Epidural Steroid Injection

An Epidural Steroid Injection (ESI) is an injection of strong anti-inflammatory steroid (cortisone) is delivered to the outermost section of the spinal column, called the epidural space. It is used to treat radiating nerve pain from the low back, middle back, or neck. Nerves in the epidural space can become pinched or irritated by a bulged disc, bone spur or narrowed spinal canal. The resulting inflammation can cause pain, numbness, or tingling into your arms, legs, or buttocks. The steroid injected can reduce inflammation of nerves in the epidural space and thus reducing pain and other symptoms.

Please note – An epidural steroid injection is not the same injection as an epidural while in labor.

How are the injections done?

These injections will be done in a sterile procedure room at one of Dr. Anden’s chosen facilities. You will be brought into the procedure room and asked to lie on your stomach. Your clothes will be moved and the targeted area will be cleaned. Once Dr. Anden has located the injection site using a live x-ray, she will numb your skin and guide her needle into place.

The procedure takes approximately 20 minutes and the majority of patients do extremely well. You will not be put to sleep for this procedure, as it only takes a few quick minutes.

You can return to your regular, normal activity following the shot.

You will be made a 3 week follow-up appointment in order to track and document your improvement.

Does my insurance cover this?

Most insurance’s that Dr. Anden takes should cover a spinal injection. Our office is very proactive in getting your injection pre-authorized with your insurance, if required.

Every insurance plan and every patient is different. There is no way for our office to know how much of the injection will be covered. You can contact your insurance they should be able to give you an “out of pocket” cost, if any.

What are the Risks?

Risks of spinal injections may include a very small chance of bleeding, infection or injury to local neurovascular structures in the vicinity of the targeted structures. You should make your physician aware of any blood thinning medication you are taking that may increase your risk of bleeding during the procedure.

Potential side effects associated with cortisone injections are as follows:

  • Headache
  • Facial flushing / redness
  • “Caffeinated” feeling or not sleeping
  • Post injection flare up of pain
  • Tenderness or redness near the injection site.

All side effects will subside a few days following the injection.

What happens after my injection?

The steroid can take 3-5 days to begin helping.

You may have relief that day, but that is related to the numbing agent and will only last a few hours. You pain may increase for 1-2 days while waiting for the steroid to kick in. Relief from a single injection usually lasts from 3 months to a year, depending on each patient’s condition.

You will be asked to make a follow-up appointment for 3 weeks, so we are able to document your improvement. You may return to work or other normal activity. It is always best to continue at home stretching and exercises which can strengthen your core and improve your mobility. Ice and heat can always be used at home on an “as needed” basis.

Facet Joint Injections and Medial Branch Blocks

If you are living with chronic, unmanageable pain from facet syndrome or spinal arthritis, these therapeutic approaches offer both a quick resolution and long-term relief.

Pain stemming from the facet joints is termed “facet syndrome.” The facet joints become inflamed and may cause pain, soreness and stiffness.

Facet joints are located on the back (posterior) of the spine on each side where two adjacent vertebrae meet. The facet joints provide stability and permit the spine to bend and twist. These joints experience constant and repetitive motion, which causes them to become worn or torn and can result in pain. Facet syndrome occurs when one or more of these joints become inflamed or irritated. Arthritis occurs when the cartilage lining the joint surface shrinks and wears thin, causing stress on the bone (bone spurs), inflammation, and enlargement of the joint. You can have facet syndrome in you Cervical, Thoracic or Lumbar Spine.

Facet joint injection or medial branch blocks are used as a diagnostic and therapeutic tool to confirm that facet syndrome is the source of your pain. In addition, Radiofrequency Neurotomy (Rhizotomy) may be recommended to offer the prolonged relief.

How are the injections done?

These injections will be done in a sterile procedure room at one of Dr. Anden’s chosen facilities. You will be brought into the procedure room and asked to lie on your stomach. Your clothes will be moved and the targeted area will be cleaned. Once Dr. Anden has located the injection site using a live x-ray, she will numb your skin and guide her needle into place.

The procedure takes approximately 20 minutes and the majority of patients do extremely well. You will not be put to sleep for this procedure, as it only takes a few quick minutes.

You can return to your regular, normal activity following the shot.

You will be made a 3 week follow-up appointment in order to track and document your improvement.

Does my insurance cover this?

Most insurance’s that Dr. Anden takes should cover a spinal injection. Our office is very proactive in getting your injection pre-authorized with your insurance, if required.

Every insurance plan and every patient is different. There is no way for our office to know how much of the injection will be covered. You can contact your insurance they should be able to give you an “out of pocket” cost, if any.

