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Advanced Treatment for Chronic Pain

Dr. Bakshi performs a wide range of advanced pain management treatments for chronic pain. These treatments include the following:

Epidural Steroid Injections (ESI): Cervical, Lumbar, and Thoracic

Epidural steroid injections, commonly referred to as ESIs, are an effective method of treating inflammation and the resulting back pain. The ESI injections reduce nerve inflammation that is caused by a narrowing of the spinal passage through which the nerves travel. This treatment is guided by X-ray, and it is performed by carefully injecting the anti-inflammatory medication into the epidural space. The epidural space is inside the bony spinal canal, outside of the tube holding the spinal fluid - thecal sac. Local anesthetic may be injected in conjunction with the steroid medication. Several methods may be employed:

  • Laminar ESI: The steroid injection is placed in the epidural space to decrease lower back or leg pain resulting from compressed or inflamed nerves. The steroid targets the discs and nerves to reduce inflammation and pain. These injections can reduce pain associated with herniated discs, spinal stenosis, and inflamed nerves.
  • Caudal: The medication is injected into the sacral hiatus at the end of the spine, above the tailbone, to relieve lower back and leg pain resulting from bone spurs, sciatica, damaged discs, herniated disks, or other conditions.
  • Transforaminal: Commonly referred to as a “nerve block,” the injection is placed next to the nerve where it exits the spinal column. The medication enters the nerve sleeve, traveling upward into the epidural space to achieve a concentrated delivery into the area causing chronic pain.
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How is an Epidural Steroid Injection Performed?

Our patients undergoing pain management in NYC are generally brought to an operative suite where they lie flat on an X-ray table. The lower back will be cleansed and sanitized, and an injection of local anesthetic is administered to numb the area. Live X-ray guidance is used to guide the insertion of the needle into the epidural space, and the needle location is confirmed by injecting contrast dye. The steroid is then slowly injected, after which the patient will rest, be monitored for a short period of time, and then discharged.

Facet Injections: Cervical, Lumbar, and Thoracic

Facet injections are a kind of treatment that utilize local anesthetic and/or steroid medication to anesthetize facet joints. The facet joints are what give the spine its flexibility, allowing for twisting and turning.

  • Intra-articular: Anti-inflammatory steroid medication and anesthetic are injected into the facet joint to address and treat lower back pain, as well as restore capability of motion.
  • Diagnostic: Facet injections can be administered to diagnose a source of pain. Anesthetic is injected into the nerves entering the facet joints to determine whether the facet joints are the source of pain.
  • Radiofrequency Ablation: After a diagnosis of facet mediated pain is established with diagnostic injections, radiofrequency ablation can be administered to address and treat facetogenic pain. X-ray (fluoroscopy) guidance is used to lead the needle to the appropriate nerves, through which an electrical current creates heat to lesion the affected nerves, thus stopping the nerve from sending pain signals.

Facet Injection Procedure

During a facet injection procedure, the patient is brought to the operative suite and lies face down on an X-ray table. The skin is first cleansed, and then the skin and tissue above the facet joint (in neck or back) are numbed with a local anesthetic. Using live X-ray guidance, a small needle is inserted into the facet joint space or adjacent to the nerve. The medication is then delivered into the target area, requiring between ten to thirty minutes to complete.

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Sacroiliac Joint Injections

The sacroiliac joint (SI) is located in the pelvis, linking the pelvis (iliac) to the lowest part of the spine above the tailbone (sacrum). Sacroiliac joint injections are comprised of steroid medication as well as local anesthetic, which are injected into the joint itself.

These injections can be used in two ways:

  • Diagnostically, to identify the source of pain
  • Therapeutically, to relieve chronic lower back and leg pain


How Are These Injections Performed?

The patient is brought to the operative suite and lies on the X-Ray table. The injection site is sterilized and numbed with local anesthetic. Using X-ray guidance, the needle is inserted into the sacroiliac joint. Contrast will be injected (X-ray dye) to ensure accurate needle placement, after which the steroid is injected to relieve the chronic pain.


Discography

Discography is a diagnostic test to identify which disc(s) is the source of the chronic back pain. After cleansing the surrounding area of skin and inserting the needle with X-ray guidance, contrast dye is injected into specific discs to pressurize the disc and determine which ones are causing the pain. This diagnostic test may be recommended for those who suffer from chronic groin, hip, back, or leg pain; it will identify the source(s) of the pain, which assists the surgeon in his decision on what levels need surgical intervention. Following the procedure, patients will be sent for a post-discography CT Scan.


Discography Procedure

Patients are brought to the operative suite and lie on their stomach on an X-ray table. First, images of your spine structure are taken with an X-ray (fluoroscopy) system to indicate the exact location of various discs. Next, local anesthetic is injected into the skin and tissue to numb the area. A needle is then inserted in the center of a disc, using contrast dye for exact and accurate placement. The disc is then pressurized using a pressure monitor to attempt to replicate the patient’s pain. The procedure requires roughly 30 to 45 minutes to complete, after which you will be monitored and then released to have a post-discography CT scan.

Trigger Point Injections

A trigger point is a tight or knotted muscle that triggers pain signals to another part of your body when pressure is applied. Trigger point injections reduce inflammation by relaxing the tight muscle, promoting recovery and healing as well as improving blood flow.

