Metro spine offers numerous non-surgical interventions aiming to alleviate pain. Some of the procedures are injections targeting specific parts of the neck and back — Medial branch blocks, transforaminal epidural steroid injections, interlaminar epidural steroid injections, sacroiliac injections, and caudal injections. These are some common Questions and Answers regarding these procedures.
Q: What are these procedures?
A: These spine interventions are non-surgical procedures which involve injecting numbing and anti-inflammatory medications into the back with the goal of decreasing pain. The procedures vary on the target area and is decided on depending on the patient’s symptoms.
- MBB (Medial Branch Blocks) – Also called facet blocks, is a type of injection to the back which targets the medial branches or small nerves in the facet joints (small joints in the spine) at specific levels of the back. This procedure temporarily interrupts the pain signal being carried by the medial branch nerves that supply a specific facet joint. It may be done to the cervical (neck), thoracic (middle back) or lumbosacral (lower back)regions, depending on the area of pain.
- TFESI (TransForaminal Epidural Steroid Injection ) – Also called selective nerve root block is a type of injection to the back which targets the area where nerves exit the spine at specific levels of the back to help relieve symptoms of pain. This procedure temporarily interrupts the pain signal being sent from the nerves in the area.
- ILESI (InterLaminar Epidural Steroid Injection) – a type of injection which targets the nerve roots at specific levels. At MetroSpine, it is most commonly done to different levels of the neck and upper back depending on the area of pain. This procedure temporarily interrupts the pain signal being sent from the nerves in the area.
- SI or sacroiliac joint injection – a type of injection which targets sacroiliac joint or the joint between the “tailbone” part of the spine and the pelvis. It may be done on the left and/or right side depending on the area of pain.
- Caudal Epidural Steroid Injection – Also called caudal block, is a type of injection to the epidural space most commonly done in patient with spinal stenosis or narrowing of the spinal canal. The caudal injection is performed through an opening in the sacrum (commonly referred to as “tailbone”). This procedure temporarily interrupts the pain signal being sent from the nerves in the area.
Q: What happens when I come in for the procedure?
A: Upon getting to the office, you will be asked to sign in and sign consent forms. You will be put in a room where the nurse will talk to you and get your vital signs. If you are getting sedation, the anesthesiologist will come in to discuss the anesthesia procedure and medications. You will then be asked to change into a medical exam gown. You will be brought to the procedure room and asked to lie down on your belly. A fluoroscopy (a type of xray) machine will be brought closer to the table. The physician will clean and drape your back and take images with the xray. After local anesthetic is applied to the area of skin to be entered, a needle is guided into the target area using the fluoroscopy for accuracy and safety. Non-ionic contrast medium is then injected to ensure proper needle placement. After ensuring proper needle placement, a combination of local anesthetic and corticosteroid is injected into the target area to block the small nerves.
Q: What are the risks or possible side effects with these procedures?
A: Like any procedure involving needles, there is a risk for bleeding and infection. More common side effects include muscle soreness, or bruising. With some of the procedures, temporary weakness of the legs may be experienced after. With any procedure that involves corticosteroids, blood sugar level may be temporarily elevated especially in diabetic patients.
Q: I am afraid of needles. How can I get the procedure? Will the needles be big?
A: You will not see the needles during the procedure. The needle length will vary depending on the depth from the skin to the spine. An option for patients with anxiety over needles is to undergo the procedure under sedation.
Q: What medications will be injected into my back?
A: The medications commonly used in the MBB are anesthetic (numbing) and antiinflammatory agents. The medications are usually Lidocaine, Bupivacaine, and Depo Medrol ( a type of steroid)
Q: Won’t steroids cause me more harm?
A: The amount of steroid used by the office in the procedure is small, usually at 40 mg. At this dose, and with the intermittent scheduling (we usually do the procedures at intervals of at least one month and not more than 3 of the same procedure in 6 months), the risk brought on by steroid is small compared to the possible benefit of helping manage pain.
Q: What should I expect after the procedure?
A: Right after the injection you may feel that your pain is gone or quite less than prior to the procedure. This is due to the anesthetic. The anesthetic will last for a few hours. The pain may return and you may have a sore back once the anesthetic wears off . You may want to apply ice to the affected area. You should start noticing pain relief 3-5 days after the procedure.
Q: Do I need someone to accompany me for the procedure?
A: As part of our protocol, we do require patients to have a driver for the procedure day. This is to ensure that you will be able to be get home safely after the procedure, since patients respond differently to the injections. With some of the procedures, weakness of the legs may also be experienced and you need someone there for assistance.
Q: I want to know more about this procedure. What resources can I look into regarding this?
A: You may read more about our procedures at our website : https://treatpainmd.com
Also, there are many readings and videos available on the internet about this procedure. You may use any of the search terms given in the first part of this pamphlet to search for related articles.