Patients with pain in the neck, arm, low back, or leg (sciatica) may benefit from ESI. Specifically, those with the following conditions:

• Spinal stenosis: A narrowing of the spinal canal and nerve root canal can cause back and leg pain, especially when walking.
• Spondylolisthesis: A weakness or fracture between the upper and lower facets of a vertebra. If the vertebra slips forward, it can compress the nerve roots causing pain.</li
• Herniated disc: The gel-like material within the disc can bulge or rupture through a weak area in the surrounding wall (annulus). Irritation, pain, and swelling occur when this material squeezes out and comes in contact with a spinal nerve.
• Degenerative disc: A breakdown or aging of the intervertebral disc causing collapse of the disc space, tears in the annulus, and growth of bone spurs.
• Sciatica: Pain that courses along the sciatic nerve in the buttocks and down the legs. It is usually caused by compression of the 5th lumbar or 1st sacral spinal nerve.

Local anesthetic is used to numb the treatment area so discomfort is minimal throughout the procedure. The patient remains awake and aware during the injection to provide feedback to the physician.

With the aid of an x-ray fluoroscope, the doctor directs a hollow needle through the skin and between the bony vertebrae into the epidural space. Fluoroscopy allows the doctor to watch the needle in real-time on the x-ray monitor, ensuring that the needle goes to the desired location. Some discomfort occurs, but patients more commonly feel pressure than pain.

When the needle is correctly positioned, the anesthetic and corticosteroid medications are injected into the epidural space around the nerve roots. The needle is then re­moved. Depending on your pain location, the procedure may be repeated for left and right sides. One or several spinal levels may be injected.

A lumbar sympathetic block is performed to “block” the sympathetic nerves that go to the leg on the same side as the injection. This may in turn reduce pain, swelling, color, sweating and may improve mobility. It is done as a part of the treatment of Reflex Sympathetic Dystrophy (RSD), Sympathetic Maintained Pain, Complex Regional Pain Syndrome and Herpes Zoster (shingles) involving the legs. Certain patients with neuropathy or peripheral vascular disease may also benefit from lumbar sympathetic blocks.

This procedure is done under local anesthesia, which makes the procedure easy to tolerate. It is done with the patient lying on stomach. The patients are monitored with EKG, blood pressure cuff and an oxygen-monitoring device. Temperature sensing probes may also be placed on your feet. The lumbar sympathetic block is performed under sterile conditions. The skin on back is cleaned with antiseptic solution and the skin is then numbed with a local anesthetic. Then X-ray is used to guide the needle or needles into the proper position along the outside of the spine.

Once in place, a test dose of dye is used to confirm that the injected medication will spread in an appropriate area. If this is okay, the injection takes place gradually over several minutes. The physician will use the X-ray to evaluate the spread of the injected medication. When a sufficient area is covered, the injection will be over. When done, the needle is removed and a Band Aid is applied.

Immediately after the injection, you may feel your lower extremity getting warm. In addition, you may notice that your pain may be gone or quite less. You may also notice some temporary weakness or numbness in the leg, although this is actually not a desired effect of a lumbar sympathetic block.

Please note that you will be unable to drive for 24 hours after your procedure. Unless there are complications, you should be able to return to your work the next day. The most common thing you may feel is soreness in the back at the injection site.

NCV is often used along with an EMG to tell the difference between a nerve disorder and a muscle disorder. NCV detects a problem with the nerve, whereas an EMG detects whether the muscle is working properly in response to the nerve’s stimulus.

Diseases or conditions that may be checked with NCV include:

• Guillain-Barré syndrome; A condition in which the body’s immune system attacks part of the peripheral nervous system. The first symptoms may include weakness or a tingling sensation in the legs.
• Carpal tunnel syndrome; A condition in which the median nerve, which runs from the forearm into the hand, becomes pressed or squeezed at the wrist by enlarged tendons or ligaments. This causes pain and numbness in the fingers.
• Charcot-Marie-Tooth disease; An inherited neurological condition that affects both the motor and sensory nerves. It causes weakness of the foot and lower leg muscles.
• Herniated disk disease; This condition occurs when the fibrous cartilage that surrounds the disks of your vertebrae breaks down. The center of each disk, which contains a gelatinous substance, is forced outward. This places pressure on a spinal nerve and causes pain and damage to the nerve.
• Chronic inflammatory polyneuropathy and neuropathy; These are conditions resulting from diabetes or alcoholism. Symptoms may include numbness or tingling in a single nerve or many nerves at the same time.
• Sciatic nerve problems; There are many causes of sciatic nerve problems. The most common is a bulging or ruptured spinal disk that presses against the roots of the nerve leading to the sciatic nerve. Pain, tingling, or numbness often result.

An NCV procedure may be done on an outpatient basis. Procedures may vary depending on your condition and your doctor’s practices. The NCV is done by a neurologist. This is a doctor who specializes in brain and nerve disorders. A technologist may also do some parts of the test.

The paste used to attach the electrodes will be removed from your skin. After the test, you may return to your previous activities, unless your physician advises you differently. Your physician may instruct you to avoid strenuous activities for the rest of the day.