Epidural Steroid Injection

Injection of medications into the epidural space. Epidural Steroid Injection is commonly used to treat pain associated with disc herniations, pinched nerves, irritated nerves or spinal stenosis. It is performed by injecting an anesthetic to numb the internal structures and then steroid to help reduce inflammation and irritation of nerves. Epidural Steroid Injection can be performed using various techniques to place the medications closest to the source of pain.

Medial Branch Block

A diagnostic block used to confirm when the source of pain suspected tobe from the small joints along both sides of the spinal column called facet joints. A small amount of anesthetic is injected to target a branch of the nerves that perceive pain from the suspected joints. A post procedure exam is performed immediately following the procedure, to evaluate if the patient's usual pain has decreased. If the patient has a significant reduction in usual pain, it is considered a positive block, confirming facet mediated pain. Because the anesthetic agent is temporary, the benefits are expected to last only several hours, then usual pain will slowly return. This is a diagnostic test to confirm that the facet joints are a significant component of the patient's usual pain. Treatment, radiofrequency ablation, to cauterize the same nerves will be considered.

Radiofrequency Ablation

Radiofrequency Ablation is a procedure that uses radiofrequency to cauterize very small branches of nerves that are sending pain signals to the brain. The branch that has been cauterized will regenerate usually between 9 to 18 months, at which time, pain may or may not return. If it returns, the procedure may be repeated.

Pulsed Radiofrequency

Pulsed Radiofrequency is a procedure derived from radiofrequency ablation. Rather than destroying the nerve, it interferes with the transmission of signals in the nerve in order to reduce the pain signals transmitted.


Discography is a diagnostic study or test used to evaluate abnormal intervertebral discs. It is usually performed after an MRI has been done. It allows for more thorough and specific evaluation of individual discs. It identifies which disc or discs are abnormal, what is abnormal about them, and which discs are contributing to the patient's usual pain. This is a very specific diagnostic study which allows the doctor to plan specific treatment to address the patient's pain.


This procedure is similar to an epidural steroid injection. It is used to target scar tissue near the spinal structures. An enzyme is injected into the epidural space where scar tissue has been identified. The enzyme helps to weaken or breakdown the scar tissue.


Chemonucleolysis is used to treat an intervertebral disc with an identified annular tear. An annular tear may be seen on MRI, CAT scan or CT scan, or Discography. It is an injection into the abnormal disc instilling a combination of chondroitin, glucosamine and dextrose. This intradiscal injection is used to reduce the pain associated with annular tears of an intervertebral disc.

Sympathetic Block

Diagnostic and therapeutic block injecting a small amount of anesthetic to the sympathetic nerve tissue. It is commonly used when reflex sympathetic dystrophy (RSD) or complex regional pain syndrome (CRPS) is suspected. The patient is evaluated immediately following the procedure to evaluate for changes in symptoms. If it is a positive block, it will usually be performed for several consecutive blocks.