Accessibility Tools
Hide
Call for Appointment
Book an Appointment
 
Home » Services » Selective Spinal Interventions » Cervical Spine

Cervical Spine

Epidural Injections


Epidural injections contain a strong anti-inflammatory agent called corticosteroid and an anesthetic for pain relief. It is not the same as an epidural anesthesia given before birth to decrease labour pain. Epidural injections are given to relieve pain in the neck, back, arm and leg due to inflammation of spinal nerves from conditions such as spinal stenosis, spondylolysis, herniated disc, degenerative disc and sciatica.

Epidural injections are administered into the epidural space of the spine. The epidural space is the space between the outermost covering of the spinal cord (dura mater) and the wall of the spinal canal. It is approximately 5mm wide and is filled with spinal nerve roots, fat and small blood vessels.

Indications

Epidural injections are recommended based on pain patterns and used to treat pain primarily from the spine.

Procedure

You will be taken to the pre op area where trained nursing staff will get you ready for the procedure, by taking vitals and reviewing your medications. Your blood sugar and coagulation status may also be checked if needed. Then you will enter the procedure room where you will lay, usually, face down or on a table.

The injection site is then cleaned and injection of a local numbing agent is given in the area so that you don’t feel pain during the procedure.

A thin hollow needle is then inserted into the epidural space. The doctor is guided by fluoroscopic X-ray to place the needle in the correct position. This system gives real time X-ray images of the position of the needle in the spine on a monitor for the surgeon to view..

A contrast material is then injected through the properly placed hollow needle to confirm that the drug flows to the affected nerve when injected.

When the doctor is satisfied with the position of the needle, the an aesthetic drug and corticosteroid are injected through the same needle inserted in the spine.

You may feel some pressure during the injection but mostly the procedure is not painful. The needle is removed and the injection site is covered with a dry, sterile bandage. The procedure takes about 3-5 minutes to complete.

Risks and Complications

With the use of live imaging though X-ray machines, contrast dye, and physicians trained in the latest interventional techniques, complications are rare. But with all medical procedures, complications may occur. To help minimize risk please follow all directions given to you by your care provider. Have all your treatment options explained, so you are aware of the risks and benefits of these procedures.

Some complications may include:

Spinal Headache: If spinal fluid leaks out of the Intrathecal space, you may have a headache that gets better when you lay down. This headache usually gets better by lying flat in bed for 12 to 24 hours and drinking caffeine. However on occasion, headaches may last longer and need further evaluation.

Infection: Your pain physicians clean and sterilize your back before every procedure to prevent this from occurring. On rare occasions oral antibiotics may be needed.

Allergic Reaction: This may occur if you have allergies to any medication used. Typically this is pretreated and on occasion your physician may recommend medications for you to take after the procedure. Pay close attention to any rashes and difficulty breathing because that may indicate need for emergent attention

Worsening pain:This may occur after the procedure due to the needle puncture and can last from 3 days to a week. Usually this pain resolves and does not cause any lasting impact.

There are many side effects of corticosteroids. However, by limiting the cumulative dose of medication used, these risks are reduced. However, some symptoms you may feel include:

Epidural injections may take 2-7 days to show any effect. They may need to be repeated. And as always, follow the instructions of your care provider and have your questions answered prior to the procedure

Medial Branch Blocks


A medial branch block involves the injection of a local anesthetic with or without a steroid near the nerve supplying a specific facet joint. More than one injection may be needed, depending on the number of joints involved.

Indications

Medial branch blocks are usually indicated in patients with back pain originating from arthritic changes in the facet joints or from mechanical stress to the back. A facet block or medial branch block can be performed for the diagnosis or treatment of pain arising from the facet joints.

Before the procedure

If an injection is performed in the neck region, you should not eat or drink anything for at least 6 hours before the procedure. You can take your prescribed medications with a sip of water. However, for injections performed in the lower back region, you can eat, drink as well as take your usual medications.

Procedure

During the injection procedure, you will be placed on your stomach, on the X-ray table. Your physician will clean the intended site with antiseptic and cover it with a sterile drape. A local anesthetic is then used to numb the skin. You may feel a stinging or burning sensation for a few seconds. A needle is directed into the facet joint or the medial branch nerves, under X-ray (fluoroscopy) guidance. Following this, a local anesthetic with or without steroid will be slowly injected through the needle. The needle is then removed and a bandage is used to cover the injection site.

After the procedure

Your pain may improveimmediately after the injection due to the local anesthetic. When steroids are used, it usually takes about 2 or 3 days for the steroid medication to take effect and about 2 weeks to reach the peak effect.

You may experience localized pain around the injection site for which ice packs can be applied to ease the discomfort. You may experience numbness and increased pain for a few days after the injection. In diabetics, there may be a temporary rise in blood sugar level.

You can arrange for someone to drive you home after the procedure. Avoid swimming or soaking in a tub, pool or Jacuzzi and the use of any form of heat to the injection site for the rest of the day, after your procedure.

Keep a record to track the degreeof pain reliefand its duration.

Risks

The possible risks associated with a medial branch block injections include bleeding, infection, allergic reaction or damage to the nerves.

Call your doctor immediately if you experience severe pain, leg numbness or weakness, or signs of infection at injection site.

