Neck, Back and Spine Care

Neck and back pain can be debilitating—it can prevent you from doing things you enjoy and simple day-to-day activities. Whether you’re experiencing a sports-related injuries, arthritis, lower back pain, or another common spine conditions, the Neck Back and Spine Care team at Riverwood Healthcare Center is here to help you find relief.

From chronic neck pain solutions to lower back pain relief, our spine care specialists can diagnose your condition and customize a pain management plan to improve your quality of life. Our team of non-surgical spine specialists, a sports medicine specialist, and a nurse practitioner collaborate with additional providers, physical therapists, and support staff to create minimally invasive care plans that may include physical therapy, exercise, rehabilitation, medication, and image-guided injections.

If conservative non-surgical spine care no longer relieves symptoms, our specialists may refer you to consult with a spine surgeon to discuss other pain management options.

Schedule a Neck, Back, and Spine Care Appointment

When you’re experiencing neck or back pain, you want relief and you want it quickly. Call 218-927-5181 to schedule your appointment with our Neck and Back Spine Care team today.

Our Neck and Back Specialists

Joshua Horowitz, DO
Daniel Lonergan, MD
Christy Nagel, APRN, AGPCNP-BC

Patient Testimonials

Treatments and Services

Balloon kyphoplasty is a minimally invasive procedure done on an outpatient basis repairing a vertebral compression fracture.

Epidural Steroid Injection (ESI) is a common treatment option for cases of neck or back pain. The procedure involves injecting a local anesthetic into the skin. This is followed by a steroid medication directly injected into the epidural space of the spine with the assistance of fluoroscopy. The goal of the ESI is to reduce pain by decreasing inflammation and swelling around the nerves. Epidural steroid injections are a non-surgical, minimally invasive therapy to assist with other conservative therapies, such as rehabilitation programs or physical therapy.

There are three specific techniques to Epidural Steroid Injections.  The specific type of epidural steroid injection chosen by your doctor or provider will depend on the underlying condition and symptoms you are having. These are not limited to, but may include:

  • Interlaminar
  • Caudal
  • Transforaminal

There are three different types of steroid medications administered:

  • Dexamethasone (Decadron)
  • Methylprednisolone (Depo Medrol)
  • Triamcinolone (Kenalog)


Genicular Nerve Block is used to treat chronic knee pain. If physical therapy, medications, viscous injections, and steroid injections are not effective, the next step may be a genicular nerve block. The genicular nerve is located by the knee joint. This nerve block requires a procedure to inject an anesthetic next to the nerves so the pain signal can be blocked.

The genicular nerve block is used as a diagnostic tool. If the nerve block is successful, the next option may be the genicular nerve radiofrequency ablation. The genicular nerve radiofrequency ablation can give lasting pain control for roughly 6-12 months.

Genicular Nerve Radiofrequency Ablation is used to treat chronic knee pain. This procedure is completed if you have had a successful genicular nerve block performed. Radiofrequency ablation is a therapy that uses heat to destroy the nerve. Radio waves are used through a needle to heat the specific nerve. An ablation is considered a more long-term treatment plan.

The radiofrequency ablation (RFA) is a minimally invasive, non-surgical technique. This is performed in an outpatient status. The goal is to provide at least 50% relief of chronic knee pain for 6-12 months.

The Sympathetic Block can be used to diagnose or treat pain from the sympathetic nervous system. Everyone responds to the injections differently; some may get weeks to months of relief. Some may require multiple injections. The relief can be gradual over time. The block is used to anesthetize small nerves and reduce pain by “resetting” the sympathetic nervous system.

There are different types of Sympathetic blocks. The provider will choose the best block based on the individual patient’s symptoms. There may be a time when the provider decides to use a steroid injection with the block.

