Types of Spinal Injections VideoEpidural injections contain a ,umbar 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 labor pain. Epidural injections are given to relieve pain in the neck, back, arm and leg due to Epidural injections are given to relieve epidurao 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 lumbar epidural steroid injection procedure video into the spine.
Epidural Steroid Injection Video | Epidural Injection Procedure Video
Video presented by Zinovy Meyler, DO. So, to discuss the injections, we'll break them up into small categories. Epidural steroid injections can be done in mainly two ways. First of all, what we're trying to achieve is to place the steroid into the epidural space. Epidural space in itself denotes space that is intimately located above the dura.
Dura is the outermost layer covering the spinal cord and the nerves that exit the spinal cord. Most of the inflammation occurs in that area and that is the area that we can place the medications most safely. This can be approached in two ways. That can be approached from what's called paramedian - or just off the mid-line - approaching this way. Another approach is called the transforaminal - what that means is "across the foramen. The approach is taken by going into space where the nerve usually doesn't appear and this is done under the guidance of x-ray or fluoroscopy.
Another type of injection is called selective nerve root block. Selective nerve root block is selectively choosing a specific nerve in order to determine whether that nerve is causing the pain. And in order to that, we approach under the guidance of fluoroscopy, to target a specific nerve then place a small amount of usually contrast to outline that we are really concentrating on this nerve root, then place a very small amount of anesthetic.
Now, the small amount is important because we don't want that that anesthetic to spread anywhere else and affect our outcome.
If the pain is relieved with this injection, then we know that was the cause of the pain or a pain generator. Another injection is a facet joint injection. One is the injection into the joint itself and in order to do that we use fluoroscopy for guidance and we approach the joint itself, going into the joint, and then place the medication into the joint. And the reason to do that is 1 to determine if injecting anesthetic and corticosteroid will relieve the pain - and that is the diagnostic part of this - and 2 the corticosteroid reduces the inflammation.
Another way to approach facet mediated pain is by blocking the nerve that actually transmits that pain. And the reason we can do that is because, anatomically, it is consistently found in the same place.
It is found traveling along this path. And what we can do, once again under fluoroscopic guidance, we approach the anatomical location of this branch placing a small amount of medication, blocking the transmission of that nerve temporarily. And that, once again, diagnostically tells us: That leads me into another type of an injection, which truly is not an injection, but more of an intervention to treat facet joint pain - that is the medial branch rhizotomy.
And in order to do that, what we do is we place a probe - that is just like a needle - along the path of this medial branch and then we use radiofrequency to concentrate at the tip of that probe to heat it up and then lyse the little nerve that travels along the path, effectively eliminating the transmission of the pain.
The effect of this doesn't happen right away; it takes several weeks to take effect, but it provides a longer-term relief for people suffering from facet mediated pain.
Another type of a spinal injection is used to treat and diagnose sacroiliac joint pain. So, once again under fluoroscopic guidance in order to ensure the safety as well as the precision, we go into the sacroiliac joint placing a small amount of contrast to outline where the medication is going to spread, then we use a small amount of anesthetic with corticosteroid.
The anesthetic serves as the diagnostic portion - if the pain is eliminated, then we know that was the pain generator and we've effectively diagnosed sacroiliac joint pain. Then, corticosteroid reduces the inflammation that usually is the cause of the pain and that is the therapeutic portion of this.
There are many other interventions that we can use for the spine, but these are the more common ones. Facet Joint Injections Procedure Video. Cervical Epidural Steroid Injection Video. Types of Spinal Injections Video.