| Procedure |
Goals |
Indications |
Comments |
|
Epidural Steroid Injection (ESI)
Lumbar
|
Diffuse distribution of steroids to nerves in lumbar & sacral spine for pain relief from anti-inflammatory effects of steroids |
- Multilevel canal stenosis
- Neurogenic claudication
- Back pain or radicular symptoms without ability to localize to 1 or 2 levels
|
- No patient prep
- Must have someone to drive home
- Schedule in Fluoro
|
Selective Nerve Blocks (SNB)
- Thoracic
- Lumbar
- Sacral
|
Focal delivery of anesthetic & steroids to a single nerve for diagnostic & therapeutic purposes |
- Radicular symptoms from nerve irritation in canal or foramen at 1 or 2 levels
- To determine pain source when multiple imaging abnormalities present
- Conflict between clinical & imaging findings
- Help select patients for surgery & determine correct levels
|
- No patient prep
- Involved extremity may be weak/numb until anesthetic disappears. Must have someone to drive home
- Schedule lumbar SNB's in Fluoro, and thoracic SNB's in CT
|
Facet Blocks
- Thoracic
- Lumbar
|
Intraarticular anesthetic & steroid injection to determine if typical pain symptoms are relieved for duration of anesthetic (6 hours) or longer (steroids), indicating the facets as a major pain generator |
- Pain elicited by extension & rotation movements of spine
- Tenderness on palpation of facet joints
- Typical referred pain patterns without a radicular component
- To select patients for percutaneous neurolysis or surgery |
- Usually of 2 levels injected (level of suspected abnormality & 1 level above)
- No patient prep
- Schedule lumbar in Fluoro; schedule thoracic in CT
- Should have someone to drive home after procedure
|
Diskogram
- Lumbar
|
- Provocation of patient’s typical pain symptoms upon injection of disk with contrast in order to determine source of pain generation
- CT afterwards to show anatomic disruption of disk: annular tears, HNPs, etc. |
- Back pain stimulated by axial loading and flexion
- Uncertainty as to source and level of pain
- To select patients for percutaneous disk decompression procedures or fusion
|
- Generally do 3 disk levels, including one normal level.
- MRI as prerequisite
- No patient prep
- Must have someone to drive home after
- Schedule in fluoro at hospital only (need CT to follow)
|