Minimally Invasive Injections for Painful Conditions of the Spine

At Lurie Children's, our Neurointerventional Radiology team performs different procedures to treat painful conditions of the spine caused by either disease or injury. These procedures include: facet nerve injections, lumbar puncture (spinal tap), epidural steroid injections, nerve root injections and myelography. 

Facet Joint Injections

A facet joint is a joint in between the spinal vertebrae in the back of the spine. Each vertebra has two pairs of facet joints, above and below, with the adjacent vertebrae. Facet nerve injections are diagnostic procedures that identify the source of pain or irritation in the nerves that run along the outer edge of the facet joints within the spine. They can also be therapeutic, causing the associated pain to decrease or resolve, even if temporary.

During a facet nerve injection, a neurointerventional radiologist uses x-ray guidance to insert a needle from the back, into the facet joint space which is thought to be causing the patient’s pain. A combination of anti-inflammatory (steroid) and anesthetic (numbing) medications are injected to relieve the pain or irritation.

This is a short procedure (approximately 10 to 20 minutes). Some patients experience pain relief very quickly while others take approximately two to ten days after the injection to feel the beneficial effects. If an initial injection provided a certain amount of relief, a second injection might strengthen the pain relief effect. Also, if your pain subsides, but begins to return weeks or months later, additional injections—up to six a year—are possible.  If there is no change in your symptoms after a week, your doctor may want to investigate other possible sources for your pain. 

Lumbar Puncture (Spinal Tap)

A lumbar puncture (or spinal tap) is used to obtain a sample of cerebrospinal fluid (CSF) from the sac that surrounds the spinal column in the lumbar (low back) region of the spine. CSF is a clear bodily fluid mostly secreted by the brain, which surrounds your brain and spinal cord and cushions them from injury. During a lumbar puncture, a long, thin needle is inserted between two lumbar bones (vertebrae) to remove a sample of cerebrospinal fluid. The needle does not touch the spinal cord.

A lumbar puncture can help diagnose serious infections, such as:

• Meningitis
• Other disorders of the central nervous system, such as Guillain-Barre syndrome, epilepsy, multiple sclerosis, and cancers of the brain or spinal cord

Sometimes a lumbar puncture is used to inject medications or chemotherapy drugs into the cerebrospinal fluid.

Epidural Steroid Injection

Similar to a facet nerve injection, an epidural steroid injection provides pain relief by delivering local anesthetic (numbing medication) and anti-inflammatory steroid medications into the spinal area on the surface of the spinal column. This is done to reduce inflammation, resulting in long-term pain relief and can provide valuable information on areas of the spine that is causing pain.

Nerve Root Block/Nerve Block Injection

A selective nerve root block (or nerve block injection) is a diagnostic procedure in which an injection of a local, non-steroidal anesthetic is administered along a specific nerve root. If the nerves that run along the outer edge of the facet joints within the spine are irritated or inflamed, the anesthetic can reduce pain and therefore identify the nerve(s) that is causing pain. Once the source of the pain is identified, a physician can further investigate the cause of the pain in that area.

Myelography

With myelography, contrast is injected through the needle for better evaluation of the spinal canal.