Diagnostic & Therapeutic Injections

Some of the diagnostic and therapeutic options available at SpineOne to manage spine pain include epidural steroid injections, facet injections and discography. These techniques have proven to be very successful to conservatively manage spinal pain.

Epidural Spinal Injections

Epidural steroid injections have been found to be an effective treatment for people who are suffering from some types of low back pain, neck pain and radicular pain (pain in the upper or lower limb due to disc/nerve root inflammation). Lower limb radicular pain is also known as “sciatica.” Commonly, nerves that supply the neck/upper limbs or the low back/lower limbs are compressed and irritated by a bulging/herniated disc, an arthritic bone spur, scar tissue or a combination of these factors. This causes inflammation the whole area. An epidural steroid injection is a procedure using a powerful anti-inflammatory medication to decrease the inflammation of the area, thereby breaking this vicious cycle of swelling and irritation and providing pain relief. The epidural space is an air pocket that overlies the protective layers covering the spinal cord. This space can be accessed effectively for depositing anti-inflammatory or other pain relieving medication, thereby producing an effective and long-lasting reprieve from some types of debilitating pain. With the use of a fluoroscope, the epidural space is entered safely and precisely from several directions and to provide more effective coverage of the inflamed tissue.

Facet Joint Injections

Facet injections are effective for some cases of localized low back and neck pain. Small amounts of steroid and/or local anesthetic medication are injected into these small joints on either side of the spine. Facet joint injections can be used therapeutically and diagnostically. If the facet joints respond to the injections by allowing improved, pain-free spinal rotation, the procedure is deemed a successful therapeutic injection. If the functional improvement is short lasting, the procedure is deemed diagnostic, indicating potential success of another procedure in which radio waves are used to destroy the small nerve endings which are sending the signals of pain. The techniques of using radio waves can provide long-lasting relief from pain emanating from these facet joints.

Discography

Discography allows us to understand the role of the disc as a pain producer.

Discography is performed by injecting a disc with small amounts of fluid and observing the fluid's presence in the disc using the fluroscope. By measuring the pressure recorded in the disc at time of injection, how much fluid the disc can hold, and whether the injection allows a build up of pressure reproducing one's pain, we can determine which disc/discs are generating pain. This pain is produced by pressure on tears inside the disc that will cause pain independent of the local structures surrounding the disc (such as the spinal nerves and facets previously discussed). These disc tears are caused by degeneration or trauma; they can weaken the disc and lead to bulging or herniation of the internal contents of the disc. Bulging discs and herniations of the inner disc materials put pressure on the surrounding tissues and, in the case of the herniation, chemically irritate the surrounding nerves. Discs can eventually flatten as they become dehydrated; this is called disc dessication.

As one can see, we are able to use spinal injections to both diagnose and treat pain of spinal origin through the use of carefully guided needle positioning, proper solutions and deposition of these solutions at precise locations. The use of injections (anesthetic and/or steroid) is also quite useful for many painful musculoskeletal conditions.