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X-rays, CT Scans, and MRIs provide excellent imaging of different spinal disorders. However, these tests do not show or reproduce pain. Spinal injections, typically used to control pain, can be used diagnostically to locate the pain source. Diagnostic spinal injections include discography (discogram), selective nerve root blocks (SNRB), sacroiliac joint injections, facet joint injections, and medial blocks.
Typically, these injections only offer 6 to 12 hours of relief from specified symptoms, which then is a diagnostic result. Please keep in mind, that if you experience dramatic relief, but relief lasts for only 6 hours, it is still a positive correlative result.
The type of diagnostic spinal injection your doctor chooses is based on your medical history, physical and neurologic examination, and other test findings.The type of diagnostic spinal injection your doctor chooses is based on your medical history, physical and neurologic examination, and other test findings.
Discography is a specific test to tell if a damaged or abnormal disc is causing pain. This is not a routine test. It may be performed prior to spinal disc surgery to determine which disc levels will be treated.
Discography, an invasive procedure, is performed using fluoroscopy (similar to x-ray, except in real time). To help you relax during the procedure, mild sedation may be administered. However, we cannot completely sedate, or put you to sleep, as you need to be alert enough to report what you feel to our team during the injection. An antibiotic may also be given intravenously before and after. You may be positioned, with pillows for support and comfort, on your side, or in another position. The injection sites are cleansed using an antiseptic and an anesthetic numbs the skin.
Using fluoroscopic guidance, a contrast agent (dye) is injected into the center of select discs. Contrast enhances the disc’s anatomical characteristics and may spread outside the disc if abnormal. The dye may irritate a damaged, symptomatic disc. Pressure measurements from inside the disc are collected too. As each disc is injected with contrast, you are asked to describe your symptoms, such as the intensity and type of pain experienced.
Please understand that the purpose of this test is not just to make you hurt! Rather, the purpose is to recreate symptoms familiar to your unique pain pattern.
When discography replicates your symptoms, it is called a positive discogram. If symptoms are not replicated, it is a negative discogram. Discography can be uncomfortable and symptoms are temporary.
The procedure may take 45-minutes, depending on the number of discs examined.
Discogram: Fluoroscopy view shows the intact disc above and the degenerated disc below.
Selective Nerve Root Block (SNRB)
A selective nerve root block is performed to determine if a specific spinal nerve is the source of pain. A SNRB is performed to diagnose cervical (neck) or lumbar (low back) radiculopathy (irritation and inflammation of a nerve root).
Using fluoroscopic guidance, steroid medication (a strong anti-inflammatory) is injected at a specific nerve root If the injection reduces symptoms, the pain source is identified. The test takes 15- to 30-minutes per spinal level.
Sacroiliac Joint Injection
The sacroiliac joint, located in the lower spine above the tailbone, is the largest joint in the spine. Inflammation of the sacroiliac joint can cause low back and buttock pain.
Using fluoroscopy, local anesthetic and steroid medication is injected into the sacroiliac joint. If pain is relieved, it could mean the joint is the pain generator.
|1 Sacroiliac Joint |
2 Coccyx (tailbone)
Facet and Medial Blocks
Joint inflammation between spinal bones can cause back pain. Facet and medial blocks involve injecting steroid medication into one or more joint structures to determine if a specific joint generates pain.
If pain is relieved, it could mean that the joint or medial nerve generates pain.
Patient Preparation: At Home
Below is a short list of common instructions. After you are seen at Colorado Comprehensive Spine Institute (CCSI), our doctor will provide a more specific list for you.
Patient Preparation: At the Medical Facility
What to Expect During the Procedure
After the Procedure
A facet and medial block, like other medical procedures, may present risks. Complications include risk of infection, low blood pressure, headache, and injury to nerve tissue.
Some patients should not undergo a facet and medial block. Restrictions include:
Diagnostic injections are important to help identify the source of pain. Although these procedures are often uncomfortable, our staff is dedicated to making your procedure as comfortable as possible.