Lumbar Procedures


The coccyx, commonly known as the tailbone, is a group of small bones (typically 3 to 5) that are fused together and connected to the sacrum, a triangle-shaped bone at the bottom of the spine. The coccyx provides a place for several of the muscles in the pelvic region to attach to, and it is also part of the structure that supports you when you sit down.

Pain in the coccygeal bone and nerve can result from an injury or trauma and can be debilitating, especially when sitting. In many cases, the cause of tailbone pain (coccydinia) is unknown.

Symptoms may include pain in the tailbone that worsens pressure is applied; pain in the buttocks and hips; pain that gets worse when sitting; pain before or during a bowel movement; pain during sex; and increased pain during your menstrual cycle (women). Seeking medical treatment is important to properly diagnose the source of your symptoms and restore your quality of life.


A coccygeal nerve block is one effective treatment for relieving chronic coccydinia. It is a minimally invasive procedure that does not require an overnight stay.
For the procedure, you will lie face down, and your skin will be sterilized and prepped for the injection. Intravenous sedation may be used to relax you for the procedure. If a sedative is used, your vitals will be monitored during and after the procedure.

Before the nerve block is injected, a local anesthetic will be used to numb your skin. The doctor will then use a real-time X-ray to guide the block needle into the appropriate space. Once the needle is placed correctly, a mixture of anesthetic and steroid medication will be injected. If you cannot have steroid injections, platelet rich plasma may be used.
If the pain goes away after the nerve block, the doctor may determine that the coccyx is the source of your problem. If this is the case, a neuroablative procedure may be recommended to more long term relief.


For more information about coccygeal nerve blocks and other treatment options to manage tailbone pain, contact us to schedule an appointment with one of our pain management experts. Our physicians are highly experienced, constantly learning about new treatment methods and innovative procedures, and focused on improving your quality of life.


An epidural steroid injection (ESI) is a minimally invasive procedure that is used to treat chronic pain in the neck, midback, or low back caused by an irritated, injured or compressed nerve root. More specifically, it is used to treat radicular pain, which is pain that starts in the spine and radiates down a spinal nerve.

When nerve irritation in the cervical spine (neck) causes pain to travel down an arm, it is called cervical radiculopathy.
When nerve irritation in the thoracic spine (midback) causes pain to travel into the ribs or abdomen, it is called thoracic radiculopathy.
When nerve irritation in the lumbar spine (lower back) causes pain to travel into the groin or down a leg, it is called lumbar radiculopathy.

Epidural steroid injections work by delivering medication (typically a combination of local anesthetic and a steroid) as close to the pain site as possible in order to reduce inflammation. They are often used to reduce inflammation caused by a variety of spinal conditions, including degenerative disc disease, spinal stenosis, sciatica and herniated disc.

ESI treatment may provide rapid pain relief, allowing patients to resume their normal activities and start physical therapy or other treatment. It may also be used to determine whether surgery may provide pain relief for patients with a herniated disc.


The procedure is performed with you lying face down. Before the epidural injection is administered, you will receive a local anesthetic to numb the skin around the area for injection. The doctor will then insert the needle, using fluoroscopy (real-time X-ray) to guide it into the epidural space. Contrast dye may be injected to confirm that the needle is in the right place. Once the needle is placed in the desired area, the medication will be injected. The injection will include a steroid to reduce inflammation and may also include an anesthetic to provide pain relief.

There are three types of epidural injections: transforaminal, intralaminar, and caudal. There are a few small differences between these ESIs, the main one being where the epidural needle is inserted. The type of injection you get will depend on your condition and the source of your pain. After reviewing your medical history and performing a physical exam, your pain specialist will decide which ESI procedure will give you the best results.


Many patients experience pain relief after an ESI, typically within three days to a week. The amount of pain relief you experience and how long it lasts will vary. If your pain improves moderately, your doctor may recommend one or two more injections to achieve more long term results. The injections may be given as part of a comprehensive care plan that includes other treatments, such as physical therapy or medication.

If the epidural steroid injection does not lessen your pain at all, you will most likely not benefit from further ESI treatments. Your pain specialist will discuss other treatment options with you to better manage your pain.

Learn more about epidural steroid injections for chronic neck and back pain. Call (859) 282-2024 today for an appointment with one of our pain and spine experts.


