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INJECTION UNDER
FLUOROSCOPY

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What are injections 
under fluoroscopy?

Fluoroscopy-guided injection techniques ensure precise medication delivery to targeted sites. The needle’s position is pinpointed under radiography, with contrast agent confirmation before medication injection to ensure accuracy. Using radio-opaque materials, internal structures are highlighted to analyze affected areas better. This procedure involves directing radiation at the patient in a radiology room with radiographic precision.

Numerous pathologies causing chronic pain can benefit from local treatments. At Rockland Physiatry and Sports Medicine Clinic, we specialize in high-precision injection treatments. For more information or appointments, contact us today!

services below

fluoroscopy-Guided injections:

An epidural injection is a procedure where a mix of anti-inflammatory (cortisone) and anesthetic (Xylocaine) agents are injected near the nerve roots in the spine to reduce inflammation and pain. This treatment targets specific areas of inflammation, such as those caused by a herniated disc or spinal stenosis. At Rockland Physiatry and Sports Medicine Clinic, our physiatrists are ready to help you find the best treatment for your needs.

Facet blocks (or intra-facet joint injections) are injections performed to reduce inflammation and pain in facet joints. Facet joints are two small joints located on each side of the back of the spine. They help create movement between vertebrae.
This practice is well-known for treating leg and back pain.
Facet blocks involve injecting medicinal substances, a local anesthetic and cortisone into cervical, dorsal or lumbar facets.

For more information on facet block procedures performed at our clinic in Montréal, contact us!

Treatment of Facet Arthrosis

Facet joints can be the cause of pain at all levels of the spinal column. Only with an injection can the source of the pain be confirmed and appropriately treated. The pain caused by facet joints may be the result of arthrosis in spinal column facets.

Please clearly write your name, address and phone number on your request form.

Please send hard copies of radiographs, axial CT scans (Ct-scan) or magnetic resonance imaging (MRI) as you did for your current medical condition. In addition, these results must be made ​​within 1 year and a half before your appointment.

Please note that results on C.D. are not enough to get an appointment and there is a waiting time of 1 to 2 weeks.

Prior to any procedure, patients complete a medical record to clearly indicate the site and path of their pain. Then they are interviewed and examined by a physiatrist before proceeding with an injection at our physiatry clinic in Montréal.

For the procedure, patients are settled comfortably on their stomach with the help of a radiology technologist. After standard disinfection of the skin, a local anesthetic is applied to the skin to ensure greater comfort.

Facet blocks are performed with a specialized radiology apparatus using X-rays to view spine structures and allow a physiatrist to position an injection needle very precisely and safely during procedure.

The procedure is performed by injection under fluoroscopic control, allowing the physiatrist to move the needle towards the affected facet joint and make sure that it is the right source of patients’ pain. A very small quantity of anti-inflammatory and saline solution (cortisone) is injected into the joint. The needle is then removed and the patients are taken to an observation room for about twenty minutes to make sure that there are no allergic reactions to the injected products.

After a facet joint injection, pain may increase slightly during the first seven to ten days. If this is the case, applying ice and taking a simple analgesic such as acetaminophen usually helps to ease discomfort and provide some relief.

Some redness and a warm sensation may occur on the face during the first 48 to 72 hours. This reaction is only a side effect and not the sign of an allergic reaction. It should pass in the days following the procedure.

Women’s menstrual cycle may sometimes be disrupted.

For patients with diabetes, glycemia may increase for a period between 48 to 72 hours. It is important to notify our clinic’s physiatrist prior to the procedure if glycemia is above 10.

Complications following a facet block injection are extremely rare. Using radiography to confirm the path of the injection needle ensures safety. In addition, our physiatrists apply very high standards of practice, which are key to lowering risks. However, there is always a very slight risk of infection during injections. If you are taking antibiotics for an infection or if you have fever, you should notify your physician prior to the procedure. There is also a slight risk of bleeding complications. If you are taking blood thinning medication (anticoagulant or antiplatelet agents), it would also be advisable to notify your physician prior to the procedure. Please note that such complications are considered as exceptional.

To reduce risks of complications, certain precautions are advised :

  • If you are taking antibiotics for an ongoing infection, you must inform your physician. You will probably be advised to end treatment for your infection before undergoing an injection.
  • During pregnancy, injections under fluoroscopic guidance like facet blocks are contra-indicated.
  • Prior to any procedure, please inform our staff of any allergies to medication or contrast products like iodine.
Facet blocks (or intra-facet joint injections) are injections performed to reduce inflammation and pain in facet joints. Facet joints are two small joints located on each side of the back of the spine. They help create movement between vertebrae.
This practice is well-known for treating leg and back pain.
Facet blocks involve injecting medicinal substances, a local anesthetic and cortisone into cervical, dorsal or lumbar facets.

