Treatments / Procedures

Injections - Pain management that fits your needs

At Florida Advanced Spine and Orthopedics, we are proud to offer a full spectrum of Diagnostic and Interventional Injection Therapy solutions, including:

Facet joint injections or blocks

The facet joints are paired joints in the back and neck, one pair at each vertebral level (one joint on each side of the vertebrae). These joints have opposing surfaces of cartilage (cushioning tissue between the bones) and a surrounding capsule that is filled with synovial fluid, which reduces the friction between bones that rub together. The facet joints can become painful due to arthritis of the spine, a back injury or mechanical stress to the back. A lumbar (lower back) facet joint injection involves injecting a steroid medication, which can anesthetize the facet joints and block the pain. The pain relief from a facet joint injection is intended to help a patient better tolerate a physical therapy routine to rehabilitate his or her injury or back condition.

Single nerve root blocks

A nerve root block is an injection of local anesthetic (numbing medicine) and steroid injected under X-ray guidance (Fluoroscopy) into the area where the nerve exits the spinal column.

A nerve root block is usually ordered by your doctor for pain in the arm or leg that follows the path of a single nerve. A nerve root block may be diagnostic (a test to determine the source of your pain) and/or therapeutic (to relieve your pain). If you get a period of sustained pain relief from the injection, the block may be repeated. Sometimes the block is done to help identify whether or not surgery might be helpful and at what level such surgery might be most helpful.

Peripheral nerve injections

Peripheral nerve blocks are generally done to control pain arising from a nerve, also known as neuralgia. Nerve injury can be caused by trauma, compression, ischemia, or toxic exposure to a nerve. The block involves the injection of a local anesthetic with a steroid in proximity to the injured nerve to decrease the conduction of pain signals along the nerve.

Far lateral (Trans-Foraminal) epidural steroid injection (TFESI/ESI)

An epidural steroid injection is a common procedure to treat spinal nerve irritation that is caused by tissues next to the nerve pressing against it. The beginning of the nerve (nerve root) is most often irritated by an inflamed intervertebral disc, or disc contents, directly touching the spinal nerve.

An epidural steroid injection involves bathing an inflamed nerve root in steroids (potent anti-inflammation medicine) in order to decrease the irritation of the nerve root that is causing pain. The epidural steroid injection procedure is quick and simple. While it is common for people to be concerned prior to the procedure, it is actually frequent to hear from patients afterwards: "Is that all?"

The spinal cord rests in the spinal canal. The nerve roots branch out from the spinal cord at each level of a spinal vertebra (the bony building blocks of the spine). The cord is protected by cerebrospinal fluid (CSF), which serves as a shock absorber for the cord. The CSF is held in place by a membrane with several layers, one of which is called the dura, from the Greek for tough (think of "durable"). The Greek word "epi" means "outside of". So, the epidural space is outside of this tough membrane.

During an epidural steroid injection, a needle and syringe are used to enter the epidural space and deposit small amounts of long-lasting steroids around the inflamed spinal nerve. A fluoroscope (a viewing instrument using X-rays) is used to visualize the local anatomy during the injection. The epidural steroid injection specifically targets the inflamed area and treats it with a maximal amount of steroids, thereby minimizing exposure of the rest of the body to the steroids.

The Epidural Steroid Injections done at the Trinity Spine Center are delivered more via a far lateral approach (more off to the side) than other physicians in the area which typically produces a much better outcome

Diagnostic nerve blocks

A Nerve Block is a procedure performed to anesthetize or numb a particular nerve in the body to treat certain forms of chronic pain. A Nerve Block involves the injection of a local anesthetic like Lidocaine or Bupivicaine onto a target nerve or group of nerves. The local anesthetic works by interrupting conduction of electrical impulses along the target nerve for a limited period. The duration of the numbing effect varies with the local anesthetic used. Lidocaine usually lasts for one hour, and Bupivicaine lasts for 3-4 hours. When the local anesthetic effect wears off, nerve conduction and function to the numbed area resumes normally.

A Diagnostic Nerve Block involves numbing a specific nerve or group of nerves that may be involved in carrying a patient's pain. The physician performing the nerve block is an expert in anatomy so that he/she knows the location of various pain-carrying nerves.

A local anesthetic is injected in very small amounts onto target nerves, and the patient is then assessed for any change in pain symptoms. If a particular pain-carrying nerve or group of nerves is/are numbed and a patient notes significant improvement in pain symptoms, the location of the pain generator is likely confirmed. If a patient notes no change or limited change in pain symptoms following a diagnostic nerve block, the treating physician may conclude that a patient's pain is originating from a different area.

Trigger point injections

A trigger point is an irritable, painful, taut muscle band or palpable knot in a muscle that can cause localized pain or referred pain. Referred pain from trigger points can mimic pinched nerves in the neck or low back. They can occur from direct muscle injuries, poor posture, repetitive strain, or secondarily from spine conditions such as a herniated disc. Trigger point injections are injections of local anesthetic (numbing) medication, saline, and/or cortisone into the trigger point(s). The basis for a trigger point injection is to relax the area of intense muscle spasm. By relaxing the muscle spasm, blood flow to the area is improved thus allowing the washout of irritating metabolites. Trigger point injections are an important part of treating myofascial pain syndrome and, in some cases, fibromyalgia. Many times multiple injections are performed in series. Trigger point injections can be done in an office setting or in an outpatient setting under IV sedation. Other treatments for trigger points include stretching exercises, heat, improvements in posture, electrical stimulation, and stress reduction.

Discography

Discography is used to determine whether the disk is the source of pain in patients with predominantly axial back or neck pain.

During discography, contrast medium is injected into the disk and the patient's response to the injection is noted; provocation of pain that is similar to the patient's existing back or neck pain suggests that the disk might the source of the pain. Computed tomography (CT) is usually performed after discography to assess anatomical changes in the disk and to demonstrate intra-discal clefts and radial tears.

Radiofrequency rhizotomy

Radiofrequency (RF) rhizotomy or neurotomy is a therapeutic procedure designed to decrease and/or eliminate pain symptoms arising from degenerative facet joints within the spine. The procedure involves destroying the nerves that innervate the facet joints with highly localized heat generated with radiofrequency. By destroying these nerves, the communication link that signals pain from the spine to the brain can be broken.

Nerve Ablation

Radiofrequency ablation (or RFA) is a procedure used to reduce pain. An electrical current produced by a radio wave is used to heat up a small area of nerve tissue, thereby decreasing pain signals from that specific area.

RFA can be used to help patients with chronic (long-lasting) low-back and neck pain and pain related to the degeneration of joints from arthritis.

RFA has proven to be a safe and effective way to treat some forms of pain. It also is generally well-tolerated, with very few associated complications. There is a slight risk of infection and bleeding at the insertion site. Your doctor can advise you about your particular risk. The main side effect of RFA is some discomfort, including swelling and bruising, at the site of the treatment, but this generally goes away after a few days.

As with any medical procedure, RFA is not appropriate for everyone. For example, radiofrequency ablation is not recommended in people who have active infections or bleeding problems. Your doctor can tell you if you should not have RFA.

Spinal Cord Stimulator Implant

A spinal cord stimulator is a device used to exert pulsed electrical signals to the spinal cord to control chronic pain. Spinal cord stimulation (SCS), in the simplest form, consists of stimulating electrodes, implanted in the epidural space, an electrical pulse generator, implanted in the lower abdominal area or gluteal region, conducting wires connecting the electrodes to the generator, and the generator remote control. SCS has notable analgesic properties and, at the present, is used mostly in the treatment of failed back surgery syndrome, complex regional pain syndrome and refractory pain due to ischemia.