If you have seen a doctor for lower back pain or sciatica, you’ve probably heard that spinal injections can help reduce your pain. Many patients find that the injections give them enough relief to complete a physical therapy program, and others appreciate that the injections keep them away from pain medication.
However, spinal injections aren’t permanent, and people debate their long-term effectiveness. Spinal injections can help, but they come with their own side-effects that patients need to be aware of.
Benefits of Spinal Injections
People use spinal injections or cortisone shots to treat two different problems:
- Inflammation or damage to a nerve, which causes sharp, shooting pain down the lower back, through the hip, and down the leg.
- A narrowed spine (also called spinal stenosis), which can happen when a herniated disc, bone spurs, or tumors press on the spine. When your spine narrows, it puts pressure on the nerves. Most people with spinal stenosis experience pain in their buttocks or down the legs. The pain becomes more intense when they are active.
Some doctors use injections to treat other types of back pain as well. Spinal injections are even used by some doctors to diagnose certain conditions. If a patient with unidentifiable back pain finds relief after an injection, a surgeon can narrow down which nerves or discs are causing the problem.
In general, epidural spinal injections are a low-risk way to avoid surgeries and medication while still finding some relief. At least 50 percent of patients say that the injection reduced their pain.
Many patients find that they experience relief just days after the injection, and some injections can even help within hours. Pain relief can last anywhere from a few weeks to a year. Sometimes, even longer.
At OSA, our orthopedic doctors work closely with the physical therapists to create a treatment plan that maximizes your outcome in as few visits as possible. You can call us to set an appointment, or request an appointment online.
Types of Injections
Epidural injections (also called cortisone shots) are the most common type of spinal injections. In this procedure, a doctor injects a steroid, usually cortisone, into the dura. The dura is the sac around the nerve root that contains cerebrospinal fluid. The steroid helps reduce inflammation, and it can help push out some of the inflammatory proteins that cause pain. Epidural spinal injections are common in patients with degenerative disc disease, herniated discs, and spinal stenosis.
Selective nerve root block injections (or SNRBs) are primarily used to diagnose the source of your pain. They can also help improve your pain and it can be a treatment for lateral disc herniation (a disc that ruptures outside of the spinal canal). In this procedure, a small amount of steroids and a numbing agent are inserted into the nerve root, which is where your nerve begins to exit the spinal cord.
SNRBs are harder to perform than epidural injections. Feel free to ask any questions that you have.
Doctors use a discography procedure to diagnose your pain. In this procedure, your doctor inserts a small amount of x-ray dye into a disc. He or she can tell if the disc is causing problems based on your reaction to the dye. After the dye is inserted, your doctor will take an x-ray of the disc and observe any tears. Typically, your doctor will suggest other treatment options after the discography is completed.
What to expect when you go get a spinal injection
The procedure only takes a few minutes. However, you should carve out an hour of time to be in the office, so that you can rest appropriately afterward.
Different types of anesthesia are used depending on your comfort level and the type of injection. Most people choose to use just a local anesthesia, but others prefer to be sedated. Much of this also depends on your preference.
At OSA, Dr. Atwater uses a C-Arm to guide the injection. His surgical assistant or nurse practitioner will help monitor your blood pressure and make sure you are comfortable. After the spinal injection, you might experience some numbness, tingling, or heaviness in your legs. Don’t worry. This is from the anesthesia, and it should go away after a couple of hours.
Some people choose to rest the day of their procedure, but others want to go back to their normal routine. Do what’s comfortable, but always talk to your doctor about your plans.
Questions to ask your doctor
Because of the different types of injections, you should ask your doctor the following questions before having the injection:
- Which spinal injections are available? What are its side-effects?
- How long will the injection take? Will I be able to drive home?
- What kind of anesthesia will you use?
- What should I do to prepare before the procedure?
- Who will perform the procedure?
- How long will recovery take? Should I take the day off work?
Some of the short-term side effects include:
- Soreness at the site of the injection
- Nausea and vomiting
Bleeding and infections are uncommon but possible side-effects. They occur in less than 1% of cases. The needle can also damage a blood vessel or nerve. This too is extremely rare.
Over time, repeated injections to the same place can cause the surrounding tissue, such as joint cartilage or even bone, to break down. Our doctors generally recommend that patients don’t have more than 3-4 injections per year.
Is a spinal injection for you?
Tell your doctor:
- If you are pregnant or may become pregnant before the procedure.
- If you have diabetes or any heart conditions.
- If you have any bleeding disorders.
- Any allergies.
These won’t automatically disqualify you from having a spinal injection. However, the information will help you and your doctor make the decision.
At OSA, we understand that back pain is discouraging and impacts your daily life. When used in a well-rounded recovery program, spinal injections can be a helpful treatment for many patients with back pain.