A cervical epidural steroid injection is a procedure to help relieve neck and arm pain. It works by reducing inflammation of irritated nerves within the spinal canal. These nerves can be irritated as a result of a herniated cervical disc or because of arthritis of the spine. The discs are "cushions" between the vertebrae that can degenerate as a result of injury or advanced age. When a disc loses its integrity, it can spill irritating chemicals onto spinal nerves and it can also cause direct pressure effects. Arthritis causes nerve irritation because this degenerating process narrows the canals where the nerves lie.

An epidural steroid injection is very safe with potential benefits of decreased pain, decreased numbness/tingling, and increased mobility. As with any procedure, there are risks involved including infection, bleeding, nerve injury, and worsened pain. There are also possible side effects relating to the steroid itself including: increases in blood sugar, weight gain, water retention, and suppression of the body's own production of cortisone.

The procedure itself is performed at an outpatient surgery center. Usually, an IV (intravenous) line is started preoperatively in order to give the patient mild sedation. The patient is then brought to the procedure suite and placed in the prone (face down) or seated position. The skin is cleansed with an antiseptic solution and drapes are placed to keep a sterile field. To be as precise as possible, the physician uses an x-ray machine to visualize the spinal anatomy. Next, the skin and subcutaneous tissues are anesthetized with a local anesthestic. An epidural needle is then inserted and advanced to the area surrounding the spinal cord and the nerves coming out of it. Contrast "dye" may be used to assure proper needle position as it outlines the intended target. During the injection of steroid, the patient may feel slight discomfort from the pressure effects of the injected solution. After the procedure is over, the patient is taken to the recovery area for approximately 30 minutes before being discharged.

After the procedure, there may be some slight discomfort from the mechanical process of needle insertion or from pressure effects from the solution. Usually the procedure is very well tolerated and patients can resume their normal activities the next day. The steroid takes approximately 1-2 days to take effect, so patients should not expect any immediate benefit. It is not infrequent that it takes 2 to 3 epidural steroid injections to obtain the most benefit.

A lumbar epidural steroid injection is a procedure to help relieve low back and leg pain. It works by reducing inflammation of irritated nerves within the spinal canal. These nerves can be irritated as a result of a herniated lumbar disc or because of arthritis of the spine. The discs are "cushions" between the vertebrae that can degenerate as a result of injury or advanced age. When a disc loses its integrity, it can spill irritating chemicals onto spinal nerves and it can also cause direct pressure effects. Arthritis causes nerve irritation because this degenerating process narrows the canals where the nerves lie.

An epidural steroid injection is very safe with potential benefits of decreased pain, decreased numbness/tingling, and increased mobility. As with any procedure, there are risks involved including infection, bleeding, nerve injury, and worsened pain. There are also possible side effects relating to the steroid itself including: increases in blood sugar, weight gain, water retention, and suppression of the body's own production of cortisone.

The procedure itself is performed at an outpatient surgery center. Usually, an IV (intravenous) line is started preoperatively in order to give the patient mild sedation. The patient is then brought to the procedure suite and placed in the prone (face down) or seated position. The skin is cleansed with an antiseptic solution and drapes are placed to keep a sterile field. To be as precise as possible, the physician uses an x-ray machine to visualize the spinal anatomy. Next, the skin and subcutaneous tissues are anesthetized with a local anesthestic (lidocaine). An epidural needle is then inserted and advanced to the area surrounding the spinal cord and the nerves coming out of it. Contrast "dye" may be used to assure proper needle position as it outlines the intended target. During the injection of steroid, the patient may feel slight discomfort from the pressure effects of the injected solution. After the procedure is over, the patient is taken to the recovery area for approximately 30 minutes before being discharged.

After the procedure, there may be some slight discomfort from the mechanical process of needle insertion or from pressure effects from the solution. Usually the procedure is very well tolerated and patients can resume their normal activities the next day. The steroid takes approximately 24-48 hours to take effect, so patients should not expect any immediate benefit. It is not infrequent that it takes 2 to 3 epidural steroid injections to obtain the most benefit.

