Services

Epidural Steroid Injections
Many injuries or degenerative conditions of the spine cause irritation and inflammation of the spinal cord or the nerve roots that exit the spinal cord going to the rest of the body. Examples of these conditions are herniated disc, degenerative disc disease, facet joint arthritis and bone spurs (spondylosis). Typically, irritated nerves cause pain that radiates along the path of the nerve. For example, an irritated nerve in the lower back may cause pain radiating down the leg. An irritated nerve in the neck often causes pain that radiates into the arm or hand. Other symptoms of an irritated nerve include numbness, tingling, weakness of the affected limb, or strange sensations in the affected limb (such as skin that is overly-sensitive to touch). Rarely, an irritated nerve in the spine can cause loss of bladder or bowel control, which represents a true medical emergency called cauda equina syndrome.

When more conservative treatments have failed or are not likely to help, one option is to place steroids in the cortisone family directly on the irritated nerves in order to lessen the inflammation and hopefully relieve some or all of the pain. This procedure is called an epidural steroid injection, and is more effective than taking the steroids by mouth because a much higher dose is placed directly on the nerve. In addition, the typical side effects seen with oral steroids, such as fluid retention, weight gain, or inability to sleep are rarely seen with epidural steroid injections because the steroid only leaks into the rest of the body in tiny amounts. Please note that these are not the same type of illegal steroids that some bodybuilders and athletes use.

We tailor one of several different techniques for each individual patient who needs an epidural steroid injection. Dr. Pearson will discuss your specific procedure with you during your visit and answer any questions you have about the procedure.

Facet Joint Injections or Medial Branch Blocks
The facet joints allow the spine to twist and turn from the neck down to the lower back. The joints are also helpful in supporting the body's weight. Aging, normal wear and tear, athletics, repetitive high-impact activities and arthritis all can cause problems with the facet joints. Facet joint pain most commonly occurs near the spine and may radiate into the shoulders (if the facet joints in the neck are involved) or into the buttocks, hips or legs (if the lower back facet joints are involved). The medial branch nerve is a branch of the spinal nerve root that tells us our facet joint hurts.

Facet joint injections are performed for two reasons, therapeutic or diagnostic. Alternatively, the medial branch nerve can be injected to numb the facet joint. Typically, the injection consists of numbing medicine and possibly some steroid. If the back pain is coming from the joint, the numbing medicine will cause the pain to dramatically improve for at least an hour. The steroid sometimes provides long-term pain relief in this joint. If the pain relief is dramatic but short-lived, we may recommend radiofrequency ablation of the medial branch nerve for longer term relief.

Spinal Cord or Peripheral Nerve Stimulators
Sometimes injections, conservative treatment, and even surgery fail to relieve the pain. When this happens, a spinal cord or peripheral nerve stimulator may be an option for pain control. This is a device that is implanted in the body to send tiny electrical signals into the targeted nerves so that the patient experiences tingling in the area of the pain. In theory, this provides pain relief because the nerves can only carry so much information to the brain at once and the tingling blocks out the pain information.

A candidate for a stimulator will first be required to undergo a trial of this technology to make sure it is going to help before actually having it implanted.

Intrathecal Drug Delivery
Another alternative when all other treatments have failed is an intrathecal drug delivery pump. This is an implanted device that automatically delivers medications directly to the spinal cord through the spinal fluid. Common medications delivered by the pump include morphine or other narcotic pain medications, Baclofen (to relax muscle spasm), numbing medicine or cancer chemotherapy. The pump is electronically programmed in our office to deliver the proper dose of medications. Typically, it must be refilled by our office every 1-6 months.

Administering the drug directly into the spinal fluid allows us to use a much smaller dose to achieve superior pain control, usually with fewer side effects than with oral medications. A candidate for the intrathecal drug delivery pump will typically be required to undergo a trial of this technology to make sure it is going to help before permanently implanting the pump.

Sedation
We strive to make our patients as comfortable as possible during procedures. For example, Dr. Pearson can often use smaller needles than are customarily used for pain injections. In addition, many of our patients request sedation for their procedures. On request, we will provide light sedation through an IV to help relax the patient and make the needle stick more tolerable. Because Dr. Pearson is an anesthesiologist, she is highly trained to provide this service in an office that is fully equipped for a safe anesthetic.


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