Facet joints are structures in the spine that connect the vertebrae (spinal column bones). They work as a cohesive unit and allow movement. The joints that are located in the lower part of the spine are called lumbar facet joints. Like other joints, they can get damaged due to injury or deteriorate with age. When this occurs, the medial branch nerve, which innervates the facet joints, can send painful nerve signals up the spinal cord and to the brain. Pain and muscle spasms may be felt in the lower back, hips, buttocks and the back of the thighs.

If lumbar facet joint pain has been properly diagnosed (typically by performing a medial branch nerve block) and pain symptoms do not go away after several nerve block treatments, lumbar radiofrequency ablation (RFA) may be recommended.

The procedure uses advanced technology to disrupt nerve conduction in an affected facet joint in order to prevent the nerve from sending pain signals to the brain. It provides more long term pain relief and is extremely safe. Results may last between twelve and eighteen months.


For the lumbar radiofrequency ablation procedure, you will be asked to lie on your stomach. You may be given local anesthetic or medication before starting to help relax you. Once the area on your back where the procedure will be performed is sterilized and numbed, the doctor will insert the RFA needle and guide it into the right part of your spine using fluoroscopy (real-time X-ray). This ensures complete accuracy.

When the needle is positioned near the medial nerve, an electrode will be inserted into the center of the needle. The electrode will be heated using radiofrequency heat and the nerves that transmit pain will be destroyed. It should be noted that there are almost no negative side effects to eliminating these nerves, as they serve no other purpose than to send pain to the brain.

Once the nerves have been properly destroyed, the doctor will cover will remove the needle and apply a small bandage. You will need to remain lying down for a while after the procedure, but you will be able to go home shortly after.

Pain relief usually lasts about three months after treatment, but for some patients it may last longer. The more treatments you have, the longer your pain relief will last.


Lumbar RFA is highly effective and is one of the main treatment options for people with facet joint damage. If you are interested in getting a medical evaluation to determine whether radiofrequency ablation will work to relieve your lumbar pain, contact our spine and pain specialists. We offer effective, cutting-edge treatments and pride ourselves on providing high quality pain care to the community.


A piriformis block – also known as a piriformis injection, piriformis nerve injection, or piriformis nerve block – is an injection near the sciatic nerve designed to treat piriformis syndrome, a condition commonly responsible for pain in the leg and buttocks. Piriformis syndrome occurs when the piriformis muscle, which runs from the anterior part of the sacrum (lower spine) to the outer thigh, spasms or becomes irritated. This puts pressure on the sciatic nerve, causing pain and discomfort.

Piriformis syndrome is characterized by pain in the buttocks and often pain in the posterior thigh as well. This pain is often aggravated by physical activity or by sitting down.


A “block” (or nerve block) refers to a procedure in which a physician injects an anesthetic and/or steroid into a problem nerve in order to relieve pain. After numbing the skin with a local anesthetic, a doctor will pass a small needle into the sciatic nerve. The needle stimulates the nerve to fire, causing the muscles along the sciatic nerve to twitch, which indicates that contact has been made with the sciatic nerve.

The physician will then inject a steroid near the sciatic nerve to ease inflammation. Anesthetic and steroid will also be injected into the piriformis muscle itself to reduce the frequency of spasms. The treatment is usually administered in conjunction with physical therapy in order to maximize effectiveness.


The results of a piriformis nerve block typically last 6 to 8 weeks. Some patients experience soreness at the injection site after the procedure, and the local anesthetic can sometimes cause the muscles in the area to lose sensation temporarily.

During the recovery period, it may be recommended that you continue your physical therapy and schedule follow-up injection treatments as needed. Many patients also find relief during the recovery period by using heating pads before exercising and icing the area after exercise.

To learn more about piriformis injections, call us at (859) 282-2024 to schedule a consultation with a pain management specialist at Paradigm Pain & Spine.

More information coming soon on the following procedures:
  • Diagnostic Medial Branch Nerve Blocks
  • Discograms
  • Endoscopic Coccygeal Nerve Ablation
  • Endoscopic Discectomy
  • Endoscopic RadioFrequency Ablation
  • Facet Joint injections
  • Intradiscal Electrothermal Therapy
  • Lumbar Sympathetic Block
  • Nerve Root Blocks
  • Percutaneous Discectomy
  • Sacroiliac Joint Injection
  • Transforaminal Injections
  • Vertebroplasty
Abdominal and pelvic