Injections

A spinal injection is a procedure in which your doctor injects medicine into a specific area of your spine to either diagnose the source of your back pain or to reduce swelling and relieve your pain.

The types of injection you will have depends on your symptoms, the location of your pain, and your treatment goals. Here are some of the most common types:

• Epidural [eh-PEE-doo-RUHL] steroid injections (cortisone) target nearby specific nerves and are given directly into the epidural space (the area that surrounds the nerves within the spinal canal). These injections can treat pain in a large region of the body. Steroid medicine is injected into the epidural space between 2 vertebrae or near a nerve. The medicine moves up and down the spinal canal to coat the nerve roots near the injection area.
• Facet joint injections and nerve blocks are injections made in or near the facet joints that connect each vertebra [VUR-tuh-bruh]. Facet joint injections are given where 2 vertebrae join together. These joints allow the spine to bend and twist. Facet joint injections can decrease inflammation caused by arthritis and joint degeneration.

  Before a facet joint injection, you may be given a diagnostic injection called a medial branch block near a nerve leading from the facet joint. This helps determine if a facet joint injection might relieve your pain. Your doctor may also recommend a radiofrequency neurotomy [noo-ROT-uh-MEE], which disables a spinal nerve so it can no longer send pain signals.

• Sacroiliac [sah-KRO-ill-EE-ak] (or SI) joint injections are given into the SI joint, located between the sacrum (at the base of the spine) and pelvic bones. The doctor injects an anti-inflammatory medicine directly into the joint that can reduce pain and inflammation in your lower back, buttocks, groin, and leg.

• A low back (caudal) steroid injection is an injection into the lowest portion of the epidural space (a fat-filled area that covers the spinal cord to protect it and the surrounding nerves from damage). The injection can help reduce chronic lower back and leg pain caused by sciatica, spondylosis, facet joint pain, spinal stenosis, herniated discs, and other back problems. 
• A cervical selective nerve root block is a procedure where a doctor injects a substance that dulls pain (anesthetic) into the neck to help temporarily or permanently reduce or stop nerve pain.  This nerve root block can help reduce pain in the shoulders, arms, hands, and neck.
• A costovertebral [kos-tuh-VER-tuh-bruhl] block is an injection of medicine to block nerve pain where the ribs meet the spine. It can sometimes be used to help diagnose the exact source of your pain as well.
• Fascia iliaca[FASH-ee-uh I-lee-uh-kuh] block (FIC or FICB) is a pain-relieving nerve block. “Fascia” means the internal connective tissue that wraps around organs. “Iliaca” refers to the pelvis or hip. For this type of block, the doctor injects an anesthetic (pain-relieving) medicine into the area around the femoral (thigh) nerve that’s sending pain signals from the lower back, hips, and thigh (femur). This helps to block short-term pain from surgery or provide temporary relief for long-term chronic nerve and joint pain.
• A lumbar sympathetic block is a therapeutic nerve block injection given in the sympathetic nerve tissue in the lower back. The sympathetic nervous system controls involuntary body functions, like blood flow and your heart rate. Your doctor may recommend a lumbar block for:

• Diagnosis. This procedure allows the doctor to test to see if there is damage to the sympathetic nerves.
• Treatment. While lumbar block is used for diagnosis, it is also a treatment for nerve pain such as CRPS, sympathetic maintained pain, reflex sympathetic dystrophy (RDS or RSDS), and herpes zoster (shingles) pain of the lower extremities.

• A stellate ganglion [STEL-it GANG-glee-uhn] block is an injection (“sympathetic nerve block”) that may help reduce chronic pain. A ganglion is a nerve cell cluster in the autonomic nervous system and sensory system. A stellate ganglion nerve block injects anesthetic (or sometimes another solution) to deaden the ganglion causing pain. The injection can help to lessen or deaden chronic pain from symptoms such as:

• Spasms in the blood vessels
• Complex regional pain syndrome (CRPS)
• Some chronic stomach pain

Different types of spinal injections carry different risks. Your doctor will explain the specific risks of your procedure.