For more information on facet block procedures performed at our clinic in Montréal, contact us!

Treatment of Facet Arthrosis

Facet joints can be the cause of pain at all levels of the spinal column. Only with an injection can the source of the pain be confirmed and appropriately treated. The pain caused by facet joints may be the result of arthrosis in spinal column facets.

Please clearly write your name, address and phone number on your request form.

Please send hard copies of radiographs, axial CT scans (Ct-scan) or magnetic resonance imaging (MRI) as you did for your current medical condition. In addition, these results must be made ​​within 1 year and a half before your appointment.

Please note that results on C.D. are not enough to get an appointment and there is a waiting time of 1 to 2 weeks.

Prior to any procedure, patients complete a medical record to clearly indicate the site and path of their pain. Then they are interviewed and examined by a physiatrist before proceeding with an injection at our physiatry clinic in Montréal.

For the procedure, patients are settled comfortably on their stomach with the help of a radiology technologist. After standard disinfection of the skin, a local anesthetic is applied to the skin to ensure greater comfort.

Facet blocks are performed with a specialized radiology apparatus using X-rays to view spine structures and allow a physiatrist to position an injection needle very precisely and safely during procedure.

The procedure is performed by injection under fluoroscopic control, allowing the physiatrist to move the needle towards the affected facet joint and make sure that it is the right source of patients’ pain. A very small quantity of anti-inflammatory and saline solution (cortisone) is injected into the joint. The needle is then removed and the patients are taken to an observation room for about twenty minutes to make sure that there are no allergic reactions to the injected products.

After a facet joint injection, pain may increase slightly during the first seven to ten days. If this is the case, applying ice and taking a simple analgesic such as acetaminophen usually helps to ease discomfort and provide some relief.

Some redness and a warm sensation may occur on the face during the first 48 to 72 hours. This reaction is only a side effect and not the sign of an allergic reaction. It should pass in the days following the procedure.

Women’s menstrual cycle may sometimes be disrupted.

For patients with diabetes, glycemia may increase for a period between 48 to 72 hours. It is important to notify our clinic’s physiatrist prior to the procedure if glycemia is above 10.

Complications following a facet block injection are extremely rare. Using radiography to confirm the path of the injection needle ensures safety. In addition, our physiatrists apply very high standards of practice, which are key to lowering risks. However, there is always a very slight risk of infection during injections. If you are taking antibiotics for an infection or if you have fever, you should notify your physician prior to the procedure. There is also a slight risk of bleeding complications. If you are taking blood thinning medication (anticoagulant or antiplatelet agents), it would also be advisable to notify your physician prior to the procedure. Please note that such complications are considered as exceptional.

To reduce risks of complications, certain precautions are advised :

  • If you are taking antibiotics for an ongoing infection, you must inform your physician. You will probably be advised to end treatment for your infection before undergoing an injection.
  • During pregnancy, injections under fluoroscopic guidance like facet blocks are contra-indicated.
  • Prior to any procedure, please inform our staff of any allergies to medication or contrast products like iodine.
Peripheral joint injections involve performing injections in various peripheral joints. Depending on the site of pain and pathology, a cortisone injection into a joint or a joint space can be performed to alleviate pain.
Here are examples of peripheral joint injections under fluoroscopy provided at our clinic:
Site Pathology Injection
Shoulder Capsulitis Glenohumeral Arthodistension
Acromioclavicular osteoarthritis Acromioclavicular Injection
Sternoclavicular joint Sternoclavicular Injection
Impingement syndrome Tendonopaty Subacromial Injection
Wrist Rhizarthrosis Carpometacarpal arthrosis Intra-joint Injection
Hip Coxarthrosis hip-joint Injection
Tear of labrum Xylo test of hip
Ankle Tibio-talar arthrosis Tibio-talar Injection
Subtalar dysfunction Subtalar Injection
Foot Tasometatarsal arthrosis Tasometatarsal Injection
NB: the peripheral joint injections are also performed under ultrasonic guidance by Dr. Martin Lamontagne. Please refer to the section ULTRASOUND for more information.

Prior to any procedure, patients complete a medical record to clearly indicate the site and path of their pain. Then they are interviewed and examined by a physiatrist before proceeding with an injection.

During the procedure, patients are settled comfortably. With the help of a radiology technologist, the physiatrist carefully disinfects the skin before proceeding with local anesthesia to ensure greater comfort.

Peripheral joint injections are performed with state-of-the-art radiological equipment (fluoroscope) using X-rays to display the structures of the spinal column or peripheral joints. The equipment allows the physiatrist to position the injection needle with a maximum of precision and safety during procedure.

The physiatrist uses a small quantity of iodine colorant to better pinpoint the location of the needle. Then an anti-inflammatory (cortisone) and anesthetic (Xylocaine) solution is injected at the desired site.

