Patient Education


Things to know before your procedure

  • If you become sick and your doctor starts you on treatment for an infection, notify our office as we may need to reschedule the procedure.
  • If you are started on a blood thinner or steroid, notify our office as we may need to obtain clearance before doing a procedure.
  • Continue all your regular medications, unless otherwise instructed.
  • Eat Breakfast or lunch as you normally would.
  • If you have sustained 90-100% improvement of your pain following an injection, notify our office as you may not need an additional injection.
  • If you need to reschedule, please notify our office so we can accommodate other patients. If you have any additional questions, please call our office at (703) 313-9111
  • If you have to reschedule, please notify the office at least 48 hours prior to your appointment.

Please be sure to be here 20 minutes before your scheduled appointment time.


What is an Image-Guided Spinal Injection or Procedure?

Image-guided spinal procedures are performed under live x-ray guidance, also known as fluoroscopy. This allows the physician to visualize your spine during the procedure reducing the risk of complications and improving the chance of positive results.

What Medication Are Used During the Procedure?

One or all of the medications types below may be used depending on the procedure:

Local anesthetic to numb the area including the skin or specific target

Contrast agent or dye to outline structures in your spine

Steroid to reduce inflammation and pain

Please inform a member of the team of an allergy to one of these above medications. If you are allergic to the contrast media, or if you have a history of allergic reactions to seafood, shellfish, or iodine, we can use a different contrast agent for the procedure.

Different types of procedures:

Diagnostic injections are test injections of contrast and local anesthetic designed to help determine which structure in your spine is causing your pain.  In order to be effective, a diagnostic injection must be performed while you are experiencing your usual pain or discomfort or while you are able to consistently provoke your pain by certain movements or positions. Shortly after the procedure, you will be assessed by a member of the team to determine whether the anesthetic reduced your level of pain.  It is important to remember that diagnostic injections are tests and once the local anesthetic agent has worn off your usual symptoms will return.  If your pain was significantly reduced after the injection, you will then be scheduled for therapeutic injections.  If you do not experience pain relief, another diagnostic injection may be required.

Therapeutic injections include steroid medication. The purpose of the steroid is to reduce inflammation and as a result your pain.  The steroid effect begins anywhere from that same day to one week after your injection. Studies show that 2 or more injections may be necessary to successfully treat your condition.

Radiofrequency ablations are therapeutic procedures used to treat certain painful spine conditions by “denaturing” the painful nerves.  This procedure does not use steroid medication and will be preceded by diagnostic injections.  Improvement of symptoms may take 2-6 weeks. Radiofrequency ablation cannot be used to treat all conditions.

What Happens After the Procedure?

After your procedure, you will be monitored for a short period of time to ensure that you’re safe to leave the office. It is not uncommon for some patients to experience mild numbness or weakness after the injection. This is due to the numbing medication and will wear off within a short period of time.

What Can I Expect?

Up to 10% of patients may experience a flare of their pain for the first 1-3 days after their procedure. This occurs because the procedure is performed in close proximity to the inflamed area. If you experience a flare of your symptoms, you should not be alarmed as your symptoms should resolve over 2-4 days. You can place an ice pack on the area for 15 minutes at a time and take Tylenol for pain control. Studies have found that for steroid injections < 10% of patients will experience a non-positional headache, mild nausea or facial flushing which usually resolves within 24 hours

What Should I Do to Prepare for the Procedure?

Eat breakfast or lunch as you normally would.  Continue all your regular medications, unless otherwise instructed.

Generally, anti-coagulant medications such as Coumadin, Heparin, Lovenox, Eloquis, Xarelto, or Plavix may need be held prior to your injection.  Anti-inflammatory medications and aspirin do not need to be held. Pain medication should be held for 12-24 hours before a diagnostic injection.

You should arrive at the office 20 minutes prior to your scheduled procedure time.

What are the Potential Complications?

As with all procedures, potential complications may arise. These potential complications include: infection, bleeding, nerve damage, dural puncture, seizure, cardiovascular collapse, fainting, allergic reaction, spinal cord injury, stroke, and death.  A published review of 5500 injection procedures identified 4 systemic adverse effects, each of which was self-limited and resolved. A retrospective review of 888 injection procedures revealed no long-term complications. Two later studies investigating complications from image-guided transforaminal cervical and lumbar injections also demonstrated no long-term complications in all the patients followed.

For What Reasons Should I Call?

A temporary flare of your symptoms for a few days after your procedure may occur. However, if any of the following develops, we should be notified at (703) 313-9111

– A temperature of 100.4 degrees or more

– Excruciating pain

– Loss of bowel or bladder control

– Loss of motor function in arms or legs

– Headache in the standing or sitting position, which is relieved by lying down

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