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Spinal injections

Overview

Injection of cortisone and a local anaesthetic is a useful modality to reduce chronic back and neck pain and for the treatment of pain radiating down the legs (sciatica) resulting from nerve root compression. In addition to providing pain relief, the procedure can also pin-point where the pain is originating from (diagnostic block) when there is a doubt.

There are two varieties of spinal injections that we provide

  • Facet injection
  • Nerve root injection
  • Facet injection - Facet joints located behind the spine allow the spine to move and can develop arthritis like the hip and knee joints. Facet arthritis can cause back pain, buttock pain and pain radiating down the back to the thighs upto the knees. An injection of cortisone and local anaesthetic into the joints under xray guidance can help reduce the pain and inflammation arising from these joints. Occasionally a series of 2-3 injections are needed to provide adequate pain relief.

b) Nerve root injection - Compression of the nerves in the spine from a disc herniation can cause pain radiating down the leg - sciatica. The pain is continuous or intermittent and usually aggravated by activity and results from nerve root inflammation due to contact with the herniated disc. An injection of cortisone and local anaesthetic around the nerve root can help in reducing the inflammation and the pain.

Steps of the procedure

  • The injection is performed in the operation theatre with the patient lying on his/her tummy. The injection is given in the operation theatre so that xray guidance (fluoroscopy) can be utilized to allow accurate positioning of the needle. The patient is awake during the whole procedure.
  • The area to be injected (lower back or neck) is cleaned with an antiseptic solution. An injection of local anaesthetic (Lignocaine-2%) is given to numb the skin and reduce the pain during the injection.
  • Needles are inserted into the facet joint (facet joint injection) or close to the nerve root (nerve root block) and the position is confirmed using an xray machine (fluoroscope). A combination of a steroid and a long acting anaesthetic (0.5% Bupivacaine) is injection into the area
  • The needle is removed and a small patch of adhesive plaster is applied to the skin.The adhensive plaster can be removed after 6-8 hours.

The Success rates and the outcomes

  • Facet injection - The success rate following facet injections in the spine are variable. While some patients get significant relief of the back/neck pain, others are not benefitted at all. The overall success rate of a course of facet injections is approximately 50-60 %. Although this may seem like a low rate, it is a less invasive option than surgery and is relatively safe. In addition, facet injections can be a diagnostic modality to pin-point the region/joint that is producing the pain.
  • Nerve root injection - The nerve root injections can provide pain relief in around 80% of patients and may help avoid disc surgery. In some patients, one injection may be all that is needed whereas others may need a second injection.

Your pathway to recovery

The procedure can be mildly uncomfortable. Following the injection, the patient is moved back to recovery/waiting area and can go home after 15-30 minutes.

Complications

A common side effect from a spinal injection is a transient increase in pain at the injection site for the first 1-3 days. This can be reduced by taking simple pain medications and applying ice wrapped in a towel over the area for 15 minutes every 3-4 hours. Other possible minor and transient side effects include post- injection muscle soreness, light-headedness, fainting, headache, nausea, vomiting and an increase in blood sugar and blood pressure.

Major complications are rare and include infection, severe allergic reactions, anaphylaxis, excessive bleeding, permanent nerve damage, permanent increased pain, dural puncture, seizure, stroke and cardiovascular collapse.

You should contact you doctor if you have the following symptoms after a spinal injection:

  • temperature above 38 degrees that is not improving;
  • loss of bowel and bladder control or retention of urine;
  • severe worsening pain;
  • loss or worsening motor power (strength) in the limbs; or
  • headache in the standing or sitting position that is relieved by lying down