Spinal Injections

For patients experiencing severe back or neck pain that hasn’t improved with conservative treatments, spinal injections may offer significant relief.

Purpose of Spinal Injections

Spinal injections serve two main functions:

• Diagnostic: Identifying the source of pain in the back, legs, neck, or arms.
• Therapeutic: Alleviating pain and managing symptoms.

These injections are often part of a comprehensive treatment plan that includes exercise to enhance spinal mobility and stability.

How the Procedure Works

Spinal injections are conducted under X-ray guidance (fluoroscopy) to ensure precise medication placement:

1. A contrast dye is first injected to confirm the proper location.
2. If the dye does not flow as expected, the needle is repositioned until the correct flow is achieved.
3. The medication is injected only after confirming accurate dye flow.

Understanding Spine Anatomy

The spine is divided into three segments, forming natural curves when viewed from the side.

Types of Spinal Injections

1. Epidural Injection

• Use: Treats pain that radiates from the spine to the arms or legs, often due to nerve inflammation or compression.
• Procedure: An anesthetic and/or anti-inflammatory medication is injected near the affected nerve. Diagnostic injections help pinpoint the pain source.

2. Facet Joint Injection

• Use: Addresses pain from degenerative conditions or injuries affecting the small joints between vertebrae.
• Procedure: An anesthetic and possibly a steroid are injected into or around the facet joints. Radiofrequency ablation may be used for more lasting pain relief.

3. Sacroiliac Joint Injection

• Use: Targets pain in the lower back, buttocks, or legs caused by the sacroiliac joint.
• Procedure: Diagnostic injections with anesthetic confirm pain origin, while therapeutic injections may include steroids for extended relief.

4. Trigger Point Injection

• Use: Treats conditions such as fibromyalgia, tension headaches, and myofascial pain syndrome.
• Procedure: Involves injecting a local anesthetic and often a steroid into specific areas, typically without X-ray guidance. Dry needling is another technique used in physical therapy.

5. Provocation Discography

• Use: Diagnoses the source of chronic back pain by reproducing symptoms through injections into the intervertebral disks.
• Procedure: Liquid is injected into the disk’s center to identify painful disks. This method is less frequently used and is generally considered when surgical options are being evaluated.

Potential Risks and Complications

While spinal injections are generally safe, potential risks include:

• Bleeding
• Infection
• Nerve injury
• Arachnoiditis
• Paralysis (rare)
• Spinal headache
• Muscle weakness
• Increased pain

Steroid injections may cause side effects such as facial flushing, increased appetite, menstrual irregularities, nausea, diarrhea, and temporary increases in blood sugar.

Who Should Avoid Spinal Injections

Spinal injections may not be suitable for individuals with:

• Skin infections at the injection site
• Bleeding disorders or those on anticoagulants
• Uncontrolled high blood pressure or diabetes
• Allergies to contrast dye, anesthetics, or steroids