Comprehensive Guide to Spinal Injections for Pain Relief

Understanding Spinal Injections for Pain Relief and Diagnosis

For back and neck pain that is not responding to conservative treatments, a spinal injection can serve two purposes: diagnostic and therapeutic. In other words, spinal injections can be used to diagnose the source of pain, alleviate that pain or both. Spinal injections are generally part of a comprehensive treatment plan that also involves strengthening and mobility exercises. Because they can deliver medication directly to the source of pain, spinal injections can provide targeted relief. They are also highly useful in identifying the source of discomfort when other tests have proved inconclusive. An injection in the spine for nerve pain can reduce inflammation and swelling, which in turn decreases pressure on the nerves. This helps alleviate pain, improve mobility, and enhance a person’s quality of life, particularly for those who suffer from acute sciatica or more severe spinal conditions. Furthermore, research has shown that reducing the inflammation around an acute disc protrusion is how the body naturally deals with this condition. Spinal injections are generally considered a minimally invasive treatment option, making them a viable choice for patients who wish to avoid surgery or for whom other treatments, such as physical therapy or medication, have proven ineffective.

Conditions Treated by Spinal Injections

Spinal injections are highly versatile and can be used to treat a range of conditions affecting the spine. These conditions often cause significant discomfort and disability, making pain management crucial for improving the patient’s daily life. Some of the most common conditions treated with spinal injections include:

• Herniated cervical (neck) discs
• Spinal Stenosis
• Degenerative Disc Disease
• Sciatica (caused by lumbar disc protrusion)
• Facet Joint Arthritis
• Chronic back or neck pain

Overview of Types of Spinal Injections

Just as there are many different conditions treated by injections, there are also different types of spinal injections for back pain.

• Epidural Steroid Injections are still common types of spinal injections. To treat inflammation and pain, particularly pain that radiates from the spine to the limbs, these injections target the epidural space and affected nerve root. This is the area surrounding the spinal cord and nerves, and an epidural steroid injection can reduce inflammation caused by conditions like herniated discs, sciatica, and spinal arthritis. There are three different types of epidural for back pain: caudal, interlaminar, and transforaminal. Caudal injections are administered into the lowest part of the epidural space, typically for widespread pain, but only reaching the lumbosacral junction in most cases. Interlaminar injections administer anaesthetic and steroid medications between the laminae (back of the spine) of two vertebrae, like an epidural delivered for anaesthesia in childbirth. These are considered less effective in modern private practice and tend to be delivered by practitioners unable to deliver image guided techniques.
• Transforaminal epidural steroid injections are injected into the space where the nerves from the spine move towards the body where the nerve root cell control box is located (dorsal root ganglion), and this works well giving long term or permanent pain relief, specifically targeting certain nerve roots that are causing pain. This is a very successful image guided procedure with 70% of patients getting permanent or long-term benefit.
• Facet Joint Injections target the small joints between each vertebra in the spine. The facet joints allow the spine to bend and twist, but they can become inflamed or arthritic, leading to pain in the neck or back. A facet joint injection can reduce inflammation and provide pain relief and is commonly used to treat acute pain in conditions like spondylolisthesis, adult degenerative scoliosis (curvature of the spine), facet osteoarthritis, whiplash, and sports related injuries. They can also help with facet pain caused by mechanical stress such as in amateur or professional golfers, where physiotherapy and chiropractic treatment are no longer working.
• Nerve Root Injections (SNRB selective nerve root blocks) are used to diagnose and treat pain caused by irritation or compression of a specific spinal nerve. These injections are used to identify the source of the pain being experienced, as well as to alleviate pain. A steroid medication or local anaesthetic is injected at a specific nerve root, and if the pain subsides, the source of the pain has been identified. If the pain is not diminished, the doctor may try another injection, into another specific nerve root, to try and diagnose the source of the pain. These are delivered outside the spinal canal and can be limited in their long-term therapeutic effect, unlike foraminal epidurals.
• Sacroiliac Joint Injections are administered between the sacrum and pelvic bones. That is where the sacroiliac joints are located, and these are the joints that help transfer weight from the legs and upper body. When they become inflamed, they can cause pain in the lower back, buttocks, groin, or legs mimicking sciatica. Conditions like ankylosing spondylitis, Sacro-iliac dysfunction, osteoarthritis, post-partum pain following childbirth, and injury can all be addressed successfully using sacroiliac joint injections.
• Medial Branch Block Injections also involve the facet joints in the spine. The medial branch nerves, which transmit pain signals to the brain from the facet joints. Like nerve root injections, medial branch blocks are primarily used to diagnose pain and sometimes longer-term benefit is obtained. These injections can be used to treat chronic back or neck pain from conditions like facet arthritis or injury, or importantly, to determine whether further treatment, like radiofrequency ablation, should be considered.

