Understanding Spinal Injections: Uses, Benefits, and Risks

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Spinal Injections

What Are Spinal Injections?

Spinal injections are recommended when back or neck problems are severe and do not respond to conservative treatments. They serve two primary purposes:

  1. Diagnostic: To identify the source of pain in the back, neck, arms, or legs.
  2. Therapeutic: To relieve pain and improve function.

Spinal injections are often part of a broader treatment plan, typically combined with exercises designed to enhance spinal mobility through stretching and stability through strengthening.

The Procedure

Spinal injections are performed under X-ray guidance, known as fluoroscopy, to ensure precise placement of the medication and to enhance safety. The process includes:

  1. Injecting Contrast Dye: A liquid contrast dye is used to confirm correct needle placement.
  2. Adjusting as Needed: If the dye does not flow to the intended area, the needle is repositioned, and additional dye is injected until proper placement is achieved.
  3. Administering the Medication: Once the correct flow pattern is confirmed, the therapeutic medication is injected.

This careful approach minimizes risks and ensures the effectiveness of the procedure.

Spinal injections are most beneficial when integrated with other treatments, providing relief and supporting long-term recovery.

Your spine is made up of three segments. When viewed from the side, these segments form three natural curves. 

ypes of Spinal Injections

Epidural Injections

Epidural injections are commonly used to address pain that originates in the spine and radiates to an arm or leg, often caused by an inflamed or compressed nerve (pinched nerve). These injections may serve both therapeutic and diagnostic purposes.

Therapeutic Epidural Injections

  • These injections deliver an anesthetic and/or an anti-inflammatory medication, such as a steroid (cortisone), near the affected nerve.
  • The medication is administered into the epidural space, located just outside the membrane that protects the spinal cord.
  • The goal is to reduce inflammation, alleviate nerve irritation, and lessen or resolve the pain.

Diagnostic Epidural Injections

  • These are performed to pinpoint the exact nerve causing pain.
  • A small amount of anesthetic is injected into a specific, isolated nerve.
  • Response Monitoring:
    • If the pain is significantly reduced, the targeted nerve is confirmed as the primary source of pain.
    • If little to no pain relief occurs, the source of pain likely lies elsewhere.

Epidural injections play a vital role in both identifying the source of discomfort and providing effective pain relief, making them a valuable tool in spinal care.

Facet joint injection in the lumbar spine.

Facet and Sacroiliac Joint Injections

Facet Joint Injections

Facet joint injections are used for both diagnostic and therapeutic purposes. These injections target the small joints between vertebrae located on the back of the spine.

When Are Facet Joint Injections Used?
Facet joint injections are effective for treating pain caused by:

  • Degenerative or arthritic conditions.
  • Injuries affecting the neck, middle back, or lower back.

Pain from these conditions can radiate beyond the spine, affecting areas such as the shoulders, buttocks, or upper legs.

Diagnostic Facet Joint Injections
Facet joints can be assessed using two me

  1. Direct Joint Injection: A
  2. Nerve Anesthetization: The medial branch nerves, which carry pain signals away from the joint, are anesthetized.
  • If pain relief is significant after the anesthetic injection, a therapeutic steroid injection may offer long-term relief.
  • If the nerve is identified as the source of pain, a procedure called radiofrequency ablation may be performed. This technique involves using heat to damage the sensory nerve, blocking pain signals. The nerve typically regenerates, so the relief usually lasts for several months.

Sacroiliac (SI) Joint Injections

SI joint injections are similar to facet joint injections but focus on the joints between the sacrum and ilium bones in the pelvis.

When Are SI Joint Injections Used?
Problems in the SI joints often cause pain in the:

  • Lower back.
  • Buttocks.
  • Legs (typically on one side).

Both diagnostic and therapeutic injections are used for SI joint pain:

  1. Diagnostic Injections: Performed under X-ray guidance, these injections deliver anesthetic into the joint to confirm it as the source of pain.
  2. Therapeutic Injections: These include steroids to reduce inflammation and provide longer-lasting pain relief.

Facet and SI joint injections are valuable tools in diagnosing and managing joint-related pain, offering targeted relief and improving function for patients.

Sacroiliac joint injection in the pelvis.

Trigger Point and Provocation Discography Injections

Trigger Point Injections

Trigger point injections are used to treat localized muscle pain caused by conditions such as:

  • Fibromyalgia
  • Tension headaches
  • Myofascial pain syndrome

How Do Trigger Point Injections Work?

  • A combination of a local anesthetic and often an anti-inflammatory (such as a steroid) is injected directly into the problem area.
  • Unlike other spinal injections, trigger point injections are typically performed without X-ray guidance.

Dry Needling as an Alternative

  • Dry needling is a similar technique where a needle, without medication, is inserted into the trigger point.
  • It is often performed in a physical therapy setting to relieve muscle tension and pain.

Provocation Discography

Provocation discography, also known as a discogram, is a diagnostic-only injection designed to identify the source of chronic back pain that has not improved with conservative treatments. Unlike other spinal injections, this procedure does not relieve pain; instead, it intentionally reproduces the patient’s typical pain to locate the problematic intervertebral disk.

When is Discography Used?

  • It is rarely performed and is primarily considered when surgical treatment for lower back pain is being planned.
  • The procedure helps surgeons determine which disk(s) require intervention.

How is Discography Performed?

  • A liquid is injected into the nucleus pulposus (the jelly-like center) of an intervertebral disk to stimulate and pressurize it.
  • Multiple disks may be injected to differentiate a problematic disk from healthy ones.
  • Diagnostic criteria include the reproduction of pain during the procedure and the disk’s appearance on X-ray or CT imaging after the injection.

Trigger point injections offer relief for muscle-related pain, while provocation discography provides valuable diagnostic insights for patients considering surgical options for chronic back pain. Both techniques play essential roles in managing complex pain conditions.

Complications of Spinal Injections

Safety of Spinal Injections

Spinal injections are generally safe procedures, and complications, when they occur, are typically mild and self-limiting. However, as with any medical procedure, there are risks to consider.

Potential Risks of Spinal Injections

  • Bleeding
  • Infection
  • Nerve Injury
  • Arachnoiditis: Inflammation of the arachnoid membrane surrounding the spinal nerves, leading to chronic pain.
  • Paralysis: Extremely rare.
  • Avascular Necrosis: Death of bone tissue due to interrupted blood supply; very uncommon in the spine.
  • Spinal Headache: Caused by a leak of spinal fluid after the procedure.
  • Muscle Weakness
  • Increased Pain

Common Side Effects of Steroids

Spinal injections involving steroids may cause temporary side effects, including:

  • Facial flushing.
  • Increased appetite.
  • Menstrual irregularities.
  • Nausea or diarrhea.
  • Temporary increases in blood sugar levels.

Who Should Avoid Spinal Injections?

Some individuals are not ideal candidates for spinal injections, including those with:

  • Skin Infections: At or near the injection site.
  • Bleeding Disorders: Or those taking anticoagulant medications.
  • Uncontrolled Conditions: Such as high blood pressure or diabetes.
  • Allergies: To contrast dye, anesthetics, or steroids.

Understanding the potential complications and side effects can help patients make informed decisions about spinal injections. A thorough evaluation by a healthcare provider ensures that the procedure is safe and appropriate for each individual.

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