, the nerve root is located, and an anesthesia and steroids (medication) are injected into the area. The entire procedure takes about 30 to 60 minutes.

Trigger Point Injections

Trigger point injections (TPI) are used to treat painful areas of muscle that contain trigger points, or knots of muscle that form when muscles do not relax. Trigger points may irritate the nerves around them and cause referred pain, or pain that is felt in another part of the body.

In the TPI procedure, a small needle is inserted into the patient’s trigger point. The injection contains a local anesthetic that sometimes includes a pain-relief agent. Relief is usually fairly immediate and can be long-lasting. TPI is used to treat many muscle groups, especially those in the arms, legs, lower back, and neck.

Facet Joint Injections

Facet Joint Injections are used for either diagnostic and/or treatment of pain. They are an injection of long-lasting medication into the facet joints, which are located on the back of the spine on each side of the vertebrae. These joints are actual joints with a joint capsule that contains lubricating fluids. A problem in the facet joint may cause low back pain.

An injected steroid reduces the inflammation and/or swelling of tissue in the joint space. This may, in turn, reduce pain, and other symptoms caused by irritation of the joint and surrounding structures.

Injections are performed under local anesthesia while lying face down on an x-ray table, guided by a fluoroscopic x-ray (which provides live x-ray/imaging of the body). The complete procedure usually takes about 30 to 60 minutes and is intended to result in partial to complete back pain relief.

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