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Services
Procedures Offered
Caudal Steroid Injection
This injection is commonly used for spinal stenosis, radiculopathy, sciatica, and herniated disks. This injection is performed to relieve low back pain and radiation of pain to the legs. The steroid medication can reduce swelling and inflammation caused by the spinal condition. In this procedure, the patient lays facedown. A cushion is placed under the stomach area for comfort and to arch the back. The physician uses a fluoroscope to find the small opening at the base of the sacrum called the sacral hiatus. A local anesthetic numbs the skin and all the tissues down to the surface of the sacral hiatus. The physician then guides a needle through the anesthetized tract and into the epidural space. The needle is carefully inserted about one to two centimeters. Once inside the sacral hiatus space, a contrast or non-allogenic iodine-based solution is injected. This solution helps the physician see the diseased and painful area using a fluoroscope. A steroid/anesthetic mix is injected into the epidural space, bathing the painful area in a medication. The needle is removed. A tiny surface wound is covered with a small bandage. In some cases it may be necessary to repeat the procedure as many as 3 times for the patient to feel the full benefits of the medication. However, many patients feel significant relief from only one or two injections.
Cervical Epidural Steroid Injection
This injection relieves pain in the neck, shoulders, and arms caused by a pinched nerve (or nerves) in the cervical spine. Conditions such as herniated disks, spinal stenosis, or radiculopathy can compress nerves, causing inflammation and pain. The medication injected helps decrease the swelling of nerves. The procedure is performed with the patient lying down. Intravenous sedation may be administered, and a region of skin and tissue of the neck is numbed with a local anesthetic delivered through a small needle. Using x-ray guidance (also called fluoroscopy), the physician guide a larger needle to the painful area of the neck. The needle is inserted into the epidural space, which is the region through which spinal nerves travel. Contrast dye is injected into the space to make sure the needle is properly positioned near the irritated nerve or nerves. A combination of an anesthetic and cortisone steroid solution is injected into the epidural space. The steroid is an anti-inflammatory medication that is absorbed by the inflamed nerves to decrease swelling and relief pressure. The needle is removed and a small bandage is applied. The patient goes to a recovery room and discharge with post treatment instructions. Some patient may need only one injection, but it may take two or 3 injections (administered two weeks support) to provide significant pain relief.
Facet Joint Injections
Each vertebra in the spine is connected to the vertebra above and below it by facet joints, which are located on the both sides of the rear of the spine. Facet joint block can be both diagnostic and therapeutic for back or neck pain. The facet joint block injection can confirm whether the facet joints are indeed the source of the pain and can help relieve the pain and inflammation. Small area of the skin is numbed with a local anesthetic injection. Guided by fluoroscopy x-ray, a needle is placed into the facet joint. The correct placement of the needle is confirmed by injecting contrast dye into the joint. A combination of a numbing anesthetic and an anti-inflammatory steroid medication is delivered to the joint through a thin needle. Depending on the location of the pain, one or more injections may be administered. If the pain subsides after the injection, this suggests that the facet joint (or joints) injected were the cause of pain. Back or neck pain may disappear immediately after a successful block. However, once the numbing effect of the anesthetic wears off, pain may return. It usually takes 5 to 10 days for the steroid medication to reduce inflammation and alleviate pain. Effects may last several days or several months. Up to 3 injections may be given per year.
Interscalene Brachial Plexus Block
Lumbar Epidural Steroid Injection
Lumbar epidural steroid injection is performed to relieve low back pain and radiation of the pain to the legs. Steroid medication can reduce the swelling and inflammation caused by spinal conditions. In some cases it may be necessary to repeat the procedure as many as 3 times to get the full benefit of the medication. Many patients get significant relief from only one or two injections. The patient usually lays facedown. A cushion under the stomach is provided for comfort. In this position the spine opens and allows for easier access to the epidural space. The fluoroscopy assists the physician in locating the appropriate lumbar vertebra and nerve roots. A local anesthetic is used to numb the skin. All the tissues down to the surface of the lumbar vertebral bone are anesthetized. The physician slides a thicker needle through the anesthetized tract. Using the fluoroscope for guidance, the physician slides the needle towards the epidural space at the appropriate levels. A contrast solution is injected. The physician uses fluoroscope to see the painful areas and confirm the correct location of the needle tip. A steroid/anesthetics mix is injected into the foraminal epidural space, bathing the painful nerve root with soothing medications. Then, the needle is removed, and a small bandage is applied to cover the tiny needle surface wound.
Lumbar Sympathetic Block
This procedure is performed to relieve leg pain caused by complex regional pain syndrome, which may develop after an injury to a joint or limb. Usually a series of injection are needed to treat the problem. Patients lie either on their side or stomach on the table equipped with a special x-ray (fluoroscope) unit, and an intravenous line is started to administer medication to relax the patient. A local anesthetic numbs the skin and tissue down to the sympathetic nerves. The physician slides the needle through the anesthetized tract, the contrast solution is injected. Physician uses a fluoroscope to identify the painful areas and confirmed the correct location of the needle tip. Next, anesthetic solution which sometimes mixed with an anti-inflammatory medicine is injected around the sympathetic nerves to block pain signals from reaching the brain. The legs may feel weak or numb for a few hours after the procedure. Then, pain from the leg should improve. More blocks may be repeated about once a week until the pain subsides. Patients who are on blood thinning medications or who have an infection near the injection site should not receive the block.
