I. Nerve Blocks & Epidurals

When pain originates from a compressed or irritated nerve — whether in the cervical spine, thoracic spine, or lumbar spine — the most direct way to address it is to reach that nerve with precision and deliver medication exactly where it is needed. That is the purpose of image-guided nerve blocks and epidural injections.

Dr. Mahajer performs the full spectrum of spinal nerve procedures under fluoroscopic guidance, ensuring that every injection is placed with anatomical accuracy. These include transforaminal epidural steroid injections, interlaminar epidural steroid injections, selective nerve root blocks, cervical and lumbar medial branch blocks, and occipital nerve blocks for cervicogenic headache. Each procedure is selected based on the specific pain generator identified through careful clinical evaluation and imaging review.

Epidural steroid injections reduce the inflammation surrounding a compressed nerve root — the inflammation that is often responsible for the burning, shooting, or electrical pain that travels into the arm or leg. A well-placed injection delivers anti-inflammatory medication directly to the site of nerve irritation, providing meaningful relief that allows patients to participate in rehabilitation and restore function.

“Transforaminal epidural steroid injections provide significant short-term relief of radicular pain and improve functional outcomes in patients with lumbar disc herniation and nerve root compression.” — Manchikanti L, et al. Pain Physician. 2012;15(3):ES33–ES98.

Selective nerve root blocks serve a dual purpose. They are both therapeutic — delivering targeted relief — and diagnostic. When a block at a specific nerve level produces significant and reproducible pain relief, it confirms that nerve as a primary contributor to the patient’s symptoms. This diagnostic precision is a cornerstone of Dr. Mahajer’s approach and directly informs subsequent treatment decisions, including the use of confirmatory blocks before radiofrequency ablation.

All nerve block procedures are performed under real-time image guidance with contrast confirmation, ensuring that the medication reaches the intended target and that inadvertent intravascular injection is identified before it can occur. Safety is not negotiated.

If you are living with arm pain, leg pain, sciatica, or radiating nerve pain from the neck or back, a precisely placed nerve block or epidural may provide the relief that allows you to sleep, move, and function again. Dr. Mahajer will review your imaging and clinical picture carefully before recommending any injection, and will explain exactly what the procedure involves, what it is designed to achieve, and what to expect during recovery.

II. Joint Injections & Ablations

Many patients with chronic spine pain are suffering not from a disc or nerve problem, but from the small joints that connect the vertebrae — the facet joints, also called zygapophyseal joints. These joints can develop arthritis, inflammation, and degenerative changes that produce deep, aching pain in the neck or back, often with referral patterns into the shoulders, buttocks, or hips that can be mistaken for disc or nerve pathology.

Sacroiliac joint dysfunction is another frequently overlooked source of low back and buttock pain — one that accounts for a meaningful proportion of patients who have been told they have “lumbar spine” problems without a clear disc or nerve finding. The SI joint is a large, weight-bearing joint at the base of the spine that can become inflamed, hypermobile, or arthritic, producing pain that closely mimics lumbar radiculopathy.

Dr. Mahajer evaluates and treats the full spectrum of spinal joint pain sources. His diagnostic approach uses medial branch blocks to confirm facet joint involvement, and SI joint injections to confirm sacroiliac pathology, before any definitive treatment is recommended. This confirmatory step is not a formality — it is the difference between treating the right structure and treating the wrong one.

“Radiofrequency ablation of the medial branch nerves provides significant long-term pain relief in well-selected patients with confirmed facet joint pain, with evidence supporting durability at 12 months and beyond.” — Engel AJ, et al. Pain Med. 2019;20(2):281–294.

When diagnostic blocks confirm that the facet joints or SI joint are the primary pain generators, radiofrequency ablation — also called RFA or neurotomy — offers a durable treatment option. RFA uses precisely applied thermal energy to interrupt the small nerve fibers that carry pain signals from the affected joint to the brain. The procedure is performed under fluoroscopic guidance with meticulous electrode placement to maximize both safety and efficacy.

The relief provided by RFA typically lasts twelve to twenty-four months or longer. As the nerve regenerates over time, the procedure can be repeated. For many patients, RFA eliminates the need for long-term medication use and significantly improves quality of life without the risks associated with open surgery.

In addition to facet and SI joint interventions, Dr. Mahajer performs image-guided injections for peripheral joint pain — including the hip, knee, shoulder, and ankle — using both fluoroscopic and ultrasound guidance to ensure precise intra-articular placement.

If you have been living with back pain, neck pain, or buttock pain that has not responded to physical therapy, medication, or non-specific injections, you may have a joint pain source that has not yet been accurately identified. Dr. Mahajer’s systematic diagnostic approach — using confirmatory blocks before any ablation — ensures that the right structure is treated and that you are not exposed to procedures that are unlikely to help.

III. Minimally Invasive Spine

For patients with spinal stenosis, disc pathology, or specific structural conditions that have not responded to conservative and interventional management, minimally invasive spine procedures offer a meaningful step forward — one that addresses structural contributors to pain without the recovery burden of open surgery.

Dr. Mahajer offers Minimally Invasive Lumbar Decompression — known as the MILD procedure — for patients with lumbar spinal stenosis and neurogenic claudication. MILD is an outpatient, image-guided procedure that removes small amounts of thickened ligament and bone material that are narrowing the spinal canal and compressing the nerves responsible for the leg heaviness, cramping, and walking limitations that define this condition. The procedure requires no general anesthesia, no implants, and no stitches — and most patients return to normal activity within days.

Basivertebral nerve ablation is another evidence-based minimally invasive option, designed specifically for patients with chronic low back pain originating from the vertebral endplates — a pain source called Modic change or vertebrogenic pain. The basivertebral nerve carries pain signals from the endplate of the vertebral body, and its ablation with radiofrequency energy has been shown in randomized controlled trials to produce significant and durable relief in appropriately selected patients.

“The MILD procedure demonstrated significant improvements in pain and physical function in patients with lumbar spinal stenosis, with a favorable safety profile and durable outcomes at two-year follow-up.” — Deer TR, et al. Pain Pract. 2019;19(7):762–775.

These procedures sit at the intersection of interventional pain management and minimally invasive spine surgery — a space that requires the training, the technical skill, and the clinical judgment to know which patients will benefit, which procedures are most appropriate, and when open surgical consultation is the right referral to make. Dr. Mahajer’s fellowship training in interventional spine medicine at Mount Sinai, combined with his ongoing clinical experience and research engagement, positions him at the forefront of this evolving field.

For patients who have been told that open surgery is their only remaining option, a consultation with Dr. Mahajer may reveal a minimally invasive alternative that has not yet been considered. And for patients approaching surgery, pre-surgical optimization — reducing inflammation, improving tissue quality, and addressing pain generators that may persist post-operatively — is a critical step that Dr. Mahajer is uniquely positioned to provide.

Minimally invasive spine procedures are not appropriate for every patient — and Dr. Mahajer will never recommend a procedure that is not indicated for your specific condition. But for the right patient, at the right stage of their condition, these procedures can restore walking tolerance, reduce dependence on pain medication, and significantly improve quality of life without the recovery timeline of open surgery. If you have lumbar stenosis, vertebrogenic pain, or a structural spine condition that has not responded to prior treatment, a consultation will clarify whether a minimally invasive option exists for you.

PAIN SHOULD NOT DEFINE WHAT YOU ARE ABLE TO DO

Dr. Mahajer is ready to help you find a better path forward.