Spinal Pain Management
Legacy is home to physicians who have provided relief to thousands of patients who suffered from spine-related pain. In our experience, fluoroscopically-guided spinal injections often deliver dramatic results with minimal side effects. Using modern x-ray technology, we are able to visualize the precise placement of the steroid or anesthetic injection in order to be most effective and receive the best results.
PREPARING FOR YOUR APPOINTMENT
Please arrive 20 minutes prior to your appointment time to complete the check-in process.
Freeway Medical Building, 2nd Floor, Suite 206 | 5800 W 10th St. | Little Rock, AR 72204
It is very important for you to confirm that you are going to keep your appointment (office visits, procedures, outside testing, etc.) within 4 business days prior to your appointment.
You will be receiving a confirmation template to fill out 4 days prior to your procedure through our Phreesia. Please look in your email or your text messages for this confirmation/registration link.
Call our phone line at (501) 661-0077
3. Confirm Injection Appointment Confirm
- Nitrous Oxide Gas
- There are no fees for this option.
- It is recommended that you hold any food for 4-6 hours prior to your procedure but you can drink clear liquids up until 2 hours prior. You do not need to eat or drink anything 2 hours prior to your procedure. This type of sedation is typical to what you would receive at a dentist office while getting dental work.
- You DO NEED a driver upon discharge
- MKO Melt
- Sublingual (you will place under your tongue) combination medication composed of Ketamine, Versed and Zofran.
- Very effective sedation option in most patients
- Quick onset of action and procedure can be done about 10-15 minutes after administration
- Can be used with or without Nitrous Oxide
- Custom compounded medication by Freiderica Pharmacy and Compounding. Pharmacy charges $25 for this medication directly. You will be asked to call them directly to pay for your melt and they will deliver this to our center so that it is ready on the day you arrive for your injection.
- There is no need for you to stop consuming food or liquids a set time before the procedure when using a MKO Melt alone. If you are planning on using Nitrous Oxide in addition to a MKO melt you will need to hold food 4-6 hours prior to your procedure and only consume clear liquids up until 2 hours until your procedure and do not need to eat or drink anything 2 hours before your procedure.
- You DO NEED a driver upon discharge
- IV Sedation with Prime Anesthesia Group
- Please arrive 30 minutes early to your injection appointment to allow extra time as a more extensive pre-op workup will be necessary. Be advised wait times may be extended if receiving IV sedation. Also expect longer post procedure recovery time prior to discharge.Commonly used IV sedation medications include: Propofol, Ketamine, Versed and Fentanyl
- Only offered on days where Prime Anesthesia is available. Currently this is on Wednesdays and every other Thursday
- Non-Medicare patients – Billed to your Insurance directly by the anesthesia provider- Prime Anesthesia Group
- Medicare patients including Medicare plans administered through commercial companies like United Health Care Medicare, AARP Medicare, Wellcare by Allwell, BCBS Medicare, Medipak Advantage, will be responsible for the $150 self-pay rate directly to Prime Anesthesia Group. The exception to this self pay only exclusion is that they can bill Medicare and Medicare replacement insurances for Rhizotomy procedures. If you are having any other type of procedure (Epidural Steroid Injection, Medial Branch Block, etc) you will be responsible for the self pay rate directly to Prime Anesthesia. There will be no billing of anyone by Legacy Surgery Center for sedation services. This is strictly an arrangement between anesthesia and you for this service when it is not covered under your insurance plan. Unfortunately Medicare has very limited coverage of sedation for spine pain procedures.
- If you have any questions about your coverage, contact Prime Anesthesia Group at 501-227-0700
- You can not eat or drink anything for EIGHT HOURS prior to your procedure
- You DO NEED a driver upon discharge
- No Sedation
- Some patients do not require any sedation for their procedure.
- You will need a responsible adult with you at the time of discharge.