Lumbar Transforaminal Epidural Steroid Injection
This injection procedure is performed to relieve low back and radiating leg pain. The steroid medication can reduce the swelling and inflammation caused by spinal conditions such as spinal stenosis, radiculopathy, sciatica and herniated disk. The patient lies facedown. A cushion is placed under the stomach area to provide comfort and flex the back. This position causes the spine to open, allowing for easier access to the epidural space. The physician uses a fluoroscope to locate the appropriate lumbar vertebral and nerve root, and a local anesthetic numbs the skin. All the tissue down to the surface of the vertebral transverse process is anesthetized. The physician slides a thin bent needle with a slightly curved point through the anesthetized track. With the aid of the fluoroscope, the physician carefully guides the needle into the foraminal space near the nerve root. The physician injects contrast solution and uses the fluoroscope to see the painful areas and confirmed the correct location of the needle tip. A steroid/anesthetics mix is injected into the foraminal space, bathing the painful nerve root with soothing medication. The needle is removed and a small Band-Aid is used to cover the tiny needle surface wound. In some cases it may be necessary to repeat the procedure as many as 3 times to provide the full benefit of the medication. However many patient feels significant relief from only one or two injections.
Medial Branch Block
This diagnostic procedure is performed to determine if a specific facet joint is the source of the patient's pain. During the procedure, an injection was used to block the nerve serving the painful facet joints. Patient's lies either on their side or stomach on a table equipped with a special x-ray (fluoroscopy) unit, and an intravenous line started to administer medication that relaxes the patient. A local anesthetic numbs the skin and all the tissues down to the medial branch. The physician's slides a needle through the anesthetized track. Fluoroscopy guidance will be used to confirm the correct location of the needle tip. Next, anesthetic medicine is injected around the nerve to block pain signals from reaching the brain. If there is no significant relief, another level may be treated to see if that there is the source of the pain. If the pain improved soon after the procedure, an ejection providing more long term relief or radiofrequency lesioning could be performed at that level.
Radiofrequency Neurotomy of the Cervical Facets
Sacroiliac Joint Steroid Injection
This injection procedure is performed to relieve pain caused by arthritis in the sacroiliac joint where the spine and hip bone meet. The steroid medication can reduce the swelling and inflammation in the joint. The patient lies facedown. A cushion is placed under the stomach for comfort and to arch the back. The physician uses touch and a fluoroscope to find the sacroiliac joint. A local anesthetic numbs the skin and all the tissues down to the surface of the sacroiliac joint. The physician advances a needle through the anesthetized track and into the sacroiliac joint. A steroids/anesthetics mix is injected into the sacroiliac joint, bating the painful area in medication. The needle is removed, and a small bandage is used to cover the tiny surface wound.
Spinal Cord Stimulator Implant
Spinal cord stimulator (SCS) is used to relieve many chronic pain conditions such as chronic low back pain, sciatic pain, and complex regional pain syndrome. It uses electrical impulses to prevent pain signals from being perceived by the brain. SCS candidates include people for whom conservative treatments have failed and surgery is not likely to help. The first step is trial implantation. This step is done under monitored care anesthesia; one or more insulated wire leads are inserted near the spinal cord by a needle or through a small incision. This is connected to a temporary stimulator. It will be used for several days or weeks to determine if SCS will help the patient. If pain decreases by 50% during the trial period, the system may be permanently implanted. The second procedure, permanent implantation, is usually performed under general anesthesia. The temporary leads are removed and permanent leads are implanted through a needle or incision. The receiver is implanted under the skin in the buttocks or abdomen. The leads are then connected to the receiver. The power source for the implant may be internal (pulse generator) or external (transmitter and antenna). The implant's electrical impulses are programmed with external unit. After surgery, patient may experience mild discomfort and swelling at the incision site for several days. Over time, leads may move or become damaged from strenuous activity and require repositioning or replacement.
Stellate Ganglion Block
This injection can both diagnose and treat pain coming from the sympathetic nerves. It is a common treatment for shingles and complex regional pain syndrome affecting the head, face, neck, or arm. Usually a series of these injections is needed to treat the problem. Patients lie on their back on the table with a special x-ray (fluoroscope) unit, and an intravenous line is started to administer medications that relax the patient. A local anesthetic numbs the skin and all the tissues down to the ganglion nerves. The physician slides the needle through the anesthetized tract. Contrast solution was injected so the physician can use an x-ray (fluoroscope) to see the painful area and confirmed the correct location of the needle tip. Next, an anesthetic solution which sometimes is mixed with an anti-inflammatory medication is injected around the ganglion nerves to block pain signals from reaching the brain. Common side effects include nasal congestion and a bloodshot, droopy eye on the side of the injection was given, as well as a hoarse voice and a warm, tingling sensation in the arm and hand. They usually disappear after several hours. If the first injection alleviates pain, more will follow over time. Pain relief usually lasts longer after each injection.
Ultrasound-Guided Injection for Shoulder Pain
Patient Education
Complex Regional Pain Syndrome (CRPS)
Frozen Shoulder (Adhesive Capsulitis)
