Our Services

Here at Delta Spine and Pain Clinic, we do utilize medications in the treatment of pain, and these include oral and injected steroids, oral and injected NSAIDs (like ibuprofen), muscle relaxants, membrane stabilizers, antidepressant-type pain medications, and opioid (morphine-like) pain medications. These medications can be very effective in helping manage pain, but are usually not sufficient on their own. They work best as part of a treatment regimen that includes rehabilitation and targeted injections. We view an improvement in function as the most important benefit from medication management. A pain management approach that combines all effective and proven methods is the best approach for pain control and increased functionality, and how we practice here at Delta Spine and Pain Clinic.

All the procedures listed below are performed by Dr. Johnson Ukpede in his office. A driver is required for some procedures. Managing anticoagulant therapy is something that needs to be discussed with Dr. Johnson Ukpede before any procedure.

 

Epidural Steroid Injections

These procedures are typically performed for leg and back pain or neck and arm pain caused by spinal nerve irritation/injury, disc pain, or joint pain. It involves injecting a solution containing steroid into the space of the spine outside the spinal cord protective lining. This does multiple things:

  1. Washes away the inflammatory mediators (chemicals that cause inflammation to continue),
  2. Coats the structures with potent anti-inflammatory steroid which decreases inflammation and irritation,
  3. Softens and degrades scar tissue.

It is a short outpatient procedure that usually does not require sedation. The risks are very low.

 

Lumbar Epidural Steroid Injection

Also known as a LESI, this epidural steroid injection involves injecting steroid into the lumbar epidural space. The skin overlying the injection site is sterilely prepared and numbed with local anesthetic. A needle is carefully guided toward the epidural space using fluoroscopy (X-ray with a TV) and location is confirmed with contrast and fluoroscopic imaging. Steroid solution is injected slowly and good spread is confirmed before completion of the procedure.

 

Transforaminal Epidural Steroid Injection

Also known as a TFESI, this epidural steroid injection involves injecting steroid into the epidural space. The skin overlying the injection site is sterilely prepared and numbed with local anesthetic. A needle is carefully guided toward the epidural space using fluoroscopy (X-ray with a TV) and location is confirmed with contrast and fluoroscopic imaging. Steroid solution is injected slowly and good spread is confirmed before completion of the procedure.

 

Caudal Epidural Steroid Injections

Also known as an Caudal, this epidural steroid injection involves injecting steroid into the lumbar epidural space. The skin overlying the sacral hiatus (just above the tail bone) is sterilely prepared and numbed with local anesthetic. A needle is carefully guided toward the caudal space using fluoroscopy (X-ray with a TV) and location is confirmed with contrast and fluoroscopic imaging. Steroid solution is injected slowly and good spread is confirmed before completion of the procedure.

 

Thoracic Epidural Steroid Injection

Also known as a TESI, this epidural steroid injection involves injecting steroid into the thoracic (chest) epidural space. The skin overlying the injection site is sterilely prepared and numbed with local anesthetic. A needle is carefully guided toward the epidural space using fluoroscopy (X-ray with a TV) and location is confirmed with contrast and fluoroscopic imaging. Steroid solution is injected slowly and good spread is confirmed before completion of the procedure.

 

Cervical Epidural Steroid Injection

Also known as a TESI, this epidural steroid injection involves injecting steroid into the thoracic (chest) epidural space. The skin overlying the injection site is sterilely prepared and numbed with local anesthetic. A needle is carefully guided toward the epidural space using fluoroscopy (X-ray with a TV) and location is confirmed with contrast and fluoroscopic imaging. Steroid solution is injected slowly and good spread is confirmed before completion of the procedure.

 

Facet Block

This is also known as a Median Branch Block It is a technique to diagnose pain associated with arthritis of the joints in the posterior aspect of the spine. Between each pair of vertebrae, there are two joints on the back side of the spine that become arthritic, just like knees and fingers. By specifically blocking the individual small nerves that go to the joints, one can assume the pain is coming from the joints if the pain is largely better after the block. Once two successful facet blocks have been performed, we can destroy the tips of the nerves and provide pain relief for 6 months, by a procedure that can be repeated when necessary. It can be performed in the neck, mid back and low back.

 

Facet/Median Branch Radiofrequency Ablation

This is the goal of performing facet blocks. Once two successful blocks have been performed, the tips of the nerves can be burned using electrically generated heat produced at the tip of a needle, in an outpatient procedure much like the blocks. Once the tips of the needles are appropriately located, heat is generated to a temperature of 80 degrees Celsius. This destroys the tips of the nerves for about 6 months. After the nerves grow back, the procedure can be repeated as needed for continued pain relief. It can be performed in the neck, mid back and low back.

 

Spinal Cord Stimulation

Spinal cord stimulation is a very effective pain management tool that is used when conservative therapy has not provided adequate enough relief.  It uses small electrical currents to confuse the spine and masks the pain.  It involves the placement of small leads into the spinal canal near the spinal cord that provide the electrical current.  While most of do not wish to have a permanent device in our spinal cords, if nothing else is helping and the pain is severe, this is a very effective and safe pain treatment solution.  It is effective in treating: continued pain after spine surgery, spinal nerve pain that cannot be corrected with surgery, foot and leg pain due to poor circulation that cannot be corrected with surgery, foot and hand pain due to neuropathies, and complex regional pain syndrome/RSD of the hands or feet, to name a few.

 

Sacroiliac Joint Injections

The Sacroiliac Joint is the largest joint of the body located where the spine (upper body) connects with the ilium (lower body).  These joints transfer the weight to the legs.  They are sensitive to changes in gait, leg length, and posture.  As a result they soften become inflamed and very painful when one has an issue with other parts of the body and continue to cause pain once the initial problem is resolved.  Physical Therapy and Chiropractic care can provide great relief.  When these fail, steroid injections int o the joint can help tremendously, especially in conjunction with rehabilitation.

 

Neuroma Injections

Neuromas occur after trauma (usually from surgery) to a small nerve. The injured nerve grows in an abnormal manner and becomes very sensitive and overactive. This results in a painful neuroma. Injection of the neuroma with steroid and local anesthetic allow for the nerve activity to be disrupted by the local anesthetic. This allows a resetting of the pain pathways. The steroid decreases inflammation and irritation at the neuroma resulting in significant pain relief.

 

Sympathetic Nerve/Ganglion Blocks

Sympathetic nerve blocks act on the autonomic nervous system - the flight  or fight system.  Pain impulses can be transmitted by the sympathetic nervous system and pain can be exacerbated by increased activity of this system under certain conditions.  The conditions include complex regional pain syndrome (which is reflex sympathetic dystrophy) and chronic pain including pelvic pain.  By blocking these collections of nerve cells called ganglions, we can "reset" the pain pathway and achieve significant pain relief.   These are safe injections performed at our clinic using Fluoroscopic imaging to ensure accurate and safe needle location.

 

Other procedures available with Dr. Ukpede at the office.

  • Piriformis Muscle Injection
  • Bursa Injections
  • Trigger Point Injection
  • Major Joint Injection (e.g., Knee, Shoulder, Hip, Elbow, Wrist)
  • Sympathetic Ganglion Blocks and Ablations
  • Peripheral Nerve Blocks
  • Occipital Nerve Blocks 

Complications from Steroids: difficulty sleeping, weight gain, increased appetite, alteration in menstrual cycle.