Shoulder Injection

Many times it is important to sort out shoulder and upper extremity pain from the neck pain radiating into the shoulder and upper arm. Sometimes an injection of numbing medication into the joint or other suspected areas of the shoulder can diagnose wether or not the shoulder is the source of pain.

Hip Injection

Many times we see patients who may have hip pain that may or may not be coming from the spine. Obviously it is important to know if the pain is hip or spine in origin because different problems require different solutions. A reliable way to sort that out is to block or inject numbing medication in the suspected hip joint and see if the pain is turned off. This is done with a thin needle with X-ray.

Sacroliac Joint Injection

There are two sacroiliac joints. One on each side where the sacrum joins the left and right ilium (hip bones). It acts as shock absorber between the upper and lower body. This joint is like any other joint and cause pain usually because of degeneration and sometimes trauma. Other structures in the spine can cause pain indistinguishable from the SI joint. The best and most reliable way to figure out if the SI joint is a major source of pain is to inject numbing medication in the joint and see if it makes a big difference. Sometimes steroid is included to hopefully produce a long term benefit.


Discography is strictly a diagnostic test. It is a way to figure out if pain is or is not coming from a disc. Many structures in the spine can cause pain. Many times the pain from one source
can feel the same as pain from a different source. It is very important to know exactly what structure is causing the pain, because different problems require very different solutions. If you hurt your arm, the doctor can grab your arm and twist, push, or pull to see if and where it huts. Obviously, you can’t do that to a disc. However, a disc can be tested as a pain source by placing a thin needle in the disc and injecting a small amount of dye pressurizing the disc. A normal disc will not have pain. An abnormal disc will have pain. This procedure is done with twilight anesthesia. Discs throughout the spine can be tested.

Facet Rhizotomy

If a major source of back pain has been shown to be the facet joints by performing the facet joint block,then the patient is a candidate for facet rhizotomy. The main ingredient in the facet block is a local anesthetic which would have only provided temporary relief for several hours, but would have diagnosed the facet joints as the source of pain. A rhizotomy is a procedure which uses special needles and radio frequency current such that the tiny nerves which were numbed temporarily with the facet block can be cauterized producing a much more long lasting period of pain relief. This is done with twilight anesthesia and takes about fifteen minutes. It can be performed at all levels of the spine.

Facet Joint Block

Each vertebra has four facet joints associated with it. They are located in the back of the spine. They are like any other joint in that they degenerate and get arthritis and can cause back pain. The problem is that there are many other structures in the spine which can cause back pain at the same time, but your brain cannot sort them out and tell you which one is causing the pain. The best and most reliable way to figure out where the pain is coming from is to selectively and precisely numb the joints and see if the pain stops or is greatly reduced. This is done with a very thin needle and X-ray guidance with or without sedation.

Selective Nerve Injection (SNI)

Selective nerve injection is the same as a selective nerve root block. Remember that an epidural steroid injection is like hunting with a shotgun, and the purpose is to simply get you better by getting steroid in your spine.Well, a selective nerve injection is like hunting with a laser guided rifle. It is very diagnostic. Specific nerves are targeted using X-ray and the tip of a thin needle is steered next to the specific nerve. Very small amounts of medication, usually xylocaine and sometimes steroid are injected around the nerve. The big advantage of SNI is that it is very diagnostic. If pain is blocked by the very small amount of xylocaine around the nerve, then we know that is the nerve causing the pain. Sometimes steroid is also added to see if perhaps prolonged relief can’t be achieved at the same time. This procedure is done along all levels of the spine with or without sedation.

Epidural Steroid Injection

ESI is the most common procedure done in our group. It is simply a technique to get steroid (cortisone) into the spine directly.The steroid is put in a place called the epidural space which surrounds all the nerves and spinal cord. Steroid is an extremely potent anti-inflammatory. The purpose of the steroid is to turn off or turn down any ongoing inflammatory response and reduce pain. The steroid medication is not directed at any one particular nerve or structure. Kind of like hunting with a shotgun.Once put in the epidural space it spreads up/down and side to side. It can be done at any level of the spine. It can be done with or without sedation.


Vertebroplasty and Kyphoplasty are both minimally invasive techniques to place cement in vertebral compression fractures. The main purpose of either procedure is to minimize pain as soon as possible and minimize complications and side effects from more traditional treatment. The technical differences and implications between the two techniques are sometimes important and sometimes not so important. Vertebroplasty does not focus on restoring the smoosh in the vertebra as much as Kyphoplasty. If you should opt for either procedure, that final decision would be between you and your doctor. The procedure is minimally invasive as an outpatient with twilight anesthesia.


As we all age our bones become weakened and we become susceptible to a particular fracture of the spine called compression fracture. It looks like a marshmallow that got smooshed when looking at the spine from the side. Traditionally these were treated with bracing and pain meds plus weeks or months of time. Some people would become bed ridden because of the pain. Today we offer patients a procedure that involves the placement of cement directly into the fractured vertebra to stabilize the fracture and perhaps restore some of the smoosh. The level of relief is usually significant within hours or a few days.This is done using minimally invasive techniques as an outpatient with twilight anesthesia.