Spinal Injections
Transforaminal Epidural
Steroid Injections
The nerve roots in the spinal canal leave the spine through openings
called neural foramen. These are openings which are formed by the
joint in the spine which interconnects the vertebral level from below, with
the vertebral level from above. This joint is also known as a facet.
Normally, the foramina are wide open, leaving a wide space for the nerve to
travel. When arthritis sets in, or when there is a herniated disc in
the foramen, the nerve can become pinched, leading to pain in the leg or
arm. By selectively placing a needle into the neural foramen, a
combination of steroid medication and local anesthetic can be placed around
the nerve. The anesthetic (such as lidocaine or marcaine) will have
the effect of immediately relieving some of the pain, while the steroid will
have a longer lasting effect. This technique allows the physician to
selectively target a nerve, which may have not only a therapeutic effect of
helping pain, but a diagnostic effect as well, in as far as it helps the
physician and patient to determine whether the target root was causing the
patients pain.
Translaminar Epidural Steroid Injections
The spinal canal, in which the nerves lie (in the lumbar spine), and in
which the spinal cord lies (in the cervical spine), is covered by a bone, or
roof of the spinal canal, known as the lamina. There is a space
between the lamina of two adjacent vertebral levels. This space is the
interlaminar space, and it is in this space that a translaminar epidural
steroid injection will deposit steroid and topical anesthetic within the
spinal canal. A needle is placed into this space, through a ligament
called the ligamentum flavum, and the steroid and local anesthetic are
instilled. In contrast to a transforaminal injection of epidural
steroid, more medication can be given here, and it will disperse out over
many nerve roots, whereas a transforaminal injection is more selective in
affecting the root it is targeted at. The translaminar epidural
steroid may have the ability to disperse medication over a broader region,
whereas the transforaminal epidural steroid injection will allow the
physician to selectively target a nerve root, and can help with diagnosing
the source of pain.
Caudal Epidural Steroid Injections
Facet Block Injections
Facet Joint Injections
Sacroiliac Joint Injections
The sacroiliac joint is located at the union of the surfaces of the
sacrum and the iliac bones (the pelvis and the spine). It is held
together by ligaments. This joint is subject to the strains of
arthritis, as it bears the weight of the upright body. Because the
ligaments and the joint receive nerve supply from the L3 to the S3 nerve
roots, the nature of sacroiliac pain is often vague and poorly defined.
An injection into the joint is generally done by the use of a spinal needle
(generally 22 guage or 24 gauge). The needle is placed, often under
x-ray guidance, into the joint. Then, a combination of steroid and
anesthetic is injected into the joint.
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