Back pain 2

Specialist Orthopaedic Doctors

Back pain 1

Back Pain Injections

Back pain 6

Fluoroscopically Guided Digital X-Ray Injections

Back pain 4

Spinal Manipulation

Back pain 3

Exercise & Rehabilitation Programmes for the Young...

Back pain 5

...and the Not So Young

Spinal Injections

What Treatments Are Available? What is a Spinal Injection?
Your doctor has suggested that you have a spinal injection to help reduce pain and improve function. This procedure can help relieve pain by reducing inflammation (swelling and irritation). An injection can also help your doctor to identify the source of your pain, by numbing certain areas of your back. Some injections can even strengthen ligaments in the back. The type of injection you receive is based on your specific symptoms and the results of your physical examination.

Anatomy of Your Spine

  • Vertebrae are block shaped bones that form your spinal column.
  • Discs are spongy shock absorbers between each of the block shaped vertebrae. A herniated disc or a disc with 'wear and tear' may cause inflammation and pain.
  • Facet joints are small joints in the back of the spine that guide the bending motions of each vertebra. These joints can become irritated or inflamed and cause pain.
  • Spinal nerves are branches from the spinal cord exiting the spinal column. They transmit signals that control the movement of your muscles and provide sensation in your arms and legs. These nerves can also become irritated or inflamed and cause pain.
  • The epidural space is the space around the sheath (dura) covering the spinal nerves. Placing anti-inflammatory medicine in the epidural space can help to reduce spinal nerve inflammation.
  • Sacroiliac joints (SI joints) are found between your lower spine (sacrum) and pelvic bone (ilium). Inflammation in these joints can cause low back, buttock and other pain.

Preparing for Your Injection
A spinal injection is an outpatient or daycase procedure. Before your injection, you will be asked questions about your general health. You will also be given instructions on how to prepare for the procedure:

  • Provide a list of the medicines you take, including blood thinners, aspirin, anti-inflammatory medicines such as ibuprofen, and over-the-counter and herbal medicines and supplements. You may need to stop taking some of these before the procedure - please ask your healthcare provider. Generally, you should continue to take medicines necessary to your health such as blood pressure or thyroid medicines. It is safe to take products containing paracetamol.
  • Provide a list of any allergies you may have to medicines, latex or contrast dye.
  • It is a good idea to arrive at your appointment with some of your usual pain present. This will make it easier to tell if the injection blocked your pain. This is why spinal injections are sometimes called 'blocks'.
  • You may be asked to have someone available to drive you home after the procedure.
  • It may be necessary not to eat or drink for 4 hours before the procedure - check with the doctor. If you are taking medicine for diabetes, tell your doctor. Your medicine may have to be adjusted both before and after the injection.
  • Bring any X-ray films and CT or MRI scans with you on the day of the procedure.
  • If your health changes - if there is the possibility that you have a cold, flu or other illness - it is important that you tell the doctor or nurse. He or she may want to reschedule the procedure.

If you need to cancel your procedure, please notify your doctor as soon as you know.

Checking In
You should arrive a little early to fill out any necessary paperwork before the procedure. Have your insurance documents with you. For your benefit and safety, current medical information may be requested again. It is important to alert your doctor if you are experiencing any new or recent medical problems. Your doctor may decide to give you a brief physical exam.

Risks and Complications
All medical interventions have risks and benefits. Spinal injections have certain risks and complications that may include:

  • Spinal headache (rare)
  • Bleeding (rare)
  • Infection (rare)
  • Allergy to the medicines (rare)

These are treated quickly and rarely result in long term problems.

During the Procedure

  • The procedure is usually brief, but your position during the procedure is important to make the injection go smoothly, with the least discomfort to you. You may have monitoring devices attached to you during the procedure to check your heart rate and blood pressure.
  • Your skin will be cleaned with a sterilising solution and a sterile drape will be placed over your skin.
  • Conscious sedation (use of a calming drug while you are awake) may be used through an intravenous line if your doctor feels it is appropriate.
  • Local anaesthetic (lidocaine) is usually given near the injection site to numb the skin. This typically feels like a pin prick.
  • Fluoroscopy (X-ray imaging) is often used for precise placement of the injection. Contrast dye may be injected to confirm the correct placement of the needle.
  • A local anaesthetic for numbing (eg, lidocaine, bupivicaine) and/or a steroid (i.e cortisone to reduce inflammation) is injected.
  • A small bandage may be placed at the injection site.
  • After some injections, you may spend time in a recovery area.
  • You may be monitored to make sure you are doing well and your vital signs may be checked.
  • You may be asked to fill out paperwork before leaving.
  • You will normally be advised to have someone drive you home.
  • You may put ice packs on the injection site for 10-20 minutes at a time if there is soreness. Avoid burning your skin with the ice by placing a towel between the ice and your skin.
  • You may take a shower but avoid baths, pools or whirlpools for 24-48 hours following the procedure.
  • You may be asked to relax on the day of injection, but usually can resume normal daily activities the day after the injection.
  • You can usually start or resume your individualised exercise programme or physical therapy programme within 1 week of your injection.
  • Side effects, which may occur but will go away within a few days, include:
    - Briefly increased pain
    - Headaches
    - Trouble sleeping
    - Facial flushing
    - Menstrual disturbance
  • It takes a few days, even a week or longer, for the steroid medicine to reduce inflammation and pain.
  • Your doctor may want to follow-up with you in 1-3 weeks.

If you had sedation, you should not drive for 24 hours after the procedure.