The Complete Procedure Reference

The epidural space (teal) surrounds and cushions the nerves of the low back.

A herniated disc presses on a nerve root and inflames it — pain shoots down the leg.

Face down, skin numbed, a very thin needle guided by X-ray between the vertebrae.

Steroid and anesthetic bathe the inflamed root — outside the nerve sac — so it can settle.

Nerve roots exit between the neck vertebrae toward the shoulders and arms; the epidural space cushions the cord.

A worn or herniated disc inflames an exiting root — pain travels along its path into the arm.

Face down with the forehead supported; a thin needle advanced under continuous X-ray at the base of the neck.

Medication spreads gently upward through the epidural space; the needle never touches the spinal cord.

Each nerve root leaves the spine through its own small window between the vertebrae — the foramen.

A disc bulge or bone spur can narrow the foramen and pinch the root right in the doorway.

From an oblique angle, a thin needle rests at the outer opening of the foramen; contrast dye confirms it outlines the nerve sleeve.

Medication flows inward along the root sleeve into the epidural space — full strength, exactly where the problem lives.

At the bottom of the sacrum sits a small natural opening between two bony horns — the sacral hiatus.

A thin needle slips through the hiatus at a shallow angle into the sacral canal — far below where the nerve sac ends.

A generous volume of medication spreads upward through the epidural space, bathing several roots at once.

Frees nerves trapped in post-surgical scar tissue

Sometimes done as a series.

Arthritic facet joints ache through their tiny medial branch nerves.

A drop of numbing medicine at each branch. Substantial relief for hours = joints confirmed.

A heated tip creates a millimeters-wide lesion alongside each confirmed nerve.

The joint's message no longer reaches the spine; nerves regrow slowly and it can be repeated.

Arthritic neck facets — commonly behind neck pain that's worse looking up or turning.

Thin needles place numbing drops where each medial branch crosses its bony pillar.

One small, controlled heat lesion per confirmed nerve.

Typically 9–18 months; repeatable when the nerves regrow.

Under X-ray, the needle slips into the small joint space; a crescent of contrast confirms it's inside the capsule.

Relief from the anesthetic within hours (diagnostic), steroid effect over the week.

Two strong, ligament-wrapped joints transfer your upper-body weight into the legs.

An inflamed SI joint causes one-sided buttock pain, sometimes to the thigh.

A thin needle enters the lower joint; contrast confirms placement.

Medication fills the joint and calms the inflammation.

Small cannulae line the sacral edge where the joint's tiny branches cross, each making one controlled lesion.

Soreness up to a week, then durable relief for many patients.

Three small nerves curve around the knee — above-inner, above-outer, below-inner — carrying its pain signals.

Arthritic cartilage and bone spurs make the joint ache; its little nerves report every step.

Three slender cannulae — one per nerve — each create a small, precise heat lesion.

With the pain wiring quiet, the same knee carries you further; relief often lasts 6–12+ months.

The basivertebral nerve branches like a small tree inside each vertebra, reporting wear at the endplates.

Through the pedicle, a curved probe reaches the nerve's trunk and quiets it with contained heat — nothing is left behind.

A frosted micro-ice-ball forms around the nerve, pausing conduction without cutting anything.

Numbness in that nerve's small territory is expected and temporary.

A chain of small ganglia runs in front of the spine; the stellate sits at the neck's base, wired to the arm and face.

In CRPS the automatic wiring misfires — the hand burns, swells, changes color and temperature.

A thin needle from the front of the neck bathes the ganglion in anesthetic — vessels and airway kept safely aside.

The arm warms and calms as the circuit resets. A droopy eyelid for a few hours means the block worked.

Beads of sympathetic ganglia run along the front of the lumbar vertebrae, wired to the leg.

A warm, flushed leg right after = the block is working.

A delicate nerve web wraps the aorta below the diaphragm, carrying pain from stomach, pancreas, liver.

Two thin needles from the back meet the web from both sides and envelop it in medication.

The ganglion impar nestles in front of the last coccyx segment; a fine needle reaches it from below.

Often combined with a tailbone cushion + pelvic-floor therapy plan.

Quiets the nerve relay station for the pelvic organs

Home the same day.

Chronic nerve pain climbs the spinal cord to the brain — soften it on the way up and the brain receives less.

Temporary leads through a needle; a small external stimulator on a belt; you live your normal week.

Gentle pulses scramble the ascending signal — soft tingling, or simply less pain.

If the trial earns it (≥50% relief), a pacemaker-like battery goes under the skin. Remote controlled, removable.

A single nerve segment misfires; the rest of the limb is fine.