Facet Joint Injections


Facet joint injections contain a strong anti-inflammatory agent called corticosteroid and an anesthetic for pain relief. They are given to relieve pain in the back, neck, arm and leg and even headaches caused from inflammation of the facet joints. Inflammation of the facet joints may occur due to:

Facet joint injections are administered into the inflamed painful facet joints. These are the joints connecting each vertebra of the spine to the vertebra below it and above it. Each vertebra has four facet joints, one pair connects to the vertebra above and the second pair connects to the vertebra below. Thus they are present on both sides of the spine from the neck to the lower back providing flexibility and smooth movement to both the neck and the spine.

Indications

Facet joint injections are recommended based on pain patterns and are used to treat pain primarily from the lumbar spine (lower back), thoracic spine (middle-back) and cervical spine (neck).

Procedure

You will be taken to the pre op area where trained nursing staff will get you ready for the procedure by taking vitals and reviewing your medications. Your blood sugar and coagulation status may also be checked if needed. Then you will enter the procedure room where you will lie, usually face down, on a table.

The injection site is cleansed and injection of a local numbing agent is given in the area so that you won’t feel pain during the procedure.

A thin hollow needle is then inserted through the skin and muscles to the nerves in the facet joint. The doctor is guided by fluoroscopic X-ray to place the needle in the correct position. This system gives real time X-ray images of the position of the needle in the spine on a monitor for the surgeon to view.

A contrast material is then injected through the properly placed hollow needle to confirm that the drug flows to the affected nerve when injected.

When the doctor is satisfied with the position of the needle, the anesthetic drug and corticosteroid are injected through the same needle inserted in the spine.

You may feel some pressure during the injection but mostly the procedure is not painful. The needle is removed and the injection site is covered with a dry, sterile bandage. One or more facet joints’ may be injected depending on the location of the pain. The time for the procedure will thus depend on the number of facet joint injections required to relieve pain.

Atlantoaxial Injections

Coming soon

Atlanto-Occipital Injections

Coming soon

Radiofrequency Neurotomy


Radiofrequency ablation (RFA) also called rhizotomy or neurotomy is a novel non-surgical technique of treating pain. This technique employs radiofrequency waves to produce heat and the heat produced damage the nerves transmitting pain signal to the brain. This procedure is performed to treat painful facet joints in the spine that usually cause chronic low back pain and neck pain.

Radiofrequency ablation treatment is considered only after it is confirmed that the cause of back pain lies in the facet joints and this is confirmed by performing a diagnostic facet joint injection. Facet joint injection relieves pain for a short duration whereas radiofrequency ablation can keep you pain-free for a longer period of time.

Radiofrequency ablation is a minimally invasive technique and therefore administration of general anaesthetic is not required. You will be conscious throughout the procedure and lying on your stomach. Only a small area over your back which requires treatment is cleansed and numbed. This procedure is performed under the guidance of fluoroscopy. The fluoroscope is a special kind of X-ray machine that helps doctors to visualize the placement of the needle electrode in invasive procedures.

During the procedure, your doctor will direct a special radiofrequency needle electrode close to the facet joint in such a manner that the needle tip lies almost near to the medial branch nerve. The needle tip is then heated so that the nerve gets cauterized and destroyed thereby reducing the pain. This procedure may last for about an hour or two.

Provocation Discography


A discogram or discography is a diagnostic procedure used to precisely locate which spinal discs are injured and causing back pain. The discs in your spine are a soft cushion that sits between each vertebra, the bones that make up the spinal column. The disc is a cartilage-like material made up of an outer portion called the annulus which surrounds an inner portion called the nucleus. The nucleus pulposus is a soft jelly like substance that acts like a shock absorber. As people age, the spinal discs dry out and become less flexible and are more susceptible to tear or rupture. An injury to the disc is a major source of pain. A discogram may help your doctor determine whether the disc is the source of pain in patients with neck or back pain.

Indications

Discography may be an option for patients whose back pain doesn’t improve with conservative treatments such as medication and physical therapy. Discogram are also used by some surgeons before spinal fusion surgery to help determine which discs need to be removed.

Procedure

Prior to your procedure, your physician may advise you to stop taking blood- thinning medications for a specified period of time. Your doctor will tell you which medications you may take and which food or drink needs to be avoided the morning before the procedure.

Discogram is performed as an outpatient procedure in a clinic or hospital room that has equipment for X-ray imaging of the discs. You will be given an intravenous sedative to help you relax during the procedure. You may be given antibiotics to help prevent infection.

You will be positioned on the table either on your stomach or side, and rolled forward slightly. Then the skin is cleaned and a local anesthetic is injected to numb the area. Your physician will pass a needle through the skin and tissues and into the center of the disc to be examined under X-ray guidance. Once the needle is inside the disc, a contrast dye is injected and an X-ray or CT scan is taken to visualize the spread of the contrast dye. If the disc is normal, the dye will remain in the center. If the dye spreads outside the disc it may indicate tears in the outer ring of the disc. During the procedure, when an abnormal disc is injected, you will feel pain similar to your back pain. You may have slight pain when a normal disc is injected.

After the procedure

After the procedure you will be under observation for 30 minutes or more. You should have someone available to drive you home after your procedure. You may experience some pain around the injection site for a couple days which can be managed with ice packs and oral pain medication.

Risks

A discogram is considered to be a relatively safe procedure. However, there are some risks associated with the test and may include:

A discogram is a diagnostic test in which contrast material is injected into the discs of the spine to evaluate your back pain. A discogram helps your doctor pinpoint the location of your back pain.

Stellate Ganglion Block

Coming soon

Brachial Plexus Injection

Coming soon

Trigger Point Injections

Click here to know more about Trigger Point Injections.