What are the Risks?

Risks of spinal injections may include a very small chance of bleeding, infection or injury to local neurovascular structures in the vicinity of the targeted structures. You should make your physician aware of any blood thinning medication you are taking that may increase your risk of bleeding during the procedure.

Potential side effects associated with cortisone injections are as follows:

  • Headache
  • Facial flushing / redness
  • “Caffeinated” feeling or not sleeping
  • Post injection flare up of pain
  • Tenderness or redness near the injection site.

All side effects will subside a few days following the injection.

What happens after my injection?

The steroid can take 3-5 days to begin helping.

You may have relief that day, but that is related to the numbing agent and will only last a few hours. You pain may increase for 1-2 days while waiting for the steroid to kick in. Relief from a single injection usually lasts from 3 months to a year, depending on each patient’s condition.

You will be asked to make a follow-up appointment for 3 weeks, so we are able to document your improvement. You may return to work or other normal activity. It is always best to continue at home stretching and exercises which can strengthen your core and improve your mobility. Ice and heat can always be used at home on an “as needed” basis.

 

What is a Medial Branch Block?

The Medial Branch Block (MBB) is a diagnostic test to determine candidacy for Radiofrequency Neurotomy (Radiofrequency Ablation or Rhizotomy).

This is done by injecting a numbing agent onto the medial branch nerves. This is meant to TEMPORARILY numb the nerve, which should “shut off” pain signals to the brain.

If you feel immediate pain relief from this temporary injection, then that is a good indication that your pain is stemming from the facet joint and that you are a great candidate for the Rhizotomy (Radiofrequency Ablation).

Once the injection has been completed you will be given a pain diary to keep track of your pain levels for the remainder of the day. The amount of relief you receive will determine if you are or are not a candidate to burn the same nerves in the Radiofrequency Ablation Procedure.

Please note that medial branches do not control muscles or sensations in the arms or legs.

How are the injections done?

These injections will be done in a sterile procedure room at one of Dr. Anden’s chosen facilities. You will be brought into the procedure room and asked to lie on your stomach. Your clothes will be moved and the targeted area will be cleaned. Once Dr. Anden has located the injection site using a live x-ray, she will numb your skin and guide her needle into place.

The procedure takes approximately 20 minutes and the majority of patients do extremely well. You will not be put to sleep for this procedure, as it only takes a few quick minutes.

You can return to your regular, normal activity following the shot.

You will be given a pain diary to take home and keep track of your pain levels. Dr. Anden’s office will contact you the following day to review these results.

Does my insurance cover this?

Most insurance’s that Dr. Anden takes should cover a this diagnostic test. Our office is very proactive in getting your injection pre-authorized with your insurance, if required. We will also pre-authorize the Rhizotomy procedure if indicated.

Every insurance plan and every patient is different. There is no way for our office to know how much of the injection will be covered. You can contact your insurance they should be able to give you an “out of pocket” cost, if any.

What are the Risks?

Risks of Medial Branch Block are minimal, as we do not use any steroid during this injection. As with any poke through the skin that is a very small chance of bleeding or infection.

You should make your physician aware of any blood thinning medication you are taking that may increase your risk of bleeding during the procedure.

What happens after my injection?

You should have good relief that day, but that is only TEMPORARY as this a TEST injection. Your pain relief can last 1 hour or 24 hours, each patient is different, but the relief will wear off and your pain will return.

Dr. Anden’s office will contact you the following day to discuss your results. Depending on the amount of relief you received, you may be scheduled for Radiofrequency Neurotomy.

You may return to work or other normal activity that day. It is always best to continue at home stretching and exercises which can strengthen your core and improve your mobility.

 

Sacroiliac SI Joint Injection

Sacroiliac (SI) joints are formed by your lower spine (sacrum) and pelvic bone (ilium). In the lower back, there are two sacroiliac joints that connect the spine to the pelvis. While these joints do not move, they support much of the body’s weight. Therefore, the SI joints are prone to degeneration.

SI Joint injections can be used to diagnose and treat low back pain that is believed to be caused by irritation and inflammation of an SI joint. Just like other joints in the body, this joint can become inflamed, unstable and dysfunctional. When the joint becomes painful, it can cause pain in its immediate region or it can refer pain into your groin, abdomen, hip, buttock or leg.

How are the injections done?

These injections will be done in a sterile procedure room at one of Dr. Anden’s chosen facilities. You will be brought into the procedure room and asked to lie on your stomach. Your clothes will be moved and the targeted area will be cleaned. Once Dr. Anden has located the injection site using a live x-ray, she will numb your skin and guide her needle into place.