Once the procedure is over, patients are taken to an observation room for about fifteen minutes for our nursing staff to make sure that there are no allergic reactions to the injected medication.

After any injection, pain may increase during the first seven to ten days. Applying ice to the treated area and taking acetaminophen helps to ease discomfort.

For patients with diabetes, glycemia may increase for a period between 48 to 72 hours following procedure. It is important to notify our clinic’s physiatrist prior to the procedure if glycemia is above 10.

Some redness and a warm sensation have been reported to occur on the face and the trunk during the first 48 to 72 hours. This reaction is not the sign of an allergic reaction. It should pass in the days following the procedure.

Complications likely to follow a peripheral joint injection are extremely rare: using our state-of-the-art radiology equipment combined with our physiatrists’ high standards of practice are key to lowering risks of complications.

However, there is always a slight risk of infection during any injection procedure. In addition, cortisone may weaken a patient’s immune system. That is why you should inform us before the procedure if you are taking antibiotics to treat an infection. There is also a slight risk of bleeding complications. If you are taking blood thinning medication (anticoagulant or antiplatelet agents), you must also notify your physician.

To reduce risks of complications, certain precautions are advised :

  • During pregnancy, injections performed with radiological equipment (fluoroscope) are contra-indicated.
  • Patients must inform our staff of any allergies to medication or contrast agents like iodine.
Medial branch blocks are diagnostic tests used to determine if facet joints are the source of a patient’s pain, such as lumbar pain (back pain). Facet joints are small joints located at the back of the spine on each of its two sides.
Medial branch block is performed under fluoroscopic guidance. This procedure involves the local injection of anaesthetics to numb the small nerve responsible for the perception of pain. In the case of lumbar pain, a percutaneous thermo-coagulation (rhizotomy) treatment may be considered to alleviate pain.
Cervical, dorsal and lumbar facet joints can be a source of pain. The painful impulse of facet joints are transmitted by the medial branch of the posterior ramus. Posterior medial branch blocks can provide temporary relief to patients and help to pinpoint the source of pain.
Facet joints can be at the origin of pain at all levels along the spinal column. Medial branch blocks are selection tests that are essential to determine whether patients are likely to be eligible for facet denervation (rhizotomy/thermo-lesion). The selection tests come in sets of two or three. If patients respond positively to the tests, they become eligible for rhizotomy.
If the pain originates in facet joints, medial branch blocks can provide some temporary relief. The duration of relief depends on the anaesthetic product used. After the tests, patients record the intensity of their pain on a pain scale. If the pain does not originate in any facet joint, these tests will not provide relief.

During the procedure, a physiatrist will start by identifying the location of the posterior medial branch through fluoroscopy (radiography).

After disinfecting the skin and applying an anesthetic, if needed, the physiatrist will make sure that the injection needle is in the right position next to the nerve in question by injecting a small quantity of iodine colorant to pinpoint the target location. Then an anaesthetic product is injected.

At the end of the procedure, patients are taken to a resting room for about fifteen minutes to make sure that there are no allergic reactions to the injected products. They will have to complete pain scales during the next 48 hours to determine if they are relieved from the pain. They then send the pain scales to our clinic to conclude whether there is relief from pain or not. If there is relief, a second appointment is made with the patients to repeat the same test.

After the procedure, pain may increase during the first seven to ten days. Applying ice to the treated area and taking acetaminophen helps to ease discomfort.

Complications following such injections are extremely rare. Radiology devices at the cutting edge of technology and our physiatrists’ standards of practice are instrumental to lowering risks of complications.

However, there is always a very slight risk of infection or bleeding complications during injections. If you are taking blood thinning medication (anticoagulant or antiplatelet agents), you must notify us prior to the procedure.

To reduce risks of complications, certain precautions are advised :

  • During pregnancy, injections performed with radiological equipment (fluoroscope) are contra-indicated.
  • Patients must inform our staff of any allergies to medication or contrast agents like iodine.
Discal stimulation is a diagnostic procedure performed to determine if a patient’s symptoms are the result of a disc affliction (disc tear, herniated disc). To do so, a needle is inserted in the intervertebral disc under fluoroscopic guidance. Then a contrast medium is injected to increase pressure inside the disc.
The purpose of this procedure is to confirm that a disc is the source (discogenic) of pain by recreating the patient’s usual symptoms. A scan can then be performed to ensure a better discal disease diagnosis. This procedure is indicated when an intra-discal percutaneous (thermal annuloplasty, PRP injection) procedure or surgery is considered after conservative treatment failed on a patient.

This test is performed to confirm a physician’s assumption that a disc is at the source of a patient’s pain, whether an intra-discal tear or a herniated disc.

