Lumbar / Spine Injections
Injections into the spine are often used as part of a comprehensive treatment regimen to relieve back pain. Spinal injections are nearly always accompanied by physical therapy designed to improve or maintain spinal mobility and stability via stretching exercises. Types of spinal injections that are used to treat pain and inflammation include epidural, facet joint, and sacroiliac joint injections. Another type of spinal injection only serves to help diagnose the location of the pain by provocation. It is called provocation discography.
Epidural injections are used to treat pain that is running down an arm or leg from an inflamed or compressed nerve (pinched nerve). It usually involves a combination of an anesthetic and an anti-inflammatory medication, such as a steroid (cortisone) to reduce the inflammation and lessen or resolve the pain. Facet joint injections can be performed in any section of the spine and are used for both diagnostic and therapeutic purposes. Facet joint injections work by first injecting an anesthetic to locate the pain and then once located, a longer acting pain reliever such as a steroid, is injected. Sacroiliac joint (SI joint) injections are similar to facet joint injections but they are performed in the joints that are in the pelvis. Provocation diskography does not have any pain relieving effect and in fact, it is designed to try to reproduce a person’s exact or typical pain. This is often used when back pain does not improve with comprehensive, conservative treatment. Diskography is often used only if surgical treatment of lower back pain is being considered. Information gained from diskography can assist greatly in planning the surgery.
Spinal injections use a special form of x-ray guidance called fluoroscopy to accurately place the injection in the appropriate location. Sometimes once a nerve is identified and anesthesia effectively relieves the pain, the next step in therapy may be to block the pain signals more permanently. This can be done with radiofrequency ablation or damaging the nerves that supply the joint with a “burning” technique.
The actual procedure is usually brief and sedation may or may not be needed. Side effects of spinal injections may occur but often resolve quickly in a few days. These include but are not limited to a brief increase in pain, headaches, trouble sleeping, facial flushing, and hiccups. It often takes a few days, and sometime a week or longer, for the steroid medicine to reduce inflammation and pain. A follow up visit is often scheduled within 1-3 weeks of the procedure.