Spine Injections

Fluoroscopically Guided Spinal Injections at All Star Pain Management

Back pain is an extremely common health problem, and it is documented as the leading cause of work absence throughout most of the world. As part of the 2010 Global Burden of Disease Study, researchers found that back pain was the most common musculoskeletal condition. Because millions of people are affected with back pain, fluoroscopically guided spinal injections are now common pain management procedures.


How common is back pain?

According to the Global Burden of Disease 2010 Study, low back pain had a 9.4% prevalence rate, affecting as many as 58 million people. The condition was found to cause more global disability than any other disease or medical condition.

What is fluoroscopy?

Fluoroscopy is a procedure that utilizes a special table, x-ray technology, and contrast media to view structures of the human body that normally do not show up with regular x-rays.

The contrast media is often injected once Dr. Zed has the needle in position to ensure accuracy. The fluid (e.g. Omnipaque) looks dark on the x-ray image, and dissipates afterwards.

What are the common types of spinal injections?

For back, neck, arm or leg pain, there are five common injections used. These include:

Epidural steroid injection (ESI)

This injection involves injecting an anesthetic and anti-inflammatory steroid into the epidural space, near the inflamed or compressed spinal nerve. This procedure is used to treat a nerve root that is inflamed such as from a herniated disc or spinal stenosis. It can help patients frequently avoid the need for neck or back surgery when suffering from sciatica or radiculopathy.

Selective nerve root block (SNRB)

This procedure involves injecting around a select nerve that is causing the neck or back pain. The procedure needle is positioned near the nerve, and an anesthetic with steroid is instilled around the nerve. The procedure is performed either for therapeutic or diagnostic purposes.

Facet joint injection (FJI)

The facet joints are tiny joints on either side of the posterior spine. A FJI involves injecting a steroid into the joint, with or without an anesthetic. Facet joints are injected for diagnostic and therapeutic purposes.

Facet rhizotomy (radiofrequency ablation)

This procedure involves inserting a special probe needle around the facet joint, and using radiofrequency energy to deaden tiny sensory nerves. This procedure offers long-term back pain relief that studies show averages fifteen months. A repeat injection can work very well if the pain returns.

Sacroiliac joint injection

These joints lie between the sacrum and ilium, which are pelvic bones. The two joints are located below the lumbar spine. The procedure needle is positioned into the joint, and an anesthetic and corticosteroid solution is inserted.

Regenerative Medicine Procedures

These procedures will involve either PRP therapy or bone marrow material being injected into the facet joints or disc itself. They have been exceptional at providing relief for all types of back pain. Read more about them HERE.

How should I prepare for the procedure?

Before the procedure, you will meet with one of the All Star Pain Management providers to discuss your condition. They will take a medical history, perform a physical examination, and conduct some preliminary x-rays and diagnostic tests.

The doctor will inquire about your medications, and certain blood thinners are to be held for a few days (aspirin, Lovenox, Coumadin, Plavix). Because light sedation may be used, arrange to have someone drive you home. Wear loose-fitting clothing to the medical facility, and be sure to leave all jewelry and valuables at home.

Depending on the procedure, you may be advised not to eat or drink a certain amount of hours prior.

What can I expect during a fluoroscopy guided spine injection?

For all spinal injection procedures, you are positioned lying on your side or abdomen on the procedure table. First, the doctor will clean the injection site using an antiseptic. The skin and deeper tissues are numbed using a local anesthetic.

The x-ray tube device is positioned over the body, and the procedure needle is guided into the epidural space, facet joint, or sacroiliac joint (depending on the procedure). While viewing the tip of the needle and inside the body on screen, the doctor then injects the medication into the joint or epidural space. After the injection, the procedure needle is removed, and a small bandage is applied to the site.

Will the injection hurt?

Because a local anesthetic is given, you should not feel pain, only pressure. When the local numbing agent is injected, you will feel a slight pinching sensation. The anesthetic is also injected near spinal nerves, so you will have immediate relief of back pain. In addition, the corticosteroid starts to work within 20-48 hours, and this pain relief last for weeks.


What will the outcome be?

Most spinal injections performed at All Star Pain Management will result in exceptional pain relief for a period of time. How long will vary based on the specific procedure performed along with your condition.

For example, the average pain relief with a radiofrequency ablation procedure is 15 months according to peer reviewed research. The typical pain relief after a medial branch block or facet injection has been shown to be three months. These procedures may be repeated when the relief wears off.

Dr. Zed Zamfirov is an expert in using image guidance for accuracy in spinal injections. This way, he insures the highest level of accuracy to obtain the best outcomes for his patients!


Hoy D, March L, Brooks P, et al. (2011). The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis, 73, 968-974.

All content has been reviewed and approved by orthopedic specialist Dr. Zvezdomir “Zed” Zamfirov. Dr. Zed’s practice — All Star Pain Management and Regenerative Medicine — proudly serves the Annapolis, Greater Baltimore and Washington D.C. areas.

Call Today to Begin Living Life Pain Free

No one is immune to chronic pain and injury. If your quality of life has continued to be affected by debilitating pain, it’s time to make a change. Schedule a consultation with Dr. Zed at All Star Pain Management and Regenerative Medicine to learn how our cutting-edge treatments can get you back to doing what you love. Call us today to book your appointment and become an all star with us.

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