Pain Management Injections

Epidural Steroid Injections

Epidural steroid injection (ESI) is a technique for relieving pain from spinal stenosis and spinal disc herniation. Using a needle, relatively small amounts of corticosteroids together with a local anesthetic are injected into the epidural space around the spinal cord and spinal nerves. This injection can be performed from a translaminar or a transforaminal approach. The anti-inflammatory effect of the corticosteroid is responsible for providing pain relief when radiculopathy exists.

Translaminar Epidural Injection

translaminar epidural injection

Facet Joint Injections

The zygapophysial joint or facet joint is a synovial joint between the superiorarticular process of one vertebra and the inferior articular process of the vertebra directly above it. There are two facet joints at each spinal motion level. The biomechanical function of each pair of facet joints is to guide and limit movement of that spinal motion level.

Facet syndrome is a syndrome in which the facet joints cause back and/or neck pain. Facet syndrome can progress to spinal osteoarthritis, which is known as spondylosis.

Facet joint injection is the injection of anesthetic and/or anti-inflammatory medication into the facet joint under imaging guidance for the diagnosis and treatment of facet syndrome.

Synovial Cyst Injection and Rupture

A synovial cyst of the facet joint is a non-neoplastic cystic lesion that develops as a response to the biomechanical stressors that are placed upon the synovial lined joints of the spine, the facet joints. When cysts arise from these joints, they may press upon critical neurologic structures, including the ventral nerve roots and the spinal cord. These benign yet painful cysts may be treated by performing synovial cyst injection and rupture. The procedure involves cyst puncture under CT or fluoroscopic guidance followed by the high pressure injection of fluids, including injection of long acting local analgesics and corticosteroid suspensions.

Cyst Injection and Rupture

ACR Mammography
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ACR Ultrasound
ACR American College of Radiology
ACR Breast MRI
ACR Breast Ultrasound

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