Spine Injections & Interventional Pain Treatments

Targeted Treatments for Neck, Back, Joint and Nerve Pain

Not every patient with neck or back pain needs surgery.

At Molina Spine, we offer a variety of image-guided injections and minimally invasive interventional procedures designed to identify the source of pain, reduce inflammation, relieve symptoms, and help patients remain active.

The most important part of any injection is choosing the right procedure for the right diagnosis.

Depending on your symptoms, physical examination and imaging, treatment may include epidural steroid injections, diagnostic nerve blocks, radiofrequency ablation, joint injections, or sympathetic nerve blocks such as a stellate ganglion block.

Cervical Epidural Steroid Injections

A cervical epidural steroid injection places anti-inflammatory medication into the epidural space around irritated nerves in the neck.

These injections may be considered for patients experiencing symptoms such as:

• Neck pain with pain traveling into the shoulder or arm

• Cervical radiculopathy

• Arm numbness or tingling

• Pain associated with a cervical disc herniation

• Foraminal stenosis

• Certain cases of cervical spinal stenosis with nerve irritation

The goal is to decrease inflammation around an irritated spinal nerve and potentially reduce pain traveling into the arm.

Cervical epidural injections do not repair a damaged disc or remove spinal stenosis, but they may help control inflammation and symptoms in appropriately selected patients.

Thoracic Epidural Steroid Injections

The thoracic spine is the middle portion of the spine located between the neck and lower back.

A thoracic epidural steroid injection may be considered when a spinal nerve in this region becomes irritated or compressed.

Symptoms can include pain traveling around the ribs or chest wall, sometimes described as a band-like pain.

Potential causes include:

• Thoracic disc herniation

• Thoracic radiculopathy

• Degenerative changes

• Certain forms of nerve irritation involving the thoracic spine

Because chest and rib pain can also arise from conditions unrelated to the spine, an appropriate evaluation is important before determining whether a thoracic injection is appropriate.

Lumbar Epidural Steroid Injections

Lumbar epidural steroid injections are commonly used to treat inflammation involving nerves in the lower back.

They may be considered for conditions such as:

• Lumbar radiculopathy

• Sciatica

• Herniated lumbar discs

• Foraminal stenosis

• Lumbar spinal stenosis

• Leg pain caused by nerve compression

Patients frequently describe pain traveling from the lower back or buttock into the thigh, calf or foot.

Medication is placed into the epidural space near the affected nerves with the goal of decreasing inflammation and improving symptoms.

For some patients, an injection can also make it easier to participate in physical therapy, exercise and rehabilitation.

Transforaminal Epidural and Selective Nerve Root Injections

Sometimes the suspected source of pain involves a specific spinal nerve.

A targeted injection can be performed around that particular nerve to help reduce inflammation and, in selected cases, provide diagnostic information regarding which nerve is producing the patient's symptoms.

These procedures can be particularly useful when symptoms and imaging findings need to be correlated before determining the next step in treatment.

Facet Joint Pain and Medial Branch Blocks

Not all neck and back pain comes from a disc or compressed nerve.

The facet joints are small joints located along the back of the spine. Like other joints in the body, they can develop arthritis and become painful.

Facet-related pain commonly causes aching pain in the neck or lower back and may worsen with certain movements, including extension or rotation.

One method of determining whether the facet joints are contributing to pain is a medial branch block.

The medial branch nerves are small nerves that transmit pain signals from the facet joints.

A small amount of anesthetic is placed near these nerves. If the patient's typical pain temporarily improves, it can provide evidence that the facet joints are an important source of the pain.

Radiofrequency Ablation

When diagnostic medial branch blocks indicate that facet joints are a significant pain generator, some patients may be candidates for radiofrequency ablation, sometimes called RFA or a rhizotomy.

Radiofrequency ablation uses controlled energy to interrupt pain signals traveling through selected sensory nerves supplying painful facet joints.

RFA may be performed in the:

Cervical Spine

Cervical radiofrequency ablation may be used for appropriately selected patients with chronic facet-related neck pain.

Thoracic Spine

Thoracic medial branch procedures and radiofrequency ablation may be considered for selected patients with pain arising from the thoracic facet joints.

Lumbar Spine

Lumbar radiofrequency ablation is commonly used for chronic lower-back pain originating from arthritic or painful facet joints.

Radiofrequency ablation is different from an epidural injection.

An epidural injection primarily targets inflammation around spinal nerves, while radiofrequency ablation targets the small sensory nerves responsible for transmitting pain from painful facet joints.

Diagnostic medial branch blocks are typically used to help determine whether those nerves are appropriate targets before proceeding with radiofrequency ablation.

Sacroiliac Joint Injections

The sacroiliac joints, commonly called the SI joints, connect the pelvis to the lower portion of the spine.