  • Ganglion Impar Block
  • Stellate Ganglion Block
  • Celiac Plexus Block
  • Hypogastric Plexus Block
  • Lumbar Sympathetic Block

Some conditions that are commonly caused by the sympathetic nervous system: cancer pain, complex regional pain syndrome type, diabetic peripheral neuropathy, neuropathic pain, and reflex sympathetic dystrophy.The sympathetic nervous system involves the “fight or flight” response and can affect all the bodies organs. This controls your involuntary body functions such as blood flow, digestion, sweating, and pain transmission.

Bursa and Joint Injections are minimally invasive, non-surgical, and low risk treatment options for pain that originates from the musculoskeletal system. Your provider will choose the best injection based on the individual patient’s symptoms. The bursa is a fluid filled sac that helps tendons, ligaments, muscle, and skin glide over the bone joint by providing a thin cushion to help reduce friction. When your bursa becomes inflamed and painful, it is called bursitis. This can be caused by a lot of repetitive movement.

Types of bursa injections:

  • Shoulder (subacromial)
  • Elbow (olecranon)
  • Hip (trochanteric)
  • Hamstring or buttock
  • Knee (pre-patellar)

A joint is the point where two bones make contact. Joint injections may be considered due to pain from arthritis, osteoarthritis, trauma, injuries, bursitis, and tendinitis.

Common joint injections:

  • Shoulder joint
  • Elbows, hands, feet
  • Hip Coccyx (tailbone)
  • Knee Ankle

There are three different types of steroid medications administered. The steroid can help reduce inflammation and irritation in the bursa or joint.

  • Dexamethasone (Decadron)
  • Methylprednisolone (Depo Medrol)
  • Triamcinolone (Kenalog)


Medial Branch Block (MBB) is a diagnostic procedure that is used to determine if the correct set of nerves are causing the patient pain. This procedure involves injecting an anesthetic near small medial nerves that are connected to a specific facet joint (a pair of small joints in between the vertebrae) while you lay on your stomach. Multiple levels of the spine are typically injected. Medial branch blocks are a set of two. The goal is to have the Medial Branch Radiofrequency Ablation (which can last 6-12 months in duration) if the medial branch blocks are successful.

There are three different types of Medial Branch Blocks. The provider will choose the best levels based on the individual patient’s symptoms. There may be a time when the provider decides to use a steroid injection with the block. This will be on an individual basis.

  • Cervical Medial Branch Block
  • Thoracic Medial Branch Block
  • Lumbar Medial Branch Block


Radiofrequency Ablation (RFA) is a minimally invasive procedure that is used to destroy nerve tissue. This procedure is used for longer-term pain management and may need to be repeated over time. Radio waves are used through a needle that is placed at the area where the nerves are painful. This area was confirmed with the Medial Branch Blocks (MBB).

There are three different types of RFA’s. The provider will base the level from the previous Medial Branch Blocks. You will be asked to hold blood thinners prior to this procedure. This is based off an individual’s medications.

  • Cervical Medial Branch Radiofrequency Ablation
  • Thoracic Medial Branch Radiofrequency Ablation
  • Lumbar Medial Branch Radiofrequency Ablation


A Spinal Cord Stimulator is an implanted device that delivers low levels of electricity to the spinal cord to help relieve pain. The spinal cord stimulator consists of a small battery pack (the generator) that has thin electrodes (wires) that are placed in the space between the spinal cord and the vertebrae. Spinal cord stimulators are used to manage specific types of chronic pain that have not been relieved from medications, physical therapy, steroid injections, or surgeries. The spinal cord stimulator is an effective, safe, and reversible way to help treat chronic pain.


Sacroiliac Joint Injections (SI joint) are a common treatment option for sacroiliac joint pain. The sacroiliac joint is where the pelvis and spine come together. Either too little or too much movement has caused tension on this joint, which can lead to pain. The pain can be felt in your low back, buttock, hip, or leg. The SI injection is used to decrease swelling and inflammation at the SI joint.

