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NASA Neuroscience & Spine Associates
Human Resource Department
8380 Riverwalk Park Blvd, Suite 320
Ft. Myers, Fl.   33919

Fax: 239-437-2535

NASA Neuroscience & Spine Associates is an Equal Opportunity Employer.

Please review an available position by selecting it under Current Job Openings to the left.

We have an opening for a Florida Licensed Physical Therapist and P.T.A.  These positions will be primarily located in one of our Naples Offices.  The perfect candidates must be able to work Saturdays and some evenings.  Send resume to mbuchwalter@nasamri.com.

SELECTIVE NERVE ROOT BLOCK FOR DIAGNOSIS
AND BACK PAIN MANAGEMENT

Another common injection, a selective nerve root block (SNRB), is primarily used to diagnose the specific source of nerve root pain and, secondarily, for therapeutic relief of low back pain and/or leg pain.

When a nerve root becomes compressed and inflamed, it can produce back and/or leg pain.  Occasionally, an imaging study (e.g. MRI) may not clearly show which nerve is causing the pain and an SNRB injection is performed to assist in isolating the source of pain.  In addition to its diagnostic function, this type of injection for pain management can also be used as a treatment for a far lateral disc herniation (a disc that ruptures outside the spinal canal).

In an SNRB, the nerve is approached at the level where it exits the foramen (the hole between the vertebral bodies).  The injection is done both with a steroid (an anti-inflammatory medication) and lidocaine (a numbing agent).  Fluoroscopy (live x-ray) is used to ensure the medication is delivered to the correct location.  If the patient’s pain goes away after the injection, it can be inferred that the back pain generator is the specific nerve root that has just been injected.  Following the injection, the steroid also helps reduce inflammation around the nerve root.

Success rates vary depending on the primary diagnosis and whether or not the injections are being used primarily for diagnosis.  While there is no definitive research to dictate the frequency of SNRB’s, it is generally considered reasonable to limit SNRB’s to three times per year.

Technically, SNRB injections are more difficult to perform than epidural steroid injections and should be performed by experienced physicians.  Since the injection is outside the spine, there is no risk of a wet tap (cerebrospinal fluid leak).  However, since the injection is right next to the nerve root, sometimes an SNRB will temporarily worsen the patient’s leg pain.

FACET JOINT BLOCK FOR BACK PAIN MANAGEMENT

In cases where the facet joint itself is the pain generator, a facet block injection can be performed to alleviate the pain.  Similar to SNRB’s, facet block injections are a diagnostic tool used to isolate and confirm the specific source of back pain for the patient.  Additionally, facet blocks have a therapeutic effect as they numb the source of pain and soothe the inflammation for the patient.

The facet joints are paired joints in the back that have opposing surfaces of cartilage (cushioning tissue between the bones) and a surro9unding capsule.  Twisting injuries can cause damage to one or both facet joints, and cartilage degeneration associated with aging may also cause pain.

In a facet block procedure, a physician uses fluoroscopy (live x-ray) to guide the needle into the fact joint capsule to inject lidocaine (a numbing agent) and/or a steroid (an anti-inflammatory medication.  If the patient’s pain goes away after the injection, it can be inferred that the pain generator is the specific facet joint capsule that has just been injected.

EPIDURAL STEROID INJECTIONS

The most commonly performed injection is an epidural steroid injection.  In this approach, a steroid is injected directly around the dura, the sac around the nerve roots that contains cerebrospinal fluid (the fluid that the nerve roots are bathed in).  Prior to the injection, the skin is anesthetized by using a small needle to numb the area in the low back (a local anesthetic).

Injecting around the dura sac with steroid can markedly decrease inflammation associated with common conditions such as spinal stenosis disc herniation or degenerative disc disease. 

It is thought that there is also a flushing effect from the injection that helps remove or “flush out” inflammatory proteins from around structures that may cause pain.

An epidural steroid injection
is generally successful in relieving lower back pain for approximately 50% of patients. 

While the effects of the injection tend to be temporary (one week to one year) an epidural can be very beneficial in providing relieve for patients during an episode of severe back pain and allows patients to progress in their rehabilitation. 

There is no definitive research to dictate the frequency of the epidural steroid injections; however, a limit of three injections in six months is generally considered reasonable.  There is also no general consensus in the medical community as to whether or not a series of three injections need always be performed.  If one or two injections resolve the patient’s low back pain, some physicians prefer to save the one or two additional injections for any potential recurrent low back pain.  Generally, there are few risks associated with epidural injections. 

LUMBAR PUNCTURE (LP) 

A lumbar puncture (LP, also known as a spinal tap, is a diagnostic and/or therapeutic procedure performed by a physician.  The procedure is performed by inserting a hollow needle into the subarachnoid space in the lumbar area (lower back) of the spinal column.  The subarachnoid space is in the canal in the spinal column that carries cerebrospinal fluid (CSF) between the brain and the spinal cord.

CSF is a clear fluid that bathes the brain and spinal cord while protecting it, like a cushion, from exterior injury.  The fluid is produced and reabsorbed in the brain on a continuous basis.  CSF is composed of cells, water, proteins, sugars, and other vital substances that are essential to maintain equilibrium in the nervous system.

SACROILIAC JOINT BLOCK INJECTION

Sacroiliac (SI) joint blocks are injections that are primarily used for diagnosing and treating the low back pain associated with sacroiliac joint dysfunction.  The SI joint lies next to the spine and connects the sacrum (bottom of the spine) with the pelvis (hip)

In an SI joint block injection approach, a physician uses fluoroscopic guidance (live x-ray) and inserts a needed into the sacroiliac joint to inject lidocaine (a numbing agent) and a steroid (an anti-inflammatory medication).  It takes a highly skilled and experienced physician to be able to insert a needle into the sacroiliac joint.

An SI joint block injection may be repeated up to three times per year.  For the treatment to be successful, the injection should be followed by physical therapy and/or chiropractic manipulations to provide mobilization and range of motion exercises.