Risks and Benefits of Spinal Injections

Spinal injections offer several benefits, particularly for patients seeking non-surgical treatment options for their back or neck pain:

• Targeted Pain Relief: By delivering medication directly to the source of the pain, spinal injections provide more precise relief than oral medications.
• Reduction in Inflammation: Corticosteroids reduce inflammation around the spine and nerves, helping to relieve pressure and improve mobility.
• Minimally Invasive: Spinal injections are minimally invasive, making them a suitable option for patients who want to avoid surgery or those who are not good candidates for surgical interventions.
• Improved Quality of Life: By reducing pain and improving function, spinal injections can enhance a patient’s ability to perform daily activities and reduce reliance on pain medication.
• Diagnostic Tool: Spinal injections can also help confirm the source of pain, guiding further treatment decisions.

They are generally considered safe, but as with any medical procedure, spinal injections do come with some risks. It is important to note that research indicates that the risk of complications from spinal injections is exceptionally low.

• Infection: As with any injection, there is a risk of infection at the injection site or very rarely in the spinal canal.
• Low Blood Pressure: In some patients, a sudden drop in blood pressure can occur after a spinal injection, sometimes resulting in fainting.
• Bleeding: Patients with bleeding disorders or those taking blood-thinning medication may be at higher risk of bleeding complications.
• Nerve Injury: In rare cases, the needle may cause injury to the surrounding nerves, leading to increased pain or numbness. This is more common in injections performed under sedation but still rare.
• Allergic Reaction: Some patients may have an allergic reaction to the admixant in the steroid solution used in the injection. This is rare but can cause an annoying itchy rash on the trunk of the body.
• Temporary Increase in Pain: Some patients experience a temporary increase in pain immediately or a few days after the injection, though this usually subsides within a week. This is called a steroid flare and is no cause for concern.
• Temporary numbness or weakness of the leg: This is a side effect of the local anaesthetic used in the procedure and is no cause for concern. Any “dead leg” sensation should pass within a couple of hours.
• Elevated Blood Sugar: For diabetics, spinal injections can result in a temporary rise in glucose levels.

Considerations Before Injection

Of course, before undergoing a spinal injection or any other medical procedure, patients should discuss their medical history with their healthcare provider. In the case of spinal injections, this information will include any medications they are taking, allergies, or previous reactions to injections. Imaging studies, such as X-rays or MRIs, will be necessary to identify the source of the pain and determine the most appropriate type of injection. Your healthcare provider will work with you to customize a treatment plan that addresses your unique needs and works to alleviate your symptoms. It may be necessary to temporarily stop taking certain medications in the days leading up to your injection. Medications like blood thinners can increase the risk of bleeding. On the day of your appointment, you will need someone to accompany you, as you will not be able to drive yourself home.

Consult the Team at Spine Art for Advice on Spinal Injections

If you are looking for pain relief without surgery, Spine Art can help. A clinical network formed by consultant spinal surgeon, Dan Fagan, Spine Art aims to provide the best care possible for patients, offering minimally invasive solutions to alleviate pain. Committed to offering comprehensive, patient-centred care, we will work to help you regain your well-being and begin your journey to a pain-free life. Using the most modern techniques and providing a comfortable environment for our patients, we help facilitate a rapid return to normal life. To learn more about how the team at Spine Art can help you, book a consultation or contact us through our website.