There are three different types of steroid medications administered. The provider will choose the best medication based on the individual. The provider will decide if you have a Left, Right, or Bilateral SI injection based on your symptoms.

  • Dexamethasone (Decadron)
  • Methylprednisolone (Depo Medrol)
  • Triamcinolone (Kenalog)

Facet Joint Injections are a treatment option for cases of neck, mid back, and low back pain. This pain is typically caused by arthritis of the facet joints. Facet joints are small synovial joints that allow your neck and back to move. When arthritis has affected the facet joints, there can be significant pain when you are bending, twisting, walking, or standing. Facet joint injections are a minimally invasive, non-surgical treatment option for arthritis or inflammation in the facet joints. The facet joint house the medial branch nerves that deliver signals to the brain.

There are three different types of Facet Joint Injections. The provider will choose the best approach based on individual patient’s symptoms.

  • Cervical
  • Thoracic
  • Lumbar

There are three different types of steroid medications administered. The provider will choose the best medication based on the individual.

  • Dexamethasone (Decadron)
  • Methylprednisolone (Depo Medrol)
  • Triamcinolone (Kenalog)

A Spinal Cord Stimulator is an implanted device that delivers low levels of electricity to the spinal cord to help relieve pain. The spinal cord stimulator consists of a small battery pack (the generator) that has thin electrodes (wires) that are placed in the space between the spinal cord and the vertebrae. Spinal cord stimulators are used to manage specific types of chronic pain that have not been relieved from medications, physical therapy, steroid injections, or surgeries. The spinal cord stimulator is an effective, safe, and reversible way to help treat chronic pain.


Frequently Asked Questions

The time from the injection to when a patient may experience relief, is variable. Some patients may have immediate relief, which can often be attributed more to the local anesthetic that is used by the doctor during the procedure. More often the process takes 7-10 days for the steroid medication to take effect and for patients to notice significant relief after an injection.

The time from completion of the radiofrequency ablation to feeling better varies among individuals. It is not uncommon to be a little sore from muscle pain the first day or two after the procedure. Most patients report relief within 5-10 days after completion of the procedure.

The frequency of the intervention / injection is determined by the cause of the problem and your body’s response to the treatment. We formulate a treatment plan specific to each individual. Some medical conditions warrant closer attention to an individual’s exposure to injected medications and treatments. Our goal is to always take the very best care of the patient that we can.

The response to an injection will be evaluated at the procedure follow up visit in the clinic. In the event that the injection does not work for you, we will reevaluate the options and determine a treatment pathway moving forward. We will always try to explore all options that are reasonable, safe, and applicable to your specific condition and do our very best to get you feeling better.

Our specialists are fellowship trained, board certified physicians in their field. They work very hard to provide you with the most state-of-the-art care possible, that is specific to your needs. They approach each procedure as if they were performing it on a family member.

Our goal is to help you feel better and alleviate your pain. Often the most uncomfortable part of an injection is the local anesthetic medication that is used to numb the skin and underlying area. This experience is very individual for each person. For some is not uncomfortable at all, and for others it can be more painful. If you have concerns about the injection or have had a bad experience with injections in the past, please bring this to the attention of our nursing staff and we will make every effort to individualize the procedure to create the best experience possible.

It is not unusual to experience anxiety or fear about the use of needles and procedures. It is extremely helpful if you notify our staff if you have these concerns or have had a bad experience in the past with injections. We try very hard to make your experience the best it can possibly be. Most of the time we can adjust the treatment plan or recommend administration of relaxing medications to be given during the procedure to reduce these concerns.

Most injections are performed by numbing the skin with local anesthetic medication and are not uncomfortable after that. However, some procedures may be more uncomfortable than others and we may administer relaxing medications for your comfort during the injection. The number one priority of our doctors is always keeping you safe. If you have concerns about being awake during the procedure, we can discuss sedation options with you and  arrive at a plan we all agree on. There may be limitations on the type of sedation that can be administered based on several variables. Again, we stress that our number one goal is to keep our patients safe from harm.

