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Transforaminal Epidural
Facet  Joint Injection
 Injections


Nearly everyone experiences an episode of low back pain at one time or another during his or her lifetime. Often low back pain results from nerve compression. Typically, the patient's complaint includes a low backache or sharp pain traveling down one or both legs. Common causes of pinched nerves include 
disc protrusions into the nerve space, arthritic facet joints with resultant narrowing of the spinal canal, and bone spurs. Less often, scar tissue that has formed from a previous surgery can cause nerve impingement and pain. Nerves exit the spinal cord through the epidural space. Often, this space is utilized to deliver medicine in close proximity to the spinal nerves. The most effective medications include local anesthetics (numbing/deadens pain) and anti-inflammatory steroids, which help reduce swelling and inflammation that can lead to pinched nerves.



Transforaminal thoracic epidural injection is a epidural injection to a specific site of a vertebra in the mid-back that places anti-inflammatory medicine close to the nerve endings and into the epidural space to decrease inflammation of the nerve roots, reducing pain in your back or around the rib cage. 
Transforaminal lumbar epidural injection is a epidural injection to a specific site of a vertebra in the lower back that places anti-inflammatory medicine and anesthetic medicine close to the nerve endings and into the epidural space to decrease inflammation of the nerve roots, reducing pain in your back and legs.

Two facet joints connect each vertebra in the spine, one on each side of the spine. Arthritic changes in the facet joints caused by irritation of the small nerve branches that communicate pain from the facet joints. Injecting a small amount of local anesthetic (numbing medicine) and steroid (anti-inflammatory medicine) near the specific nerve being tested performs the Facet Injection. Blocking these nerves stops the transmission of pain signals from the joints to the brain. An x-ray is used to help place the needle into the facet joint, then to verify correct placement of the needle contrast dye is injected into the joint. 









Trigger points are central areas of spasm and inflammation in the skeletal muscle. Common sites of trigger point areas are the rhomboid and trapezius back muscles, located in the upper back and behind the shoulder areas. Trigger points located in these common areas can cause neck pain, shoulder pain, and headache. In addition to the upper spine, trigger points can also occur in the low back or less commonly in the extremities.
Patients may have regional, persistent pain resulting in a decreased range of motion in the affected muscles. These include muscles used to maintain body posture, such as those in the neck, shoulders, and pelvic girdle. 
To treat trigger points the physician may inject an anesthetic such as lidocaine or bupivacaine, a mixture of anesthetics, or a corticosteroid alone or mixed with lidocaine.

Sympathetic Blocks
Sympathetic pain is usually described as a constant burning or electrical pain. A sympathetic nerve block involves injecting medicine around the sympathetic nerves in a lumbar or cervical area. By doing this, the system is temporarily blocked in hopes of reducing or eliminating pain. If the initial block is successful, then additional blocks are generally repeated in 7-10 days and repeated again until the pain diminishes.