Therapeutic Injections for Spinal Stenosis
If you experience leg or arm pain as the result of spinal stenosis, and nonsurgical treatment doesn’t relieve it, pain management specialists at NYU Langone offer therapeutic injections to alleviate symptoms.
A corticosteroid injection, also called an epidural injection, involves placing medication directly into the epidural space—an area inside the spinal canal between the vertebrae and the fluid-filled sac surrounding the nerve roots and spinal cord. The medication used is a combination of corticosteroids and a local anesthetic, which together reduce inflammation in the spinal canal and relieve pain.
At NYU Langone, pain management experts use live video X-rays to guide the needle and precisely target the area of stenosis. An epidural injection can be administered in the lumbar or cervical spine.
The anesthetic relieves pain immediately, and the corticosteroids typically take effect within 24 to 72 hours, but it may take up to a week. Pain relief may last weeks or months, though epidural injections may not work at all for some people. There is no reliable way to predict whether an injection can relieve your pain.
An epidural injection is performed using local anesthesia, and the procedure takes about 30 minutes. Most people experience few side effects, aside from soreness around the injection site, and can return to normal activities the following day.
Facet Joint Injections
Facet joints are the joints that connect the vertebrae all along the spine. These joints provide the spine with flexibility and allow movement. If any of these joints becomes irritated or inflamed—for example, due to osteoarthritis—the bone tissue swells and can press painfully against nearby nerve roots.
A facet joint injection, also called a facet block, is an injection of local anesthesia and corticosteroids that doctors guide directly into the affected facet joint. The anesthesia temporarily provides pain relief in the joint, and the corticosteroids reduce inflammation in the joint, shrinking its size and reducing pressure on the affected nerve roots.
Doctors use a special X-ray called a fluoroscope that provides live images of your spine and joints to ensure precise injection into the facet joint. This procedure takes between 15 and 30 minutes, and you can return home on the same day. Most people don’t experience side effects and can resume normal activities the following day.
Radiofrequency ablation is a procedure that uses high-energy electromagnetic waves to safely destroy nerves that carry pain impulses. This procedure is appropriate for people who have already tried facet joint injections and found that they were effective in relieving pain. Radiofrequency ablation targets the same symptoms but can ease pain for a longer period.
To perform this procedure, the doctor applies a local anesthetic on the back and then inserts a needle to guide a small probe into the affected nerves. A special kind of X-ray, which provides live video images of your spine, may be used to ensure the correct placement of the probe.
Once the probe is inserted, a number of electrodes may be placed. This allows for treatment of a larger area. Once the probe and electrodes are in place, a small amount of heat—via electromagnetic waves—is passed through the probe and into the nerves. The heat produces a lesion on an area of the nerve, destroying the tissue and eliminating pain.
For nerve pain caused by spinal stenosis, radiofrequency ablation can be effective for up to 12 months.
This procedure typically takes less than an hour to perform, and most people can return home on the same day. Side effects include soreness around the injection site.
Trigger Point Injections
NYU Langone doctors may recommend trigger point injections if you have neck or back pain associated with muscle tension and not with a pinched nerve root. For someone with spinal stenosis, this may occur as a result of continued poor posture or other abnormal body positions. Injections of an anesthetic mixture directly into the muscle can help the muscle relax and relieve pain.
Trigger point injections take about 30 minutes, and you can expect to go home on the same day. Side effects may include slight soreness at the injection site, but most people feel pain relief in the muscle right away.