Through a needle, a fine lead comes to rest alongside the nerve — no incision.

Gentle waves wash the nerve's red signal quiet; a wearable or small implant powers it.

The fluid-filled intrathecal space bathes the spinal cord — medication here acts directly on pain pathways.

Oral dosing floods the whole body; intrathecal dosing whispers directly to the spine at ~1/100th the dose.

A slim pump under the abdominal skin, a fine catheter curving to the spine.

Refills by a simple office needle-stick every few months; dosing adjusted wirelessly.

Pinpoint neurostimulation for focal nerve pain

You test-drive it for about a week first.

Retrains the spine’s deep stabilizing muscle

Different philosophy from SCS: instead of masking pain signals it restores muscle control, so improvement accumulates gradually.

A vertebral body collapses into a wedge — every movement grinds the crack, and posture tips forward.

Via the pedicle, a small balloon gently lifts the collapsed bone back toward its height.

The space is filled with bone cement — the crack is knitted, the pain generator stabilized.

Through a pencil-width tube, excess ligament is trimmed — the canal visibly opens and the nerves decompress.

Walking distance is the scoreboard — most gains show over the first weeks as the nerves calm.

Cement reinforcement for a fractured sacrum

Like kyphoplasty, pain relief can be dramatic within days as the fracture is internally splinted.

A small implant that holds the "standing room" open

Walk-in, walk-out decompression: standing and walking tolerance typically improve because the segment can no longer pinch shut in extension.

Stops the painful micro-motion of a failed SI joint

Reserved for well-confirmed SI pain.

Treats pain arising inside the disc itself

A niche but real option when the disc itself is the pain generator and surgery feels like too big a step.

Shrinks a contained herniation from the inside

The disc stays intact; only a few percent of its core volume is removed — enough to decompress the nerve in well-chosen cases.

A taut band with a dense, irritable knot — the trigger point.

Trigger points send pain elsewhere along predictable maps — a shoulder knot can 'become' a temple headache.

A fine needle reaches the knot; a local twitch and a drop of medication let the band release.

The muscle lies smooth again. Stretching and posture work keep it that way.

Hair-fine needles place micro-doses at the standardized sites; most patients rate it far easier than expected.

Benefit builds across the first two cycles — judge it at 24 weeks, not 2.

A drop of medication where the occipital nerves emerge — scalp numbness right after means the target was hit.

Relief within minutes (anesthetic phase) predicts steroid-phase benefit.

The nerve is bathed at its notch — often unlocking enough comfort to make therapy possible.

Best used as a bridge INTO the shoulder exercise program.

Medication spreads in the layer between abdominal muscles, enveloping both nerves.

If relief is real but temporary, cryo or PNS of the same nerves is the logical next step.

The nerve is reached deep in the pelvis where it rounds the ischial spine.

Paired with pelvic-floor physical therapy for lasting change.

Medication spreads through the crowded tunnel, shrinking the swelling around the median nerve.

Night splinting and tendon-glide exercises extend the benefit.

The burning-thigh nerve, calmed at the hip crease

Numbness of the outer thigh for a few hours confirms the diagnosis; steroid quiets it longer.

The rib nerves, numbed along their groove

Relief is often immediate.

Relaxes the deep muscle that irritates the sciatic nerve

Pairs naturally with the stretching program — the injection opens a window; the exercises keep it open.

A long thin needle from the front-side; medication spreads between ball and socket.

If numbing the joint erases your pain, the hip is confirmed as the generator.

Medication floods the inflamed bursa beneath the shoulder's bony roof — the classic impingement target.

In frozen shoulder, injections buy the comfort that makes stretching possible.

Your own platelets, concentrated and returned to the joint — a biology-based signal rather than a suppressive one.

PRP typically means a few days of achy fullness, then gradual gains over weeks; steroid = faster but shorter.

The bursa under the outer-hip tendon band is bathed in medication.

Lasting fix = the hip-strengthening program; the injection opens the window.

Your own platelets, concentrated onto a struggling tendon or joint

Expect a sore week (the point is a controlled re-injury), then gradual gains over 6–12 weeks.

Small irritant injections that provoke ligaments to remodel

A slower-burn cousin of PRP with a long clinical history; best evidence is in knee OA and some tendinopathies.

A reclined, monitored infusion over hours — most patients describe it as strange but tolerable, with staff steps away.

Dream-like sensations during infusion are expected and wear off; benefits accrue across a series.

The blood settles over the leak like a living patch — many headaches lift within hours.

Lie flat briefly after, avoid straining for 24–48h.

A body-wide reset for wound-up nerve pain

You sit monitored while it runs.