With any procedure, there are different types of risks. Your doctor will explain the specific risks of your procedure. These potential risks, many of which are rare, include:

• Nerve problems that cause arm and leg weakness
• Damage to the nerve, which can cause Increasing feelings of numbness or paralysis
• Increased pain (may be brief or long term)
• Incontinence
• Post-injection headache (also known as “spinal headache”)
• Allergic reactions to the medicine
• Seizure (if the medicine is accidentally injected into a blood vessel)
• Raised blood sugar level (for steroid injections)
• Itching, swelling, or pain at the injection site
• Bleeding
• Infection
• Stroke
• Spinal cord injury
• Sleeping problems

Potential benefits can include:

• Pain relief
• Improved mobility
• Diagnosis of source of pain
• Faster recovery
• Fewer risks than surgery
• No hospital stay required

To make the procedure go better:

• Bring any x-ray films, MRIs, or CT scans to the appointment.
• Bring a list of all your current medicines. Be sure to include all prescriptions, over-the-counter medicines (such as allergy pills or cough syrup), inhalers, patches, vitamin supplements, and herbal remedies. Tell your healthcare providers if you have allergies to any medicines. You may be asked to stop taking certain blood thinners before the procedure. Always check with your healthcare providers before stopping any medicines.
• If the purpose of your injection is to diagnose, you may be asked to skip your regular pain medicine. It’s important to feel the usual amount of pain because it will make it easier tell if the injection relieved the pain.
• Follow all instructions about food and drink. You may be asked not to eat or drink anything for several hours before the procedure.
• Tell your healthcare providers if you are sick or pregnant. If you have a cold, flu, or other illness the day of the procedure, or if there is any chance you may be pregnant, be sure to tell your healthcare providers.

The actual injection takes only a few minutes, but plan on 30 to 60 minutes for the whole procedure. You will remain awake and able to communicate the entire time. Your procedure will include:

• Monitoring. You may have devices attached to you to check your heart rate and breathing.
• Sedative. You may be given a sedative to help you relax.
• Position. You may lie face down, face up, or on your side.
• Local anesthetic. You’ll be given a local anesthetic near the injection site to numb the skin. This usually feels like a pinprick with some burning and only lasts a second.
• Fluoroscopic [floor-ah-SKOHP-ik] x-ray guidance. The doctor may inject a contrast dye that helps identify specific parts of your spine and confirm correct needle placement.
• Injection. Numbing medicines or anti-inflammatory medicines (steroids) will be injected into your spine.

The results will vary somewhat based on why you are getting the injection. For example:

• If your injection is for diagnosing pain, you should feel relief right away from the anesthetic, but the relief will end in about an hour or so. You may need more than 1 injection for the doctor to diagnose the pain.
• If your injection is for reducing inflammation and relieving pain, it can take a few days, or even a week, to feel relief. Your pain will go away slowly and steadily.

After the procedure, you may stay in a recovery area and have your vital signs (heart rate, blood pressure, breathing rate) monitored. You should be able to walk immediately after the procedure, although some patients experience leg weakness, numbness, or tingling for a few hours. You may be asked to fill out some paperwork before leaving.

These are things to be aware of as you’re recovering at home: 

• Driving. Someone may need to drive you home after the procedure. Your doctor will likely allow you to resume driving the next day. 
• Possible side effects. You may experience briefly increased pain, headaches, or trouble sleeping. These should go away in the first few days. 
• Food and drink. You may be asked not to eat or drink for a few hours. 
• Activity. You may be asked to take it easy on the day of the injection. But it may help to get up and move around every hour or so. You should be able to resume normal activity the next day. Walk around if you feel up to it, but avoid activities that may strain your back. 
• Showering and bathing. You can take a shower, but avoid baths or pools for 48 hours. 
• Returning to work. Ask your doctor when you can return to work. 
• Follow up. Be sure to go to all follow-up appointments.

After your procedure, call your doctor right away if you experience any of the following:

• Severe pain or headache
• Fever or chills
• Loss of bladder or bowel control
• Redness or swelling around the injection site
• Weakness or numbness