Most insurance companies require an authorization approval prior to your procedure. This is dependent on the specific insurance company and their individual policies. Some require longer authorization times than others for approval. We most often will receive approval for your procedure within 10 business days. Our goal is to always try to provide the most efficient care and treatment possible. Please help in being understanding that in today’s world, there are many factors that are out of our control that may affect the timeline of getting your procedure completed. Thank you for your patience and understanding.

You will receive a phone call from the procedure scheduling office the day before your procedure. This call will provide you with the specific arrival time for which you should arrive at the hospital to check in. This varies based on the type of procedure and if you are receiving sedation. We try very hard to accommodate every patient and their individual schedule. Please be understanding that we cannot always give procedure or arrival times that are best for everyone; however, if you have travel limitations it is helpful for our clinic staff to know early so that we can try our very best to accommodate those requests in advance.

In the event you are feeling better and your specific pain as resolved on its own, we recommend that you postpone or cancel your procedure.  Please call our office to speak with our nursing staff; in these situations, we want to avoid doing your procedure if there is no longer an indication or need.

This is a great question. In most instances we would reschedule your procedure if you have been prescribed an antibiotic medication for treatment of an infection. Our number one goal is to keep our patients safe, and doing an injection on a patient with an active infection that is still being treated increases the risk of complications to that patient. We do not want to spread the infection to another area by doing a procedure. It is best to complete the antibiotic treatment and ensure the infection has resolved before undergoing a procedure. The only common exception is a chronic condition for which you take the antibiotic all the time, and there is no active, acute infection being treated. If you have any concerns or questions about your medications, and if they will affect your procedure, please contact our nursing staff.

Please do not make any changes to your medications unless directed to do so by our nursing staff. Some procedures do require you to stop blood thinning medications, but this is very specific to each procedure and each type of blood thinning medication. We will assist you in that process and ask for permission from your family doctor or heart doctor if necessary. If you have a procedure scheduled, please update us of any changes to your blood thinning medications.

Our practice focuses on the interventional treatment of painful conditions of the spine. We are not a conventional pain management practice, and do not provide chronic pain management services such as narcotic pain medications.

We do not offer treatments for Fibromyalgia. This type of pain does not respond well to injections. Generalized pain disorders such as Fibromyalgia often respond best to a multidisciplinary treatment approach that includes cognitive therapies, non-opioid medications, physical therapy, and exercise. These therapies are found through a conventional pain management clinic, and we do not offer these therapies.

This is a great question. If you have pre-diabetes or diabetes, the nursing staff will check your blood sugar upon arrival to the procedure area. For safety reasons, in most instances we may reschedule your procedure if your blood sugar is greater than 200. This is because administration of steroid during your injection can raise your blood sugar, and starting off with a blood sugar above 200 causes a rapid increase in your sugars and can be problematic. If you are diabetic, we advise that you eat a light, non-sugary meal prior to your procedure, so when your blood sugar is checked before your procedure, it is not significantly elevated.

Also, we encourage that you monitor your blood sugars several times a day for the first 3-5 days after the injection to ensure they are staying within the normal range. If they are elevated to a concerning level, please contact your primary care provider or our office for assistance.

Each patient must be evaluated individually. We want to provide the very best care for you, and sometimes there may be details that are important to your situation and pain that need to be discussed. We promise to evaluate you and come up with the very best treatment plan for your specific condition.

Most injections may take 7-10 days to reduce your pain. This is due to the nature of the medications that are administered and their mechanism of action within the body and cells. Our number one priority is to keep you safe. If you are experiencing WORSENING pain after your injection, please call our office and speak to our nursing staff to determine if you should be evaluated in clinic and discuss the next course of action. If it is outside our clinic hours, unfortunately the best action at that point is to be seen in the Emergency Department for evaluation.