Female doctor in mask and gloves provides covered patient with spinal injections on a c-armIf you have seen a doctor for neck or back pain, 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 rehabilitation program, and others appreciate that the injections keep them away from pain medication.

Millions suffer with neck and back pain, and it’s often difficult to diagnose and treat.  Many in the medical community debate the long-term effectiveness of spinal injections. Here in Vero Beach, we have seen they help more often than not; however, they come with their own side-effects, and there is always a chance the treatment won’t help.

Benefits of Spinal Injections

People use neck or back injections (sometimes called cortisone shots) to treat one of two problems:

  1. Inflammation or damage to a nerve, which causes sharp, shooting pain down the lower back, through the hip, and down the leg.
  2. A narrowed spine (also called spinal stenosis), which can happen when a disc herniates, with bone spurs, or if a tumor presses on the spine. When the 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 spinal injections to treat other types of back pain as well. They’re 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 (video) are a low-risk way to avoid surgeries and medication while still finding 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.

Types of Spinal Injections

Lumbar Epidural Steroid Injections (without contrast) Video

Lumbar epidural steroid 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. These injections are common in patients with degenerative disc disease, herniated discs, and spinal stenosis.

 

Diagram of cervical selective nerve root block spinal injections

Selective nerve root block

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, 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 Dr. Atwater any questions about the procedure at your next office visit!

 

Image of red disc on discography during spinal injections

Discography

We 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 can tell if the disc is causing problems based on your reaction to the dye. After the dye is inserted, Dr. Atwater will take an x-ray of the disc and observe any tears. Typically, he will suggest other treatment options after the discography is completed.

 

What to expect from spinal injections

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:

  • Which spinal injections are available for me? What are the 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?

Potential Risks

Some of the short-term side effects include:

  • Soreness at the site of the injection
  • Headaches
  • Anxiety
  • 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 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.
  • Have diabetes or any heart conditions.
  • 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, making it hard to live that active Florida lifestyle many of us enjoy. When used in a well-rounded recovery program, spinal injections can be a helpful treatment for many patients with back pain.

 

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