Trigger points are localized, very sensitive areas in skeletal muscle that contain palpable, taut bands of muscle. This is felt as a rope-like thickening. Trigger point pain is sometimes called myofascial pain. Myofascial refers to muscle and connective tissue. Trigger points are painful to palpation and are associated with referred pain. Referred pain is discomfort which is felt at a point away from the actual source of pain. For example, trigger points in certain shoulder muscles can refer pain to the arm and even to the hand. Thus, other conditions can mimic myofascial pain including arthritis, bursitis, nerve impingement, and pain from internal organs.

Trigger points are divided into active and latent groups. Active trigger points cause constant pain and inhibit movement. This leads to a reduction in the use of the muscle group, with a further decrease in muscle tone and strength and loss of range of motion. Latent trigger points do not cause constant pain. They are formed by injuries or microtrauma and may be present for years after the inciting event. Latent trigger points do not manifest themselves or become active until movement in the involved joint is extended beyond the usual range.

The treatment of myofascial pain is to search and eliminate the trigger points that perpetuate the pain cycle, prevent normal range of motion, and shorten the active length of the involved muscle. Trigger point injections are very safe and effective in decreasing or eliminating myofascial pain. After identifying the involved muscle, an injection of local anesthestic is made into the trigger point. In certain circumstances, Botox© may be used to lengthen the duration of pain relief. Complications are extremely rare and involve the risks of needle placement (infection, bleeding, local tissue injury) and local anesthetic injection. A series of trigger point injections is most likely to be effective when added to an ongoing program of physical therapy followed by home stretching exercise.

In certain pain and spasticity conditions, it is advantageous to deliver medications directly into the spinal canal rather than taking pills by mouth. When a medication is given by mouth, the drug is absorbed into the bloodstream from the stomach and intestines. The drug is then taken to the liver where the medication is partially metabolized. From there, the drug is sent to all tissues/organs of the body including the spinal cord. In this way, a large amount of oral medication is required to obtain high drug concentrations in the spinal cord. High concentrations of drug will also reach the brain, intestines, and bladder making side effects of sedation, mental clouding, nausea, constipation, and urinary retention problematic. Thus, this therapy is designed to increase the effectiveness of the medication and decrease potential side effects.

Not all patients suffering from chronic pain or spasticity will benefit from an intraspinal delivery system. To determine if a patient is a candidate, a trial procedure is necessary. This is accomplished in the operating room at Tallahassee Memorial Hospital. During the trial, the patient will be placed face down (prone) on the procedure table and will be given light sedation. The patient has to be awake enough to communicate with the surgeon. The surgeon will use an x-ray machine to visualize the spinal anatomy. Next, local anesthestic will be given to numb the skin and subcutaneous tissues. After that, a special needle will be placed into the spinal canal. The medication will then be injected into the spinal fluid and the needle removed. After the procedure is over, the patient will be admitted to the hospital overnight for observation.

At this point, a decision will be made on whether or not to proceed to implantation based on the results of the trial. The patient should obtain good pain relief or a decrease in spasticity during the trial. Intraspinal delivery systems can signficantly decrease pain or spasticity, but as with any surgical procedure, there are risks involved. These include infection, bleeding, injury to the spinal cord, equipment failure, or future lack of benefit.

The patient is also made aware of the cosmetic changes from implantation. The medication reservoir/pump has the same shape as a hockey puck, although slightly larger. This is implanted in the abdomen, just underneath the skin and on top of the abdominal musculature. Depending on the amount of fatty tissue present, the profile of the implant may range from relatively flat to a significant bulge. Finally, the patient is informed of the "maintenance" involved with intraspinal delivery systems. The electronic pump/reservoir only holds a limited amount of medication and will need to be refilled approximately every 4-8 weeks. For refills, the reservoir is accessed via a needle which is placed through the skin. The remaining old medication is removed and new medication is added.

