FAQs

If your spine physician has suspected that you have pain from the facet joints of the spine (cervical spine, thoracic spine, or lumbar spine) or pain arising from the sacroiliac joint (SIJ), then RFA may be offered to you. This involves a three-step process:

Two separate sets of medial (neck and back) or lateral (SIJ) branch blocks.
If the two sets of blocks provide 70-80% relief of pain during the next few hours after injection, they are considered diagnostic and we proceed with RFA.

RFA procedure
Please see the page on medial branch blocks and radiofrequency ablation for more information on this procedure.

The use of epidural steroid injections (ESI) can be very helpful in reducing pain of pinched nerves in the neck or low back that cause radiation of symptoms to surrounding areas.

If your first ESI provides some length of time of pain relief or improved strength, then a second injection may be considered in the following cases:

Partial relief with the first ESI (for example 50% pain reduction). A second injection could eliminate the residual pain.

Substantial response with the first ESI but short-lived relief (for example several days, weeks, or months). When the pain begins to return, a repeat of the ESI can provide additional relief.

The decision to proceed with a second or third ESI will be made in consultation with your spine care provider. It is usual to wait two weeks or more between injections.

In general, when neck or back pain, with or without arm or leg pain, is present for six weeks or more, then imaging studies including x-ray and/or MRI are more helpful. If these studies are performed prior to six weeks, they tend not to help with treatment decision-making, and there is a high likelihood that the pain will resolve without aggressive treatments including injections and surgery.

Exceptions do exist, and there are several situations where radiological imaging studies may be indicated sooner than six weeks. These include:

History of trauma with significant pain
Regular nighttime awakening with pain
Loss of energy or weight
Fever or chills
Significant or progressive neurological findings
Weakness
Loss of coordination
Loss of bowel or bladder control

It is recommended that patients who have anxiety about the procedure or will need pain control opt for sedation. There are essentially three levels of sedation/anesthesia care available for procedures done at an ambulatory surgery center (ASC):

No sedation
Any of our procedures can be done without sedation.
Intravenous conscious sedation (IVCS) consists of small or large doses of midazolam and/or fentanyl. This is a good option for:
Procedures with a risk of fainting
usually seen with procedures in the neck
Pain with needle placement
Discography
When better comfort is desired
Radiofrequency ablations
Monitored anesthesia care (MAC) consists of doses of propofol administered and monitored by an anesthesiologist or a certified registered nurse anesthetist (CRNA). This is a good option for:
Cervical transforaminal epidural steroid injections (TFESI)
C0-C1 or C1-C2 joint blocks (these are the first two levels of vertebrae)
Cervical (neck), thoracic (midback), or lumbar (low back) radiofrequency ablations (RFA)
Diagnostic discography
Patients with high anxiety surrounding the procedure or past injection experience dictates the need for sedation

The majority of spinal injection cases require that another driver take you home from your procedure. This is because anesthetic (numbing medication) is placed around nerves and/or intravenous sedation medications are used, thus limiting your functional ability to drive. Also, we cannot release you to a cab or other public transportation alone if you have had sedation.