If you are taking any anti-inflammatory or blood thinning medications, you must STOP taking them prior to each procedure. NSAIDS need to be stopped 4 days prior to your procedure and blood thinners need to be stopped up to 7 days prior to procedure. A list of common medications that need to be stopped are below. Also, if you take Methotrexate, you may continue doing so, but you will need to have blood work done prior to procedure and within 30 days to each procedure so if you are doing a series of injections you might have to obtain more than one lab work.
MEDICATIONS TO BE STOPPED 4 DAYS BEFORE YOUR PROCEDURE
- Advil Allergy Sinus
- Advil Allergy-Congestion Relief
- Advil Cold & Sinus
- Advil Liqui-Gel
- Advil Migraine
- Advil PM Liqui-Gels
- Aleve Cold & Sinus
- Aleve Sinus & Headache
- Aleve-D Sinus & Cold
- Aleve-D Sinus & Headache
- Anaprox DS
- Child Ibuprofen 100 mg/5 mL oral suspension
- Children’s Advil
- Children’s Sudafed
- Children’s Sudafed PE Cough & Cold
- Children’s Sudafed PE Nasal Decongestant
- Comfort Pac-Ibuprofen
- Comfort Pac-Meloxicam
- Comfort Pac-Naproxen 500 mg kit
- diclofenac ER
- diclofenac potassium
- diclofenac sodium
- diclofenac sodium (bulk)
- etodolac (bulk)
- etodolac ER
- Flector 1.3 %
- hydrocodone with Ibuprofen
- ibuprofen (bulk)
- Ibuprofen Cold
- Ibuprofen Cold-Sinus
- Ibuprofen IB
- Ibuprofen Jr Strength
- Ibuprofen PM
- Infant’s Ibuprofen
- Infant’s Motrin
- Infants Ibu-Drops
- ketoprofen ER
- ketoprofen, micronized
- ketorolac (bulk)
- meclofenamate powder
- mefenamic acid
- mefenamic acid (bulk)
- meloxicam (bulk)
- Midol (Naproxen Sodium)
- Motrin IB
- Motrin PM
- nabumetone, micronized
- Naprelan CR
- naproxen (bulk) powder
- naproxen sodium
- naproxen sodium powder
- piroxicam (bulk)
- salsalate (bulk)
- Sudafed 12 Hour
- Sudafed 12 Hr Pressure-Pain
- Sudafed PE
- Sudafed PE Cold & Cough
- Sudafed PE Sinus Headache
- Sudafed Triple Action
- sulindac powder
MEDICATIONS TO BE STOPPED WITH MEDICAL CLEARANCE FIRST
- If prescribed by a physician Aspirin*** will need a medical clearance but if you take it on your own, then please hold this for 6 days prior to each injection. Various medications are to be held various periods of time pre procedure. Make sure you have been given instructions on this
- anisindione (bulk) 100 % powder
- ASPIR 81
- Aspirin Adult Low Dose
- Aspirin Childrens
- Aspirin Low-Strength
- aspirin, buffered
- Baby Aspirin
- Bayer Aspirin
- Bayer Aspirin (with caffeiaspirin-caffeine )
- Bayer Chewable Low Dose Aspirin
- Bayer Childrens Aspirin
- Buffered Aspirin
- Child Aspirin
- Children’s Aspirin
- dicumarol (bulk) powder
- Enteric Coated Aspirin
- heparin (porcine)
- heparin flush (porcine)
- Heparin Lock
Heparin Lock Flush (Porcine)
Lite Coat Aspirin
- Lo-Dose Aspirin
- St. Joseph Aspirin
- Tri-Buffered Aspirin
- warfarin (bulk)
- Women’s Aspirin with Calcium
What is an epidural steroid injection?
