Thoracic Procedures


Facet joints are joint structures in the spine that give it the support and mobility to bend and rotate. Each of these joints contains medial branch nerves, which carry pain signals from the facet joints to the brain. If a facet joint becomes damaged, which can happen as the body ages or as a result of a trauma such as whiplash, it can cause back or neck pain.

A diagnostic medial branch nerve block is an outpatient procedure for diagnosing back/neck pain. It is an injection of local anesthetic around a medial branch nerve that is connected to a specific facet joint. If the nerve block succeeds in “numbing” the nerve and significantly reducing your pain, the doctor may confirm that the facet joint is what is causing it.

Depending on how the injection affects your pain, you may or may not need to repeat the procedure. For longer term pain relief, your doctor may recommend another procedure called radiofrequency ablation.


The entire procedure takes a few minutes to complete. The needle used for the medial nerve branch is very thin, so sedation is not required.

The physician will start the procedure by inserting a small amount of local anesthetic into the skin to numb the area.

When the medial nerve branch injection needle is inserted, you may feel some pressure. The physician will guide the needle into the appropriate medial branch nerve using fluoroscopy (real-time X-ray). After the needle is removed, a small band-aid may be placed over the injection site.


You may feel instant pain relief following the injection. This relief can last a couple of hours or even up to two weeks, at which point the pain may return. Some people may experience tenderness for a day or two. You will be given a pain diary to record your response to the procedure. You will need to bring it with you to your next appointment.

After it has been determined that the medial branch nerve is the source of your pain, you and your doctor can discuss treatment options for longer term pain relief.

To learn more about medial branch nerve blocks for diagnosing chronic back/neck pain, call (859) 282-2024 to make an appointment with one of our pain management experts.


The intercostal nerve sends pain signals to the brain. An intercostal nerve block works by blocking or “numbing” the nerve to provide temporary or even permanent relief. It is an injection of anesthetic (and sometimes steroid) into the intercostal nerve, which is located under the rib cage.

The procedure is commonly performed to reduce inflammation in patients experiencing chest pain that arises from a recent surgery in that area. It is also a treatment option for people suffering from other medical conditions, such as herpes zoster (shingles).

You may be a candidate for an intercostal nerve block if your pain comes from any of the following sources:

  • Surgical incision
  • Rib fracture
  • Viral infections
  • Inflammatory conditions

An intercostal nerve block takes less than 30 minutes to perform. You will lie down on your side during the procedure. The doctor will clean the skin near your ribs and then inject anesthetic to numb the area. Using fluoroscopic guidance (real-time X-ray), the doctor will insert the intercostal nerve block needle and inject the pain medication. He or she will remove the needle and repeat the procedure as necessary to make sure the treatment is effective.


Some people experience immediate pain relief after the injection. However, other people may not feel the medication working until two or three days after. The medication may last for several days or even months. We will send you home with a pain diary to document your response to the procedure. Depending on your response to intercostal nerve block you maybe a candidate for radiofrequency ablation.

To learn more about intercostal nerve blocks for treating pain in the rib cage, call 859-282-2024 to make an appointment and talk to one of our pain management specialists.


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.

More information coming soon on the following procedures:
  • Endoscopic RadioFrequency Ablation
  • Vertebroplasty
Abdominal and pelvic