Atlanto-axial joint block
The atlanto-axial joint is a joint between the first and second vertebrae of the cervical spine. Injections into the atlanto-axial joint may be used to treat pain at the back of the head.
Atlanto-occipital joint block
The atlanto-occipital joint is a joint between the base of the skull and first vertebrae of the cervical spine. Injections into the atlanto-occipital joint may be used to treat pain at the back of the head.
Botulinum toxin injections
Botulinum toxin is injected into localized areas of muscle in extremely low concentrations. This potent medication blocks the release of chemicals from nerves supplying muscle. This may result in decreased pain and muscle spasms lasting several months.
A specially designed epidural needle is placed under X-ray control and through it a catheter is directed to the site of pain and scarring. Through this catheter, local anesthetics, steroids and concentrated saline are injected to shrink scar tissue and decrease pain.
Epidural steroid injections
The epidural space is within the spinal canal and surrounds the spinal cord. Steroid injections into this space can help to decrease inflammation of spinal nerves. These injections are usually given in a series of three for a cumulative effect. They are used for problems such as, herniated discs, sciatica, radiculopathy, narrowing of the spinal canal (spinal stenosis), and discogenic low back pain. They can be given in the neck (cervical spine), upper back (thoracic spine), lower back (lumbar spine), and from the level of the tailbone (caudal approach).
The facet joints allow movement of the spine bones. The facets joints start near the base of the skull at the cervical region and extend to the sacrum. These joints can be a source of pain. Injections into the joints can be used to diagnose and treat this type of pain. If local anesthetic and steroid injections give only short-term relief, then radiofrequency heating of the nerves supplying the joints may give more prolonged relief.
Intradiscal Electrothermal Annuloplasty (IDET)
This procedure is used to treat pain as a result of damaged discs. This procedure involves the insertion of a needle into the affected disc with the guidance of an X-ray machine. A wire is then threaded down through the needle and into the disc. The wire is then heated, resulting is destruction of small nerve fibers that have grown into and invaded the degenerating disc. The heat also triggers the body to generate new reinforcing proteins in the fibers of the disc.
This procedure is used to treat pain as a result of damaged discs. Under X-ray guidance, a needle is inserted into the disc causing pain. A drill-like probe is inserted through the needle into the disc, and disc material is removed.
This procedure is used to treat pain as a result of damaged discs. Under X-ray guidance, a needle is inserted into the disc. A flexible tube (catheter) is inserted through the needle into the disc. Using radiofrequency energy, disc material is slowly heated. This results in damage of nerves transmitting pain and generation of new reinforcing proteins in the fibers of the disc.
Myofascial rigger point injections using local anesthetics and steroids may provide relief of muscle pain and spasm.
Neurolytic procedures involve the interruption of pain signals along a nerve from a source of pain. The interruption, known as denervation, is accomplished by a radio-frequency probe that heats the nerve.
Occipital nerve injections
Injury and compression of the occipital nerve within the muscles of the neck can cause headache and neck pain (occipital neuralgia). Occipital nerve injections can be used treat neck pain and headache.
This procedure is used to treat pain as a result of damaged discs. A needle is inserted into the affected disc. A special radiofrequency probe is inserted through the needle into the disc. This probe generates a highly focused plasma field with enough energy to break up the molecular bonds of the gel in disc. The result is that 10-20% of the disc is removed which decompresses the disc and reduces the pressure both on the disc and the surrounding nerve roots.
Sacroiliac joint injections
The sacroiliac joints are joints in the region of the low back and buttocks where the pelvis actually joins with the spine. If the joints become painful they may cause pain in the low back, buttocks, abdomen, groin or legs. Injections into the sacroiliac joints can be used to diagnose and treat this type of pain.
Selective nerve root injections
These injections are performed to determine if a specific spinal nerve is the source of pain. Local anesthetic and steroid is injected very close to the nerve in question. This type of injection can also be used to reduce inflammation around the nerve root, thus relieving the pain.
Sphenopalantine nerve block
This can be very useful block for treatment of certain types of headaches and facial pain. This block is performed using X-ray guidance. A small amount of local anesthetic is injected through the cheek to numb the sphenopalatine ganglion. Pain relief is immediate if this is a structure involved in the pain pathway. A neurolytic procedure may produce longer lasting pain relief.
Stellate ganglion block
The sympathetic nervous system is a network of nerves throughout your body. The nerves branch from your spine. They control some body functions, such as closing of blood vessels. A problem with these nerves can affect blood flow and cause pain. Symptoms are often felt in the hands or feet. They may hurt, burn, feel cold, or be tender to the touch. This block is performed under X-ray guidance to determine if there is damage to the sympathetic nerve chain and if it is the source of the patients arm pain. This block may be used to diagnose the cause of pain and may also provide pain relief. A local anesthetic injection is given near the base of the neck on the affected side.
Suprascapular nerve block
A suprascapular nerve block with local anesthetic and steroid may be a useful for the treatment of shoulder pain.
Sympathetic blocks, Lumbar
The sympathetic nervous system is a network of nerves throughout your body. The nerves branch from your spine. They control some body functions, such as closing of blood vessels. A problem with these nerves can affect blood flow and cause pain. Symptoms are often felt in the hands or feet. They may hurt, burn, feel cold, or be tender to the touch. This block that is performed to determine if there is damage to the sympathetic nerve chain and if it is the source of pain. This block may be used to diagnose the cause of pain and may also provide pain relief. A local anesthetic injection is given in the lumbar area of the back. The block may be performed on both sides of the spine.
Spinal cord stimulation
Spinal cord stimulation uses an implanted device to deliver low levels of electrical energy directly to nerve fibers, resulting in interruption of pain signals.
Trigeminal nerve blocks
The trigeminal nerve and its branches supply the face. Blocking these nerves can be used to treat facial pain and headache.
This procedure is used to treat compression fractures of the spine. A needle is placed into the back and polymethylmethacrylate (PMMA) is injected into vertebral compression fractures for relief of pain. It is believed that the delivery of the PMMA into the fracture stabilizes the vertebral body, resulting in decreased pain.