SI joint pain can sometimes mimic lower-back, hip or buttock pain.

Symptoms may include:

• Pain over one side of the lower back or buttock

• Pain when standing from a seated position

• Pain with prolonged standing

• Pain when climbing stairs

• Pain when rolling over in bed

An image-guided SI joint injection may be used to help determine whether the joint is contributing to the patient's symptoms and may also provide therapeutic relief.

Hip, Shoulder, Knee and Other Joint Injections

Pain does not always originate from the spine.

One of the most important parts of treating musculoskeletal pain is determining the true pain generator.

A patient with hip arthritis may believe the pain is coming from the lower back. Likewise, shoulder pathology may sometimes be confused with cervical nerve symptoms.

At Molina Spine, joint injections may be used in appropriately selected patients to help diagnose and treat painful joints.

Depending on the condition, injections may be considered for areas such as:

• Shoulder

• Hip

• Knee

• Sacroiliac joint

• Other symptomatic joints

These injections can sometimes serve both a diagnostic and therapeutic role.

Stellate Ganglion Block

A stellate ganglion block is different from a traditional epidural or joint injection.

The stellate ganglion is part of the sympathetic nervous system and is located in the neck.

A stellate ganglion block places medication around this group of sympathetic nerves to temporarily interrupt sympathetic nerve activity.

The procedure may be considered for certain conditions involving abnormal sympathetic nerve activity or neuropathic pain, including selected patients with complex regional pain syndrome (CRPS) affecting the upper extremity.

Because a stellate ganglion block targets the sympathetic nervous system rather than a spinal disc or facet joint, careful patient selection and an accurate diagnosis are particularly important.

Are Spine Injections Done With Imaging?

Precision matters when performing spinal procedures.

Many spine and pain injections are performed using fluoroscopic X-ray guidance or other appropriate imaging techniques to confirm the location of the needle and accurately deliver medication to the intended area.

Image guidance is particularly important when working around the spinal nerves and other sensitive structures.

Are Injections a Permanent Cure?

Usually, injections should be thought of as one component of an overall treatment strategy rather than a cure for every spinal condition.

Depending on the diagnosis, injections may be used to:

• Decrease inflammation

• Reduce nerve-related pain

• Identify the source of pain

• Improve function

• Help a patient participate in physical therapy

• Delay or potentially avoid surgery in selected situations

• Determine whether another procedure such as radiofrequency ablation may be appropriate

The duration and amount of relief vary considerably between patients.

Finding the Pain Generator

An MRI may show several abnormalities, but that does not necessarily mean every abnormality is causing pain.

For example, a patient may have arthritis at multiple levels of the lumbar spine while only one particular structure is responsible for the majority of the symptoms.

That is why treatment at Molina Spine begins with the question:

Where is the pain actually coming from?

Your symptoms, physical examination, imaging and response to diagnostic procedures can all help identify the pain generator.

Once the source is better understood, treatment can be targeted rather than simply treating an MRI.

When Should You Consider an Injection?

An interventional treatment may be appropriate when pain continues despite conservative treatments such as:

• Activity modification

• Physical therapy

• Home exercise

• Anti-inflammatory medications when appropriate

• Other nonsurgical treatments

In other situations, an injection may be recommended earlier to help establish a diagnosis or control significant nerve-related pain.

Not every patient is an appropriate candidate for every injection.

Your medical history, medications, imaging, symptoms and physical examination should all be reviewed before deciding on a procedure.

Interventional Pain Treatment at Molina Spine

Our goal is not simply to perform injections.

Our goal is to determine why you hurt and choose the least invasive treatment that appropriately addresses the problem.

Treatment options available through Molina Spine may include:

• Cervical epidural steroid injections

• Thoracic epidural steroid injections

• Lumbar epidural steroid injections

• Transforaminal epidural injections

• Selective nerve root blocks

• Cervical medial branch blocks

• Thoracic medial branch blocks

• Lumbar medial branch blocks

• Cervical radiofrequency ablation

• Thoracic radiofrequency ablation

• Lumbar radiofrequency ablation

• Sacroiliac joint injections

• Hip injections

• Shoulder injections

• Knee injections

• Other joint injections

• Stellate ganglion blocks

If you are experiencing persistent neck pain, back pain, radiating arm or leg pain, joint pain, or certain types of nerve pain, schedule an evaluation with Molina Spine to determine whether an image-guided injection or other minimally invasive treatment may be appropriate.

Domingo Molina IV, MD, FAAOS
Orthopaedic Spine Surgeon
MolinaSpine.com

This information is provided for general educational purposes and is not intended to replace an individual medical evaluation. The appropriate treatment depends on each patient's diagnosis, medical history, symptoms and imaging.