Nonsurgical

  • nurse assisting patientNot all spine issues require surgery. In fact, only about 10 to 15 percent of people with back and neck problems are candidates for surgery. Most people can find relief with a non-surgical option.

    To treat pain without surgery, we first try to pinpoint your “pain generator.” That means we locate the bone, joint, muscle, disc, or nerve that is causing the pain and treat it with physical therapy, alternative treatments, an injection of pain-relieving medication, a nerve block, or a combination of treatments. Our expert pain management team will help you determine which treatments are best for you.

    Some people find their back or neck pain can be relieved with:

    • Massage therapy 
    • Body movement therapies such as tai chi or yoga

    The following special injections and procedures may also bring relief without surgery.   

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     Spinal Injection

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    • Diagnostic injections are used to locate your pain generator and diagnose the problem. The goal is to give the injection in the correct place to alleviate the majority of your pain. If the pain stops after the injection, we know we’ve found the pain generator.
    • Trigger point injections -- trigger points are extremely sensitive, tight bands of muscle or fascia (the connective tissue between the skin and muscles). They can be caused by muscle over-use, injury, disease, or infection. Trigger points usually respond well to gentle stretching and posture changes. If the tight areas persist after several weeks of other treatments, injections can be considered. The injections include saline, a steroid, or an anesthetic and are given directly into the tight band.

     

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     Spinal Joint Block

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    Spinal joint blocks are injections given in specific locations to block pain signals. They are given with local anesthesia, meaning you are not completely unconscious, but you do not feel anything in the area of the injection.

    For the procedure, you will lie face-down on a table. We will first inject a numbing agent using a very small needle. Your doctor will then use X-ray images (called fluoroscopy) to guide the placement of a larger needle containing the blocking agent. The injection only takes a few minutes. Afterward, you must be driven home and should rest for the remainder of the day. Most people can return to normal activities the next day.

    The long-term response to spinal blocks varies. Most people feel relief within a week. Generally people who have recent or new pain get more relief than people who have been experiencing pain for a long time. As with any medical procedure, there are some risks involved. These may include infection, bleeding, worsening of symptoms, or headache. Your physician will discuss all of the risks with you before the procedure. We offer the following nerve block procedures:

    • Epidural steroid injections in which we inject cortisone, a powerful anti-inflammatory steroid, into the space near the disc and spinal column. The cortisone shrinks the swelling in bulging or herniated discs and decreases inflammation. Most patients feel complete relief of symptoms within two weeks. A second injection can be given within a few months, if needed. A transforaminal epidural steroid injection is aimed at a specific nerve root and may help diagnose the pain generator. A translaminar epidural steroid injection covers a larger, more general area of the spine.
    • Medial branch block involves blocking or numbing clusters of nerves called “medial branches.” These nerves carry the pain signals to the spinal cord and brain where the pain is recognized. If the nerves are blocked, they cannot carry the pain sensation, and you will experience temporary relief. The medial block is used to diagnose exactly where the pain is coming from. If the pain signals are from a condition such as joint disease or arthritis, steps can be taken to provide longer-term relief.
    • Sacroiliac joint injection -- the sacroiliac is a large joint in the lower back where the pelvis and tailbone come together. An injury can cause the joint to become very painful, with symptoms radiating to the lower back, hip, or groin area. A numbing agent and steroid may decrease pain and inflammation in the joint.
    • Facet injection involves injecting cortisone, a powerful anti-inflammatory steroid, into the facet joints located on the spine. The cortisone reduces inflammation and swelling in the joint space, which may reduce pain.
    • Lumbar sympathetic block involves injecting an anesthetic into the sympathetic nerve tissue located on either side of the spine. The injection may be used to treat reflex sympathetic dystrophy, sympathetic maintained pain, complex regional pain syndrome, and shingles pain in the lower extremities.

     

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     Peripheral Joint Injection

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    This injection is given in the hip to determine if pain is coming from the hip or the back. We inject an anesthetic into the joint, followed by a steroid. Steroid injections may be especially beneficial to people experiencing long-standing pain from arthritis, inflammatory disorders, and traumatic synovitis.

     

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     Peripheral Nerve Block

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    Peripheral nerve blocks are given to control pain coming from a nerve, also known as a neuralgia. We inject a local anesthetic and a steroid near the injured nerve to block pain signals along the nerves. In cases of specific sensory nerves, cold (cryotherapy) or heat (radiofrequency lesioning) may also be used to provide longer-term relief for six to nine months.