A spinal cord stimulator is an advanced treatment for chronic pain. With this therapy, a small implanted device generates electrical signals within the spinal cord. Pain messages are then changed before they are sent to the brain. Previous areas of pain are replaced with a different sensation. Usually patients describe this is a tingling feeling.

A potential candidate for spinal stimulation will undergo a trial procedure. The trial determines if a patient is a candidate for surgical implantation. The patient should obtain good pain relief and feel comfortable with the sensations of stimulation. During the trial, the patient will be placed face down (prone) on a procedure table and will be given light sedation. The patient has to be awake enough to communicate with the surgeon. The surgeon will use an x-ray machine to visualize the spinal anatomy. Next, local anesthestic will be given to numb the skin and subcutaneous tissues. After that, a special needle will be placed just outside the spinal cord. A wire or lead will then be threaded through the needle along the spinal canal. The patient will then tell the surgeon where stimulation is felt and the wire/lead will be adjusted appropriately. The needle is then pulled out, leaving the wire/lead in place. Thus, there will be a wire coming out of the skin which will be taped down. This will be attached to an external battery. The patient will then go home for several days to assess the amount of pain relief. Upon return to the doctor's office, the trial wire/lead will be pulled out.

At this point, a decision will be made on whether or not to proceed to implantation based on the results of the trial. Spinal cord stimulators can signficantly decrease pain, but as with any surgical procedure, there are risks involved. These include infection, bleeding, injury to the spinal cord, equipment failure, or future lack of benefit. It should also be noted that after implantation the patient will no longer be able to have a MRI. Prior to implantation, the patient will also be referred to a psychologist. The psychologist will assess the patient's understanding and expectations of the procedure.

For implantation, the wire/lead will be placed just as during the trial. However, the lead will be connected to a small battery placed underneath the skin. The battery is placed in either the upper buttock or abdomen. Today, most batteries implanted are rechargeable. From time to time, the patient will have to recharge the battery at home using a remote control device. The remote control device is placed on top of the skin, overlying the implanted battery, and the battery's energy is restored over a few hours.

Radiofrequency lesioning is a procedure in which sensory nerves are purposefully altered by a heated probe. This technique is usually performed for focal back or neck pain caused by degenerative facet joints. Facet joints are true synovial joints which connect the posterior spinal column. They are subject to degeneration and inflammation and become a very common cause of pain, especially in the elderly. Each facet joint is innervated by 2 sensory nerves and their location is predictable along the bony spine. A diagnostic block of each nerve with local anesthetic will determine if the presumed facet joint is the cause of pain. If the patient obtains pain relief after the diagnostic block, then the patient will return for the radiofrequency lesioning procedure.

The aim of radiofrequency lesioning is improved pain and function. The procedure is not permanent however with recent literature stating an average pain relief of 9 months. As with any procedure, there are potential risks including: infection, bleeding, nerve injury, and worsened pain.

The procedure is performed at an outpatient surgery center. An IV (intravenous) line is started preoperatively in order to give the patient mild sedation. The patient is then brought to the procedure suite and placed in the prone (face down) position. The skin is cleansed with an antiseptic solution and drapes are placed to keep a sterile field. The physician uses an x-ray machine to visualize the spinal anatomy and intended targets. Next, the skin and subcutaneous tissues are anesthetized with a local anesthestic. A special needle is then inserted and placed next to the sensory nerve. Sensory and motor testing is then performed by a special machine which informs the physician of his proximity to the sensory nerve. When appropriate, the physician will give some local anesthetic prior to heating the needle. The lesioning (heating) process itself only takes 90 seconds.

After the procedure, there may be some slight discomfort from the process of needle insertion. Usually the procedure is very well tolerated and patients can resume their normal activities the next day. The full effect can take several days, so the patient may not perceive any immediate benefit. Radiofrequency lesioning can be repeated on an as needed basis.