The procedure takes approximately 20 minutes and the majority of patients do extremely well. You will not be put to sleep for this procedure, as it only takes a few quick minutes.

You can return to your regular, normal activity following the shot.

You will be made a 3 week follow-up appointment in order to track and document your improvement.

Does my insurance cover this?

Most insurance’s that Dr. Anden takes should cover a spinal injection. Our office is very proactive in getting your injection pre-authorized with your insurance, if required.

Every insurance plan and every patient is different. There is no way for our office to know how much of the injection will be covered. You can contact your insurance they should be able to give you an “out of pocket” cost, if any.

What are the Risks?

Risks of spinal injections may include a very small chance of bleeding, infection or injury to local neurovascular structures in the vicinity of the targeted structures. You should make your physician aware of any blood thinning medication you are taking that may increase your risk of bleeding during the procedure.

Potential side effects associated with cortisone injections are as follows:

  • Headache
  • Facial flushing / redness
  • “Caffeinated” feeling or not sleeping
  • Post injection flare up of pain
  • Tenderness or redness near the injection site.

All side effects will subside a few days following the injection.

What happens after my injection?

The steroid can take 3-5 days to begin helping.

You may have relief that day, but that is related to the numbing agent and will only last a few hours. You pain may increase for 1-2 days while waiting for the steroid to kick in. Relief from a single injection usually lasts from 3 months to a year, depending on each patient’s condition.

You will be asked to make a follow-up appointment for 3 weeks, so we are able to document your improvement. You may return to work or other normal activity. It is always best to continue at home stretching and exercises which can strengthen your core and improve your mobility. Ice and heat can always be used at home on an “as needed” basis.

 

Radiofrequency Ablation

Radiofrequency Ablation (RFA) is a non-surgical, out –patient procedure used to treat pain resulting from arthritis of the Facet Joints. This is done by using radio-frequency energy to heat and burn the area around the medial branch nerve. The burning will disrupt the nerve’s ability to send pain signals to the brain; therefore giving you a feeling of relief.

Most patients will receive a full year of relief; or until the burned nerves regenerate and grow back. Our body naturally heals itself and the nerves will grow back. Once the nerve grows back (1 year later), the procedure is repeated.

Patients who undergo the RFA procedure must have tried and failed prior cortisone injections and must have a Medial Branch Block done to verify candidacy for the procedure.

Medial branch nerves in each facet joint send and carry pain messages to and from the brain. Destroying a few of these nerves can keep certain pain messages from reaching the brain; thus bringing you relief.

How is RFA done?

First, you’ll be given an intravenous (IV) medication to relax you. Then, you will lie on your belly on an x-ray table.

Dr. Anden will numb first your skin before placing any needles.

  • Dr. Anden will locate the problem area under x-ray guidance and then insert a thin needle into the area where you feel pain. You will typically have 3-4 needles placed, depending on how many levels are affected.
  • There will be some pain while the needles are placed as this is a highly sensitive area.
  • One the needles are in place, Dr. Anden will insert the electrode through the needle; and test the placement. You may feel muscle twitching.
  • Once placement has been confirmed, she will turn on the RFA machine.
  • This will slowly warm up each needle (such as curling iron) sending radiofrequency current through the electrode to heat and burn the affected nerve.
  • Dr. Anden will do 4 burns lasting 90 seconds each.
  • Once complete, you will be taken back to the waiting area where you will be check on by our nurse. You will be able to return home the same day.

What are the Risks?

Common side effects can include: temporary numbness and temporary increase in pain.

Rare, but more serious complications include: Bleeding, infection and possible nerve damage.

Overall, the RFA Procedure is very safe and has been done safely for many years.

What happens after the RFA Procedure?

You will notice soreness in the neck or back following the procedure for 2-4 weeks; however you may resume your normal activities the following day and can return to work.

Pain medication will be given if necessary. You can experience symptom relief from 6 months to 1 year, but can last longer as well.

The benefit from this procedure will typically occur within 3 weeks and you will follow-up with Dr. Anden 1 month after the procedure.

How to prepare for a Radiofrequency Ablation

  • Stop any blood thinner medication prior to the procedure.
  • You may eat and drink normal before and after the RFA procedure
  • You will need a driver. You will be given a heavy sedative and cannot drive for 24 hours following the procedure
  • You will change into a hospital gown, so wear easy clothes to change out of
  • The RFA procedure is done under live x-ray guidance, please inform us if your pregnant or planning to become pregnant.