Epidural steroid injections can often be helpful in the treatment of pain of disc degeneration or disc displacements and spinal stenosis of the various types with or without associated alignment issues. These can only be accurately and safely performed by experienced specialists and under proper fluoroscopic guidance. Often spinal epidural injections are repeated a second or third time depending on the response. The levels and the target/type of epidural injection may also be adjusted in subsequent injections to try and pinpoint the main pain generator site. Epidural injections can be done either interlaminar, which is between the two lamina of adjacent vertebra, transformainal, which is through the exit hole aimed inward, or caudal which is through a hole at the bottom of the spine.
ESIs may help with pain, tingling, and numbness caused by nerve problems in your back or neck. Some people get several of these shots over weeks or months.
How is an epidural steroid injection done?
During an ESI, you may choose to use the nitrous oxide to help you relax. you will be lying face down on the injection table with your head in a specially designed pillow. The doctor will use x-rays during the procedure to assure proper placement of the needle for your injection.
After determining the best location for your injection with x-rays, the doctor injects a numbing medicine into the skin in the area where you will get the epidural shot. Then he or she puts a needle into the numbed area and uses further x-ray images to guide the needle into the epidural space. The medication is then injected around the nerves, disks and deep structures of the back.
The procedure takes about 5 to 10 minutes. Please arrange for someone to drive you home.
See our videos on lumbar and cervical ESIs for more details about the procedure.
What can you expect after an epidural steroid injection?
The full effect of an ESI may take 1 to 5 days. Sometimes multiple injections are needed before benefits are felt. Of course, like any treatment some patients do not get relief from ESIs and require other treatments.
After your injection patients are normally able to resume normal activity return to their daily routine.
Some people are dizzy, feel sick to their stomach or anxious after getting an ESI. These symptoms usually do not last very long. If you have a severe headache, it could be a sign of a spinal fluid leak. Call your doctor if you have a headache after having an ESI.
If your pain is better, you may be able to continue your normal activities or physical therapy. But try not to overdo it, even if your back pain has improved a lot. If your pain is only slightly reduced, or if it returns, your doctor may recommend another ESI in a few weeks. If your pain has not changed, talk to your doctor about other treatment choices.
What is a facet injection?
A facet injection is a minimally invasive procedure that meant to help patients with localized back or neck pain caused by inflammation of the spinal joints. Facet is another name for the joints in the spine. Like other joints in the body, arthritis can affect the numerous joints in the spine. In fact, facet pain and is one of the most common causes of chronic spine pain.
Facet injections involve a three-step process. It is not possible to determine the cause of pain by looking at an MRI, listening to a patient’s symptoms or by doing a physical exam. This is because there are many structures in the spine that can cause back pain. Therefore, The first two steps are injections done to help determine if the joints in the spine are actually the cause of a patient’s pain. This is done by injecting the spinal joints in the area of a patient’s pain with numbing medication and an anti-inflammatory to see if short term relief is achieved. If a patient receives excellent short term relief from both initial injections, that is a good indication that the facets are contributing or causing the patient’s pain.
If the results from the first two injections indicate that the facets are the cause of pain, the patient will receive a third procedure with the purpose of destroying the small sensory nerves that innervate the painful joints. Destruction of these small sensory nerves is called an ablation or rhizotomy. The goal is to disrupt the pain signals given by the painful joint. Remember, these are only small sensory nerves that go to the joints that will be destroyed during this procedure, these nerves do not provide any motor or sensory function to any other important structures like the legs or muscles of the back. This can often give patients long term-relief for facet related pain.
Treatment is carried out on one side of the spine at a time since there are joints/facets on both sides of the spine. Sometimes patients only require that one side be treated.
The risks associated with facet injections are very small. However, anytime a needle put into the body near the spine there is risk of infection, bleeding, CSF leak and nerve injury.
How is a facet injection done?
The first injection consists of numbing medication (bupivacaine) with a little bit of steroid (anti-inflammatory into the actual joints (facets) of the spine. A second injection will be scheduled if the patient experiences good temporary relief, usually 12 hours to a few days.
