Epidural Steroid Injections (ESI) are performed for relief of low back pain and/or leg pain. The epidural space is a tissue space surrounding the nerves and spinal cord. The ESI distributes medication to several nerves in the lower spine simultaneously, though it can be directed to the side and level felt to be the likeliest source of one's symptoms. A series of three injections may be prescribed to obtain maximum benefit.

Preparation:
Procedure
The patient is placed on his/her stomach. The skin is cleansed with antiseptic solution and injected with a local anesthetic. A needle is then passed to the facet joint using either CT scan or x-ray guidance. A small amount of anesthetic and steroid medication are injected into the joint. X-ray contrast may be used. A minimum of two levels is injected. The level suspected to be causing the pain and the one above the area of suspicion. You will likely briefly experience your usual pain and may feel some pressure or mild discomfort during the injection. The procedure takes approximately 30 minutes to complete.

Normal activity can be resumed after the procedure, though it's best to avoid those movements and activities that typically cause you pain.

Please arrive 15 minutes prior to your appointment time. The doctor will talk with you before beginning the procedure to answer any questions. An IV is started in the arm for sedation. You are then taken to the Special Procedure room in the Radiology Department (next to the emergency room). You are placed on your stomach. You are given pain medications, but you will be awake during the procedure.

After Discharge
We suggest that someone drive you home after a lumbar nerve root block, as your leg may be weak. If you drive yourself, you must wait 30 minutes to make sure your legs are not weak. You may drive yourself after a cervical or thoracic nerve root block. Normal activity can be resumed after the procedure, though it is best to avoid those movements and activities that typically cause your pain.

Side Effects
If you are diabetic the use of steroids may increase your blood sugar levels for several days. Please consult your family doctor or your diabetes doctor as to the treatment.The spread of anesthetic around the nerve can cause temporary weakness and/or numbness. You may have an allergic reaction to the iodine in x-ray contrast. Occaisionally the needle is inadvertently passed to the next tissue layer where steroid should not be deposited. If this occurs you will be required to rest at the hospital for 2-3 hours and have the procedure rescheduled for several days later.

Facet pain is neck or back pain made worse by twisting the body or bending backwards. The area is painful if it is pressed. The pain radiates (spreads out) from your back or neck. For example pain may extend from you low back to your hips or legs. Please inform the x-ray staff if you have had reactions to x-ray contrast. The purpose of this procedure is to determine if your pain arises from the facet joints and to provide pain relief. A series of three injections may be prescribed to obtain maximum benefit.

Preparation:
Procedure
The patient is placed on his/her stomach. The skin is cleansed with antiseptic solution and injected with a local anesthetic. A needle is then passed to the facet joint using either CAT scan or x-ray guidance. A small amount of anesthetic and steroid medication are injected into the joint. X-ray contrast may be used. A minimum of two levels is injected. The level suspected to be causing the pain and the one above the area of suspicion. You will likely briefly experience your usual pain and may feel some pressure or mild discomfort during the injection. The procedure takes approximately 30 minutes to complete.

After Discharge
Normal activity can be resumed after the Procedure, though it's best to avoid those movements and activities that typically provoke you pain.

Side Effects
If you are diabetic the use of steroids may increase your blood sugar levels for several days. Please consult your family doctor or your diabetes doctor as to the treatment. Report any fever or worsening pain to the radiology nurse. You may have brief weakness or numbness due to the anesthetic spreading around the nerves. Patients can react to the iodine in the x-ray contrast. Please inform x-ray staff if you have had reactions to x-ray contrast.

What is NRB? Nerve root blocks (NRB) are performed to relieve pain in one's neck, back or legs and to confirm whether one's pain and/or numbness arises from irritation of a particular nerve. The nerve root emerges from an opening near the spinal column and medication is deposited precisely at that site. A series of three injections may be prescribed to obtain maximum benefit.

Preparation:
Procedure
The patient is placed on his/her stomach. The skin is cleansed with an antiseptic solution and numbed with a local anesthetic. A needle is passed to the nerve root using either x-ray or CT scan guidance. A small amount of contrast may be used. Anesthetic and steroid medication are then injected into the area surrounding the nerve. The procedure takes approximately 30 minutes.

After Discharge
We suggest that someone drive you home after a lumbar nerve root block, as your leg may be weak. If you drive yourself, you must wait 30 minutes to make sure your legs are not weak. You may drive yourself after a cervical or thoracic nerve root block. Normal activity can be resumed after the procedure, though it is best to avoid those movements and activities that typically provoke your pain.

Side Effects and Risks
If you are diabetic, the use of steroids may increase your blood sugar levels for several days. Please consult with your family doctor or your diabetes doctor as to the treatment. Report any fever or worsening pain to the radiology nurse. You may have temporary weakness or numbness due to the anesthetic's effect on the nerves. You may have an allergic reaction to the iodine in the x-ray contrast. Please inform x-ray staff if you have had reactions to x-ray contrast.

for compression fractures of the spine. It can also be used for bone pain related to cancer. Compression fracture is the collapse of the individual bones of the spine (vertebrae) usually due to osteoporosis. Osteoporosis is the loss of bone structure in which bone becomes more porous (more holes). As the bone becomes increasingly fragile the weight of the body compresses the vertebrae causing pain. When conservative treatment (pain medication, bedrest, a brace) don't work, percutaneous vertebroplasty is the treatment of choice.

Preparation:
Procedure
You check in at the Ambulatory Treatment Unit (ATU) at Valley Medical Center. The doctor will talk with you before beginning the procedure to answer any questions. An IV is started in the arm for sedation. You are then taken to the Special Procedure room in the Radiology Department (next to the emergency room). You are placed on their stomach. Patients are given pain medications, but they are awake during the procedure. The collapsed vertebrae is viewed under Fluoroscopy (x-ray). The cement (Polymethylmethacrylate) is then mixed and injected into the bone. The cement hardens in 5-7 minutes. Multiple vertebrae may be treated at this time. The total procedure takes approximately 2 hours. You then returns to ATU to lie on your back for about 1 hour. The second hour they can slowly begin to move. You are then discharged to home within 2-4 hours. You may stay over night if they are uncomfortable going home. Please have someone drive you home after the procedure.

After Discharge
In the first 24 hours after the procedure plan to rest and do not drive a car. The day after the procedure, expect soreness. Within 48 hours your pain should be markedly reduced. 80% of patients report marked reduction in pain by day two. You should be able to resume your normal activity slowly. The radiology nurse will call you at intervals of 2 weeks, 2 months, and 6 months. Feel free to call earlier if you have concerns. It is important that you follow up with your primary care provider to begin medicines to help treat the osteoporosis. These drugs help to build bone, and reduce bone loss.

Side Effects and Risks
There is a risk of infection anytime a needle is inserted into the body. If you have fever, redness, discharge at the needle insertion site, increased pain, or new pain, you need to report this to the radiology nurse. There is a small risk of nerve damage which the doctor will explain at the time of the procedure.

For further information, please check out www.vertebroplasty.com