The procedure is reserved for patients who have not responded to usual conservative treatment, including various types of medication and therapeutic approaches (physiotherapy, osteopathy, massage therapy, etc.) and cortisone injections (epidural). It should not be performed if additional treatment like an intra-discal percutaneaous procedure (thermal annuloplasty, PRP injection) or a surgical procedure is not considered. A scan of the lumbar spine may be performed after disc stimulation for a better view of disc anomalies.

When disc stimulation shows that the pain is due to a disc disease, certain percutaneous (thermal annuloplasty, PRP injection) or surgery procedures may be considered.

The procedure takes about one hour. Patients are settled comfortably on their stomach. When disc stimulation is completed, patients must inform their physiatrist if the pain felt is the usual pain or not.

Save for some cases, the procedure is performed on a minimum of two intervertebral discs, most often three discs. The appropriate position of the injection needle is validated under fluoroscopic control.

In the case of hernia, the pain felt by patients is recreated during the procedure, during which patients work closely with their physiatrist to inform about the site and intensity of the pain and whether the pain stimulated is similar to the chronic pain usually felt.

Pain may increase slightly during the first seven to ten days after injection. If this is the case, applying ice to the treated area and taking acetaminophen helps to ease discomfort.
Risks of intra-discal infection are quite low, since intra-discal antibiotics are injected during this procedure. Allergic reactions to contrast products are extremely rare and can be treated quickly if they occur.
Patients must temporarily stop taking anticoagulants and antiplatelets before the procedure. They must obtain an authorization to do so from their prescribing physician. Disc stimulation during pregnancy is contra-indicated.
This procedure is also referred to as neurotomy, facet denervation, thermo-lesion or thermo-coagulation.
Facet rhizotomy involves “burning” with a radiofrequency device the nerve (the medial branch) innerving the joint facet responsible for the perception of chronic back pain. The procedure is performed once the source of a patient’s pain is identified as being of facet origin through medial branch blocks. The technique involves inactivating the medial branch that innerves a facet and transmits pain signals.
This procedure is indicated for patients suffering from chronic low back pain, who have responded positively to facet blocks but with a short duration or little improvement. To become eligible for facet rhizotomy under radiofrequency, patients must respond positively to a double medial branch block with Xylocaine and Marcaine.
Rhizotomy can provide long-lasting, significant relief to patients suffering from chronic back pain originating in facet joints.
For more information or the make an appointment for rhizotomy at Clinique de physiatrie et de médecine du sport Rockland, call us today!
A facet joint can be the cause of pain felt at all the levels along the spine. Rhizotomy is indicated for patients who continue to suffer from pain (chronic pain originating from facet joints) despite usual conservative treatment (medication intake, physiotherapy treatment or any other type of therapy and cortisone injection). To be eligible for facet rhizotomy by thermo-lesion, patients must have responded positively to double medial branch blocks with Marcaine and Xylocaine.
When patients are properly selected using the medial branch block diagnostic test, results are generally satisfying. When the pain originates from facet joints, facet rhizotomy by thermo-lesion can provide prolonged relief from one to two years. A second rhizotomy procedure may be considered and performed in the case of recurrent symptoms, if the physiatrist deems it relevant.

After local anaesthesia, an electrode is placed at the site where the medial branch should be inserted. With guidance under fluoroscopic control, the most adequate, precise and safe position of the injection needle is determined. Using a low-intensity electrical current, the physiatrist confirms the right position of the needle with the help of their patient who indicates if the electric current felt is located at the site where there is usually pain.

When the tip of the needle is at the right place, another electric current—this time at a higher intensity—is used to heat the tip of the needle and burn the nerve. To make the procedure as comfortable as possible for patients, a local anesthetic is administered.

This procedure can be performed at several levels of the spine, depending on the physiatrist’s analysis and patients’ response to medial branch blocks.

Following the rhizotomy procedure, patients are taken to a resting and observation room for about fifteen minutes to make sure that there are no allergic reactions to the medication injected.

Patients may experience numbness or weakness in a limb as a result of anaesthesia during the procedure. Symptoms may last anywhere from a few minutes to a few hours, but they will eventually disappear. In the weeks following the procedure, patients may experience numbness or loss of feeling on the skin around the procedure site. This situation is generally temporary.
Complications are extremely rare and generally short-lived. Bleeding and infection, although possible, are unusual. Owing to our experienced staff and the state-of-the-art equipment they used, potential risks are reduced to minimum.
  • Prior to procedure, any allergies to medication must be reported to our staff.
  • Patients must stop taking anticoagulants and Plavix before the procedure.
  • Patients must obtain an authorization to stop taking medication temporarily (antibiotics) from their prescribing physician.
  • Patients with pacemakers are not eligible to undergo rhyzotomy.
  • Rhizotomy during pregnancy is also contra-indicated.