Depending on how severe your back or neck pain is and how it hasn’t improved with conservative measures, your doctor may recommend a spinal injection.
There are two ways to administer spinal injections.
- Typically, they are performed to diagnose the source of back, leg, neck, or arm pain (diagnostic).
- Pain can be relieved by using them (therapeutic).
It is common practice to perform spinal injections in the course of a more comprehensive treatment program. Exercises are almost always included in simultaneous treatment programs to improve or maintain spinal mobility (stretching exercises) and stability (strengthening exercises).
What Are Spinal Injections?
Injecting spinal fluid directly into the bone mass of the spine is called a spinal injection. Spinal injections can take many forms, but each shares a few common characteristics. The first is that all are performed with x-ray guidance. Fluoroscopy is the term used for this procedure.
A simple procedure involves hooking up to an IV while lying on an x-ray table. Images are then generated from the scanner of the part of the spine being scanned. Secondly, each procedure begins with a liquid contrast to determine where the incision will be made. Besides double-checking the flow pattern inside the body, this does not contain any medication. It is injected when the flow pattern has been verified.
How Injections Relieve Pain
As injections deliver medications directly to the anatomic location that generates pain, they may provide more relief than oral medications for neck or back pain.
Depending on the type of injection, neck and back pain can be treated:
- Reduce inflammation and numb the area of pain by injecting a steroid or other pain-relieving medication into it.
- Heat a nerve causing pain to stop it from sending pain signals to the brain (radiofrequency ablation).
An injection may also help determine the anatomic structure of the spine that may be causing the pain, such as a herniated disc or a compressed nerve.
Types of Spinal Injections
A corticosteroid injection may be prescribed if you have neck pain caused by a herniated disc or pinched nerve. In the vast majority of cases, doctors recommend injections only after more conservative treatments have failed.
It is well known that steroids are powerful anti-inflammatory agents. In a procedure called a nerve block, they are injected directly into the space that surrounds the spinal cord in the spinal canal. In epidural injections, they are injected into the fluid-filled space outside the spinal canal around the spinal cord.
Under local anesthesia, doctors administer these injections, and our pain management specialists and radiologists observe the injection sites to ensure steroids are injected where they should be. It typically takes less than 30 minutes to administer these injections.
From a week to more than a year, injected steroids can provide pain relief. Some people, however, do not benefit from injections. There is, unfortunately, no way to predict whether an injection will work or not. Steroids are beneficial for some people.
When you use steroids before you begin physical therapy, you will be able to begin strength-building exercises without feeling any pain. Surgery may be necessary if steroid injections do not relieve pain.
Epidural Steroid Injections
Steroid injections into the epidural space surround the nerve roots and spinal cord and allow doctors to inject medicine directly into the spinal canal. Patients with pinched nerves or cervical spinal stenosis can benefit from them. Combining corticosteroids and a local anesthetic reduces inflammation and relieves pain in the spinal canal. The needle is guided by live video X-rays at NYU Langone to the correct location in the spine by pain management experts.
Pain typically subsides within 48 to 72 hours after these injections, but it may take up to a week for them to completely work. The relief may last for weeks or months, although some people may not benefit from epidural injections. Epidural injections cannot be predicted with any accuracy.
An epidural injection is performed under local anesthesia. The procedure takes approximately 30 minutes. Aside from soreness at the injection site, most people experience few side effects and can return to their normal routines the following day.
Facet Joint Injections
Along the spine, facets connect spinal bones, called vertebrae. Facets allow flexibility and movement in the spine. During osteoarthritis of the spine, for instance, any of these joints can become inflamed and thickened, encroaching into the neural foramen and pressing painfully against nearby nerve roots.
Injections of local anesthesia and corticosteroids are administered directly to the joint affected by a facet joint injection, also known as a facet block. In addition to providing temporary pain relief, anesthesia and corticosteroids reduce inflammation in the joint and nerve roots that are affected.
The injection is guided to the facet joints through the use of a special X-ray device called a fluoroscope, which provides live images of the spine and joints. A 15 to 30-minute procedure is required. It is common for people not to experience side effects, to reach work the next day, and to continue their normal lives.
Sacroiliac Joint Injection
An injection into the SI joint is similar to injection into the facet joint in many ways. These joints connect the sacrum to the ilium (pelvic bone).
In the past, SI joint problems have been associated with lower back, buttock, and leg pain. The pain usually occurs on one side of the lower body due to one joint. When both SI joints are experiencing pain at the same time, it is less common.
Both diagnostic and therapeutic injections can be performed on this joint.
- It is the gold standard for diagnosing SI joint pain to anesthetize the SI joint by injection under X-ray guidance. If the sacroiliac joint is injected with an anesthetic, it should significantly reduce the amount of pain in a particular area of the low back, buttock, or upper leg.
- To provide long-lasting pain relief, therapeutic injections usually contain steroid medications.
Trigger Point Injection
Trigger point injections are another type of injection. Fibromyalgia, tension headache, and myofascial pain syndrome are among the conditions treated with trigger point injections.
Trigger point injections work similarly to epidural and facet joint injections, which combine a local anesthetic and, typically, an anti-inflammatory (like a steroid) into the problem area. Generally, trigger point injections don’t require X-ray guidance.
Physical therapists can also perform dry needling, in which a needle without medication is inserted into the trigger point.
Injection for the diagnosis of pain is called a provocation diskography. There is no pain relief associated with this procedure. In this process, a person’s exact or typical pain is reproduced with the intent of identifying the source or origin of longstanding back pain that hasn’t improved with comprehensive, conservative treatment. Back pain caused by this type of injection may be severely exacerbated.
In contrast to the other injections discussed above, discography is much less common. In many cases, it is used only in conjunction with surgical treatment of low back pain. Diskography can provide information to help with surgical planning.
- In diskography, a liquid is injected into the jelly-like center (nucleus pulposus) of an intervertebral disk to stimulate and pressurize it.
- Several disks are injected to differentiate symptomatic disks from those without any symptoms.
- In addition to the type and location of the pain, provocation discography determines the existence of a painful disk based on the appearance of the disk after the procedure on X-rays and computed tomography scans.
When not go for Spinal Injections
You should consult with your doctor before deciding whether to get a spine injection. Based on your medical conditions, preferences, and other factors, your provider can explain the risks and benefits of the procedure.
Only a few conditions disqualify a candidate. They include:
- Inflammation, cancer, or trauma-induced new-onset pain
- Symptoms of progressive neurological deficits resulting from spinal cord compression or entrapment of the cauda equina (a bundle of nerves in the low back)
Those whose benefits may be outweighed by risks include those who:
- Uncontrolled diabetes
- A severe bleeding disorder
- Have immunosuppression
It is also possible to be disqualified if you have a recent infection or severe allergy to a medication found in the injection. To avoid exposure to radiation after delivery, pregnant women may opt to undergo spinal injections.
It is generally safe to inject spinal fluid into the spine. Any complications are usually minor and self-limiting. Here are some risks associated with spinal injections:
- Nerve injury
- Inflammation of the arachnoid membrane, which surrounds the spinal cord nerves, causes Arachnoiditis (pain disorder).
- The cause of avascular necrosis is a temporary or permanent loss of blood supply to bone tissue. This is rare in the spine.
- Spinal headache
- Muscle weakness
- Increased pain
Common side effects from steroids include:
- Facial flushing
- Increased appetite
- Menstrual irregularities
- Temporary increase in blood sugar