Spinal Interventions
Spinal Interventions Treatment
After evaluation of your symptoms, x-rays and scans, surgeon may decide to offer you a course of spinal injections. The aim of the injections is to reduce the pain and inflammation, which in certain types of spinal problems, can be long lasting and may obviate the need for spinal surgery.
Blocks are injections of medication onto or near nerves. The medications that are injected include local anesthetics, steroids, and opioids. In some cases of severe pain it is even necessary to destroy a nerve with injections of phenol, pure ethanol, or by using needles that freeze or heat the nerves. Injections into joints are also referred to as blocks. Although not technically correct, such shorthand is commonly used.
Purpose of Nerve Block
- Blocks with local anesthetic can be used to control acute pain. (Hence, the shot at the dentist or the epidural block for a surgery or a delivery.)
- Pain and injury often makes nerves more sensitive, so that they signal pain with less provocation. Think about lightly brushing against your skin when you have a sunburn. Blocks can provide periods of dramatic pain relief, which promotes the desensitization of sensory pathways.
- Steroids can help reduce nerve and joint inflammation and can reduce the abnormal triggering of signals from injured nerves.
- Blocks often provide diagnostic information, helping to determine the source of the pain.
How Are Nerve Blocks Used
There are different kinds of nerve blocks used for various purposes.
- Therapeutic nerve blocks are used to treat painful conditions. Such nerve blocks contain local anesthetic that can be used to control acute pain.
- Diagnostic nerve blocks are used to determine sources of pain. These blocks typically contain an anesthetic with a known duration of relief.
- Prognostic nerve blocks predict the outcomes of given treatments. For example, a nerve block may be performed to determine if more permanent treatments (such as surgery) would be successful in treating pain.
- Preemptive nerve blocks are meant to prevent subsequent pain from a procedure that can cause problems including phantom limb pain.
- Nerve blocks can be used, in some cases, to avoid surgery.
Types of Nerve Blocks
Various areas of pain require different nerve block types. Below are a few of the available nerve blocks and some parts of the body where they are used.
- Trigeminal nerve blocks (face)
- Ophthalmic nerve block (eyelids and scalp)
- Supraorbital nerve block (forehead)
- Maxillary nerve block (upper jaw)
- Sphenopalatine nerve block (nose and palate)
- Cervical epidural, thoracic epidural, and lumbar epidural block (neck and back)
- Cervical plexus block and cervical paravertebral block (shoulder and upper neck)
- Brachial plexus block, elbow block, and wrist block (shoulder/arm/hand, elbow, and wrist)
- Subarachnoid block and celiac plexus block (abdomen and pelvis)
Other types of Nerve Blocks
Other types of nerve blocks include:
- Sympathetic Nerve Block
- Stellate ganglion Block
- Facet Joint Block
Spinal Injections
Spinal Injections After evaluation of your symptoms, x-rays and scans, your surgeon may decide to offer you a course of spinal injections. The aim of the injections is to reduce the pain and inflammation, which in certain types of spinal problems, can be long lasting and may obviate the need for spinal surgery.
Your surgeon will decide which of the two types of spinal injections will benefit you:
- Facet Injection or Facet Block; or
- Transforaminal Epidural Steroid Injection or A Nerve Root Block.
Facet Injection
The facet joints are paired joints in the back that have apposing surfaces of cartilage (cushioning tissue between the bones) and a surrounding capsule. Twisting injuries can cause damage to one or both facet joints, and cartilage degeneration associated with aging may also cause pain.
In cases where the facet joint itself is the pain generator, a facet block injection can be performed to alleviate the pain. Similar to Selective Nerve Root Blocks(SNRBs), facet block injections are a diagnostic tool used to isolate and confirm the specific source of back pain for the patient. Additionally, facet blocks have a therapeutic effect as they numb the source of pain and soothe the inflammation for the patient.
Epidural Injections
The Epidural means “around the spinal cord.” Typically, epidural injections are performed in a doctor’s office or the hospital. They’re usually given by anesthesiologists, physiatrists, or interventional radiologists with special training. Before receiving an epidural injection, you will probably undergo an imaging test. This may involve a CT scan or an MRI of the back. The test allows the doctor to identify possible causes of back pain.
The epidural injection takes place in several steps :
- The skin will be cleaned and injected with an anesthetic to numb it.
- The doctor will insert a needle through the skin toward the spine.
- The doctor will use a machine that produces live X-ray video called fluoroscopy. With it, the doctor will maneuver the needle between the bones of the spine.
- Using a contrast dye, the doctor will confirm the needle is placed in the epidural space. That’s the space between the spine and the spinal cord inside it.
- When the needle is in position, the doctor will inject a solution into the epidural space. The solution contains a steroid medicine, also called corticosteroid, and usually an anesthetic medicine, too.
The epidural injection is usually not painful because of the numbing medicine used at the start. Many people do have mild tenderness for up to a few days after the injection.