For the second injection, numbing medication (bupivacaine) is administered onto the nerve that enters into the joint that received the first injection. This is referred to as a medial branch block (MBB). With the second injection, we are looking for good but very temporary relief lasting from 3-12 hours as the numbing medication quickly wears off.
Both facets injections and MBB’s are very similar in terms of the procedure and goals which is to determine if patient gets good temporary relief of their pain.
During a facet injection or MBB, you may choose to use the nitrous oxide to help you relax. You will be lying face down on the injection table with your head in a specially designed pillow. The doctor will use x-rays during the procedure to assure proper placement of the needle for your injection.
After determining the best location for your facet injections/MBBs with x-rays, the doctor injects a numbing medicine into the skin prior to placing the needle. Then he or she puts a needle into the numbed area of the skin and uses further x-ray images to guide the needle into the desired location on or near the joints in the spine. The medication is then injected either into the joint (facet injection) and/or onto the nerve innervating that joint (MBB). Multiple injections are performed in order to inject multiple joints in your neck or back.
These procedures take about 10 minutes. Please arrange for someone to drive you home.
If the patient experiences good temporary relief from both initial injections then he/she is considered a candidate for a rhizotomy which is the third step in treatment. In the final phase of this minimally invasive treatment, a needle is placed onto the nerve of the joint(s) which then destroys the sensory nerve of the joint using heat at the tip of the needle. The procedure itself is very similar for the patient but takes about 20 to 25 minutes to perform.
See our videos on facet injections for more details about the procedure.
What can you expect after a facet injection?
Many patients experience long-lasting relief from this treatment if they have facet/joint related spine pain and undergo all three treatments. However, the small sensory nerves that were treated do have the ability to grow back, which may result in the reoccurrence of pain. If the nerves do grow back, the process usually takes 12-18 months. If needed, the procedure can be done again at that point.
After any injection there may some back discomfort while the tissues heal from needle placement, injection or medication and/or heat during ablations.
If no relief is experienced with the facet injections and/or MBBs then other treatment options may have to be considered as facet/joint pain is unlikely the patient’s source of pain.
What is a selective nerve root block?
A selective nerve root block (SNRB) is a procedure done to help the surgeon determine the source of your leg or arm pain. There are many nerves in the cervical and lumbar spine and it is sometimes necessary to use more than an MRI, physical exam and symptoms that a patient is having to determine the cause of pain. A SNRB is one tool to help determine which nerve is causing the problem. This is done by placing a needle on specific nerves and applying anti-inflammatory with numbing medication. The goal is to see a patient’s response both during the procedure and for 3–24 hours after procedure. It is very important that the patient records a log of their response to the SNRB to see if they have temporary relief of their symptoms. Remember, this is not a treatment and effects will only be temporary.
How is an SNRB done?
During an SNRB you may choose to use the nitrous oxide to help you relax. You will be lying face down on the injection table with your head in a specially designed pillow. The doctor will use x-rays during the procedure to assure proper placement of the needle for your injection.
After determining the best location for your injection with x-rays, the doctor injects a numbing medicine into the skin in the area where you will get the SNRB. Then he or she puts a needle into the numbed area and uses further x-ray images to guide the needle onto the specific nerve the surgeon is interested in. The medication is then injected around the nerve. During the procedure you will be asked if the needle reproduces the pain you usually feel and if you feel it in the same distribution of your arm and leg that you normally get pain. The discomfort associated with this part will be very temporary. Next numbing medication and anti inflammatory is injected onto the nerve.
Your leg or arm may go numb soon after this injection, this will be temporary lasting less than 24 hours but you will be taken out of the procedure room in a wheel chair. It is important to have assistance when using the affected limb. Remember to record if you have relief of your symptoms at anytime during the 24 hours after your injection.
Your surgeon will use this information to determine the next step in your treatment plan.
The procedure takes about 10–15 minutes. Please arrange for someone to drive you home and to have assistance until the medication wears off, usually within 24 hours.
Watch our videos on how selective nerve root blocks are performed.
Click here to view our injection handout