What is the Trigger Point Injection Procedure?

You will be lying down or seated for the procedure. We will press on various muscle areas to identify the painful area(s). The injection site is sanitized, and then a small needle is placed into the painful muscle, administering a mixture of anesthetic and medication. The entire process takes only a few minutes to perform, after which you can return home.


Hip Injections

Hip joint injections are one of our NYC pain management treatments during which medication is injected directly into the hip joint to diagnose or treat chronic hip pain.

How is a Hip Injection Procedure Performed?

Live X-ray (fluoroscopy) and contrast dye are used to guide exact and accurate needle placement. You will be lying on an X-ray table, and the injection site is sterilized. Local anesthetic is injected, and then the steroid medication is slowly and gently injected into the hip joint. You may experience a sensation of pressure and minor pain during the injection. Some patients are more comfortable with IV sedation, which is another option available to you.


Bursa Injections

A bursa is a fluid-filled sac, lubricating the motions of muscles moving over a bone. When a bursa is inflamed, these injections can reduce chronic pain that is commonly associated with bursitis, arthritis, and other inflammatory conditions. These injections can be administered to either diagnose the source or relieve chronic pain in the hip.

Bursa Injection Procedure

During this procedure you will lie on a treatment table, and the area to be treated is first cleaned and draped. The treatment area will be numbed with local anesthetic. Using X-ray guidance, the needle will be placed in the exact location required, after which the local anesthetic and steroid medication are injected. The procedure is then complete, taking a total of only ten to fifteen minutes. After a short period of observation you can return home.


Lumbar Sympathetic Blocks

Lumbar sympathetic blocks are an injection of medication into your back, to relieve lower back and leg pain. These injections are administered along the outside of the spine and may be the appropriate pain management treatment for several conditions. Some of these conditions are:

  • Complex Regional Pain Syndrome: Chronic pain affecting legs or arms, CRPS involves symptoms such as swelling, sensitivity, burning, throbbing pain, stiffness, muscle spasms, decreased motion, and tremors.
  • Peripheral Neuropathy: Diseased or damaged nerves can lead to chronic pain, which may be alleviated with a lumbar sympathetic block.
  • Vascular Insufficiency: Pain associated with vascular insufficiency may be successfully treated and reduced with a lumbar sympathetic block.
Pain Management in NYC

Spinal Cord Stimulation

Spinal cord stimulation may be an effective treatment if other treatments for chronic back pain have not led to relief. A device delivering electrical pulses can be implanted in the upper buttock, sending a mild electrical current to your spinal cord to relieve chronic back, leg, or arm pain that has not successfully responded to other treatments. The electrical pulses modify the pain signals prior to reaching the brain.

IV Sedation can be used with any of these procedures to make the treatment more comfortable. This can be discussed, in more detail, with Dr. Bakshi at your evaluation.

Why Choose Dr. Stieber?

Dr. Jonathan Stieber is one of the top spine surgeons in New York. He is a board-certified, fellowship-trained orthopedic spine surgeon who brings 15 years of experience in spine surgery and pain management. Dr. Stieber serves as a Director of the Spine Center at OrthoManhattan and an Associate Professor of Orthopedic Surgery at NYU School of Medicine. Because of excellence in results and patient satisfaction, Dr. Stieber has been named a New York Magazine Best Doctor for 2021 and Castle Connolly Top Doctor for 2022.

At Dr. Stieber's Advanced Back and Spine Care, our focus is patient safety and comfort when performing our procedures and pain management plays a vital role in this. Learn more about our procedures and how our pain management in New York can help you.

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Dear Patients:

Our patients' health and safety is our number one priority. Our office continues to be open for all email, telephone, and online inquiries. You can call us at 646-916-3962 or contact us via email to schedule your virtual telemedicine or in-person visit. Our doctors will be holding regular office hours for virtual video consultations and follow-up visits that permit you to stay in the comfort of your own home, utilizing your computer, tablet, or mobile device.

Additionally, we will continue to see select patients in the office for consultation and follow-up visits, including preoperative and postoperative appointments. Our doctors continue to perform procedures in our private, free-standing surgery center that offers an array of outpatient surgical services to treat spinal issues such as acute back pain, disc herniations, sciatica, and pinched nerves in the back or neck. We are also able to offer clean and efficient on-site x-ray capabilities in our office.

Please know that we join our community in taking all advised precautions* to limit the spread of the Coronavirus and ensure the safety of patients and staff.

Call today to schedule a consultation and explore your options with the Spine Center at OrthoManhattan.

The following precautionary measures have been established to ensure the safest environment possible:

  • All patients are screened both prior to and on the day of their office appointment. Patients will not be permitted in the office and will be asked to reschedule their appointment if:
    • You or anyone in your household are experiencing flu-like symptoms, such as fever, cough, congestion, runny nose, or shortness of breath.
    • You have been in contact with anybody who has tested positive for coronavirus or have traveled (both domestically and internationally) within the last 14 days.
  • We have updated our patient and visitor policies:
    • Only a limited number of patients will be permitted on the office hour schedule.
    • No additional visitors or family members are allowed to accompany the patient during their office visit, unless the patient is in need of an aide or a translator
    • Infants, children, and adolescents are asked to stay home and will not be permitted to accompany the patient to their appointment.

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