Spinal injections are performed as a treatment, to reduce pain and inflammation within the spine, as a well as a diagnostic tool to confirm a suspected cause of the symptoms, thus allowing appropriate planning of further treatment.
Injections can be used to treat pain within the arms or legs due to nerve root compression, or pain within the neck or back, which may be arising from either the degenerative facet joints or the degenerative intervertebral discs. (See Back Pain).
The procedures involve the injection of local anaesthetic and steroid into the area of the spine, which is causing the problem. The local anaesthetic gives immediate, but short lasting pain relief from half to several hours. The steroid is an anti-inflammatory drug which reduces swelling and which may take several days to have its full effect.
How are these performed?
Ideally these should be performed by your treating surgeon as they provide information important to the future care of your spinal problem. The procedures are performed within an operating theatre using local anaesthetic for pain relief and an X-ray machine (Image Intensifier (IT)) is used to ensure the correct placement of the needle within the spine. The injection may also require the use f a special dye, which is visible on the IT.
The type of injection performed depends upon the predominant symptom which needs to be treated.
Injections
Nerve Root Sleeve Injections (NRSI)
NRSI means an injection around a nerve root and is used both therapeutically and diagnostically. They may also be called Nerve Root Blocks.
Therapeutically, to relieve leg or arm pain which is produced by pressure on a nerve root, usually caused by a disc prolapse, but may be due to bone compressing the nerve or other rare causes.
Diagnostically to help determine which area within the spine is the cause of the problem. This can be extremely useful when surgery is being planned.
Caudal Epidural
The epidural space surrounds the spinal nerves but still within the central spinal canal. The needle is placed within this space and is similar to a NRSI, but treats several nerves. This is beneficial if several areas are affected, but does not have the same diagnostic ability as a NRSI.
Facet Joint Injections
The facet joints are positioned at the back of the spine in pairs, connecting two adjacent vertebrae. They move when the spine and the intervertebral disc moves. They may become degenerate or arthritic, which may then become a source of back pain. Facet joint injections are used diagnostically to determine if they are the source of pain and therapeutically to reduce the inflammation.
Complications
Complications are very rare, but as the needle is near the nerves, spinal cord and arteries complications include infection bleeding, nerve damage, paralysis and leakage of the Cerebrospinal fluid, which surrounds the nerves.