    Peripheral nerve blocks are commonly used for:

    • Pain from carpal tunnel syndrome
    • Groin pain after hernia surgery or an injury
    • Leg or knee pain
    • Pain in the ball of the foot (also called Morton’s neuroma)

    Complications from a peripheral nerve block are rare, but may include bruising, infection, or nerve injury. If the injection site is inflamed or irritated after the injection, applying ice for 20 minutes three times a day may help.

     

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     Lumbar Discography

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    This procedure may be ordered for persistent low-back pain that does not respond to other treatments. A lumbar discography may be necessary to prepare for back surgery. The procedure uses X-ray technology called fluoroscopy to get a clear picture of the inner workings of each disc in the lower spine.

    For the procedure, you will lie on your stomach on a table. You will receive local anesthesia to numb the area being examined. Next, a very small needled is guided to the center of each disc being examined. The discs are then “pressurized” one at a time. Pressurization consists of injecting small amounts of a sterile liquid into the center of each disc. You will be asked to focus on and describe the sensations you feel. You will be asked to give one of three answers:

    • You feel nothing
    • You feel pressure
    • You feel pain

    If you feel pain from the injection, you will be asked if the pain is familiar (what you feel all the time), or unfamiliar (new pain).

    The pressurized discs are photographed with fluoroscopic equipment. The needles are removed and the procedure is typically over within an hour. Some people experience pain from the procedure. You may use acetaminophen, ibuprofen, or apply an ice pack to ease the soreness.

     

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     Spinal Cord Stimulator

    Content:

    Nerve damage pain that does not respond to any other treatment may benefit from a spinal cord stimulator. This device sends electrical impulses to the nerves to interrupt the pain signals so they cannot reach the brain.

    This procedure is done in two stages. In the first stage, you lie face-down on a table while a local anesthetic is used to numb the skin and tissue. Guided by X-ray images, your doctor will place wires on your spinal cord. You’ll be given an external device to create an electrical current in the wires and block the pain. If the temporary device does in fact relieve your pain, you will come back for the second stage of the procedure.

    For the second stage, you will receive sedation through an I.V. needle. Your doctor will implant a generator to provide permanent electrical stimulation. If your pain is in your lower back or legs, the generator will be placed on the side of your abdomen. If your pain is in your upper back or arms, the generator will be placed in your chest. The batteries in the generator typically last several years, but they cannot be recharged or replaced.

    Most people can return home the same day. You will need somebody to drive you home and you should take it easy for a day or two. You may use acetaminophen, ibuprofen, or apply an ice pack if you feel sore after the procedure.

     

     

    Spinal Injection

    • Diagnostic injections are used to locate your pain generator and diagnose the problem. The goal is to give the injection in the correct place to alleviate the majority of your pain. If the pain stops after the injection, we know we’ve found the pain generator.
    • Trigger point injections -- trigger points are extremely sensitive, tight bands of muscle or fascia (the connective tissue between the skin and muscles). They can be caused by muscle over-use, injury, disease, or infection. Trigger points usually respond well to gentle stretching and posture changes. If the tight areas persist after several weeks of other treatments, injections can be considered. The injections include saline, a steroid, or an anesthetic and are given directly into the tight band.

    Spinal Joint Block

    Spinal joint blocks are injections given in specific locations to block pain signals. They are given with local anesthesia, meaning you are not completely unconscious, but you do not feel anything in the area of the injection.

    For the procedure, you will lie face-down on a table. We will first inject a numbing agent using a very small needle. Your doctor will then use X-ray images (called fluoroscopy) to guide the placement of a larger needle containing the blocking agent. The injection only takes a few minutes. Afterward, you must be driven home and should rest for the remainder of the day. Most people can return to normal activities the next day.

    The long-term response to spinal blocks varies. Most people feel relief within a week. Generally people who have recent or new pain get more relief than people who have been experiencing pain for a long time. As with any medical procedure, there are some risks involved. These may include infection, bleeding, worsening of symptoms, or headache. Your physician will discuss all of the risks with you before the procedure. We offer the following nerve block procedures:

    • Epidural steroid injections in which we inject cortisone, a powerful anti-inflammatory steroid, into the space near the disc and spinal column. The cortisone shrinks the swelling in bulging or herniated discs and decreases inflammation. Most patients feel complete relief of symptoms within two weeks. A second injection can be given within a few months, if needed. A transforaminal epidural steroid injection is aimed at a specific nerve root and may help diagnose the pain generator. A translaminar epidural steroid injection covers a larger, more general area of the spine.
    • Medial branch block involves blocking or numbing clusters of nerves called “medial branches.” These nerves carry the pain signals to the spinal cord and brain where the pain is recognized. If the nerves are blocked, they cannot carry the pain sensation, and you will experience temporary relief. The medial block is used to diagnose exactly where the pain is coming from. If the pain signals are from a condition such as joint disease or arthritis, steps can be taken to provide longer-term relief.
    • Sacroiliac joint injection -- the sacroiliac is a large joint in the lower back where the pelvis and tailbone come together. An injury can cause the joint to become very painful, with symptoms radiating to the lower back, hip, or groin area. A numbing agent and steroid may decrease pain and inflammation in the joint.
    • Facet injection involves injecting cortisone, a powerful anti-inflammatory steroid, into the facet joints located on the spine. The cortisone reduces inflammation and swelling in the joint space, which may reduce pain.
    • Lumbar sympathetic block involves injecting an anesthetic into the sympathetic nerve tissue located on either side of the spine. The injection may be used to treat reflex sympathetic dystrophy, sympathetic maintained pain, complex regional pain syndrome, and shingles pain in the lower extremities.

    Peripheral Joint Injection

    This injection is given in the hip to determine if pain is coming from the hip or the back. We inject an anesthetic into the joint, followed by a steroid. Steroid injections may be especially beneficial to people experiencing long-standing pain from arthritis, inflammatory disorders, and traumatic synovitis.

    Peripheral Nerve Block

    Peripheral nerve blocks are given to control pain coming from a nerve, also known as a neuralgia. We inject a local anesthetic and a steroid near the injured nerve to block pain signals along the nerves. In cases of specific sensory nerves, cold (cryotherapy) or heat (radiofrequency lesioning) may also be used to provide longer-term relief for six to nine months.

    Peripheral nerve blocks are commonly used for:

    • Pain from carpal tunnel syndrome
    • Groin pain after hernia surgery or an injury
    • Leg or knee pain
    • Pain in the ball of the foot (also called Morton’s neuroma)

    Complications from a peripheral nerve block are rare, but may include bruising, infection, or nerve injury. If the injection site is inflamed or irritated after the injection, applying ice for 20 minutes three times a day may help.

    Lumbar Discography

    This procedure may be ordered for persistent low-back pain that does not respond to other treatments. A lumbar discography may be necessary to prepare for back surgery. The procedure uses X-ray technology called fluoroscopy to get a clear picture of the inner workings of each disc in the lower spine.

    For the procedure, you will lie on your stomach on a table. You will receive local anesthesia to numb the area being examined. Next, a very small needled is guided to the center of each disc being examined. The discs are then “pressurized” one at a time. Pressurization consists of injecting small amounts of a sterile liquid into the center of each disc. You will be asked to focus on and describe the sensations you feel. You will be asked to give one of three answers:

    • You feel nothing
    • You feel pressure
    • You feel pain

    If you feel pain from the injection, you will be asked if the pain is familiar (what you feel all the time), or unfamiliar (new pain).

    The pressurized discs are photographed with fluoroscopic equipment. The needles are removed and the procedure is typically over within an hour. Some people experience pain from the procedure. You may use acetaminophen, ibuprofen, or apply an ice pack to ease the soreness.

    Spinal Cord Stimulator

    Nerve damage pain that does not respond to any other treatment may benefit from a spinal cord stimulator. This device sends electrical impulses to the nerves to interrupt the pain signals so they cannot reach the brain.

    This procedure is done in two stages. In the first stage, you lie face-down on a table while a local anesthetic is used to numb the skin and tissue. Guided by X-ray images, your doctor will place wires on your spinal cord. You’ll be given an external device to create an electrical current in the wires and block the pain. If the temporary device does in fact relieve your pain, you will come back for the second stage of the procedure.

    For the second stage, you will receive sedation through an I.V. needle. Your doctor will implant a generator to provide permanent electrical stimulation. If your pain is in your lower back or legs, the generator will be placed on the side of your abdomen. If your pain is in your upper back or arms, the generator will be placed in your chest. The batteries in the generator typically last several years, but they cannot be recharged or replaced.

    Most people can return home the same day. You will need somebody to drive you home and you should take it easy for a day or two. You may use acetaminophen, ibuprofen, or apply an ice pack if you feel sore after the procedure.