Neuroforaminal Injections

If low back pain, lower extremity pains or numbness, or disc herniations are your concern, you may be a candidate for Neuroforaminal Injections. When a patient continues to have pressure on specific spinal nerves I perform this injection to remove the pressure on those nerves.

The most common cause of low back pain is due to problems of the disc between the bones of the lower back. Disc problems can include either a herniated or a degenerated disc. Both can cause pain in either the leg, back, or both. As far as the neck goes, again the most common problems are related to the disc located between the bones of the neck. Problems in the neck can cause arm and neck pain, but also problems in the entire body if the spinal cord is compressed. This is a very serious situation, although it doesn't occur with high frequency.


How is it supposed to work?
A very small needle is placed in the foramen of the nerve that is being treated. This is done under x-ray guidance, and can be completed in my office. I am able to see the flow of the medication into and out of the specific nerve root sheath. Typically, this procedure removes the pressure from the nerves and allows the healing process to continue. As long as pressure remains on the spinal nerves they will continue to cause you pain, and potentially neurological symtoms may begin to develop such as muscle weakness.


How is this different from epidural steroid injections?
Epidural Steroid Injections require a small needle placed into the epidural space of your spine (the space around the spinal nerves), where I inject small amounts of steroid to decrease inflammation. Neuroforaminal Injections are placed right into the nerve root itself, at the origin from the spine, and do not include steroid injection but rather a potent numbing medicine.


How many will I need?
The response to treatment varies from individual to individual; depending upon one's healing ability. You may feel significant pain relief in as little as one injection, or may need multiple injections which can be completed as needed. Sometimes, when a patient requires mulitple injections on mulitple levels, this procedure can be done in the hospital on an outpatient basis so that the patient may receive medication to help them relax intraprocedure.


What are the risks?
Neuroforaminal Injections are a minimally invasive procedure; risks including infection and bleeding, increased pain, allergic reaction, hypotension, headache and nerve irritation at the site.


What is the recovery?
Typically after your procedure we will keep you in our office for fifteen minutes, to have your vital signs monitored by licensed staff for the above listed adverse conditions. Most of our patients are able to leave the office and return to work or home, driving themselves and having no ill effects. Some patients do have a period of increased pain or tenderness, due to the application of medication at the already irritated nerve root, but this should be relieved with stretching, ice and time (usually up to 72 hours).


Post Procedure Instructions

After your procedure today, you should follow the instructions below.
Please read carefully. Your nurse will be available to answer any of your questions. The injection that you received contained local anesthesia and possibly some steroid medication. The steroid is to reduce any inflammation and pain; this is not the steroid that is used to build muscle. You may have some pain at the sight of the injection and in the area of your normal pain. This may last several hours to several days. You will not feel the full effect of your treatments for 3 months. During this time, your body will be attempting to return to a neutral position and the nerves will be healing as much as they possibly can.


Epidural steroid injection and/or neuroforaminal injection:
Simple rest or light activity is recommended for the remainder of the day. You may experience an increase in your own pain for several days following your Epidural. You may feel lightheaded or dizzy when going from a sitting to standing position today. You may also feel some weakness in your legs (lumbar injections) or arms (cervical injections) today and this should return to normal by tomorrow. If you are unsteady, assume a standing position with an easily available support. If these feelings occur lie down and rest. These feelings usually go away in less than 24 hours.


After Your Procedure:

  • Increase your intake of fluids today. If you can tolerate caffeine, include some caffeinated beverages.
  • Perform the prescribed exercises every morning before you get out of bed and every night before you go to bed.
  • Do not soak in water today. You may shower today, but do not take a bath and do not go to the pool or hot tub today. Begin your water exercises tomorrow.
  • Remove your bandage later today.
  • No hot packs to the injection area today. If the site of your injection bothers, you place ice on the site for 15 minutes every hour as needed.
  • Do not hesitate to contact your doctor for unusually severe back or neck pain, fever, chills, stiff neck, headache, inability to urinate, redness or drainage from the injection site, or new onset of leg/arm burning, muscle spasms, numbness, or weakness.

IF YOU EXPECT A CALL BACK FROM YOUR PHYSICIAN AND YOU HAVE CALLER ID BLOCK, YOU MUST REMOVE THE BLOCK OR YOU WILL NOT RECEIVE A CALL BACK FROM THE PHYSICIAN. If you are unable to reach your doctor, go to the emergency room for evaluation and they will notify your doctor.

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External links for additional info
American Medical Association
Memorial Hospital West
Memorial Hospital Pembroke
Sheridan HealthCare
American Osteopathic Association
American Society of Interventional Pain Physicians

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