Injection procedures for spine problems – when and how?

Spine related pain is a very common symptom. Almost all of us will experience back or neck pain at some point in our lives. Most spine related pain settles down within a few days with rest, simple pain medications and physiotherapy. But, sometimes the pain may be persistent, recurrent or become chronic.

First and foremost step in treating persistent back pain or neck pain is to rule out any serious condition. Serious conditions like an infection, tumour or inflammatory arthritis of the spine can be the cause of back pain.

What are the warning signs that indicate a serious disease as a cause for back pain?

The spine specialist will perform clinical evaluation and imaging studies of the spine as required. MRI of the spine helps to see if there are any signs of a serious condition. In addition, it can give an idea about the severity of natural age related changes that happen in the spine. Most common cause of back or neck pain is the over strain of spinal muscles, ligaments or joints in the spine. It happens due to repetitive injury as a result of prolonged bad posture or it could be due to a one time injury while performing a strenuous activity like bending and lifting a weight. Once it is clear that there is no other serious cause for pain, the focus is on relieving the pain first. Then we educate the patient about postural precautions and exercises to minimise he chances of recurrence of pain.

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But sometimes the pain persists or keeps recurring despite the usual treatment with medications, rest and physiotherapy. Injection procedures on the spine are an effective option in such a situation.


Types of injection procedures on spine:

Three most common types of injection procedures on spine:

  1. Trigger point injections
  2. Facet joint or medial branch block injections
  3. Epidural injections – nerve root blocks
  4. Sacroiliac joint block injections

Each one of the above injection procedures has its role in treating spine related pain.

The injections usually consist of a long acting local anaesthetic agent and a locally acting steroid. Bupivacaine or Ropivacaine are the common local anaesthetic agents. Most spine specialists use Triamcenolone as the steroid component.

The idea of injection procedures is to relieve the pain temporarily so that the patient can start exercises and improve postural habits, which in turn will prevent recurrence of pain. In some situations, injections help tide over the painful initial days after an acute disc prolapse while waiting for natural resorption of symptoms eventually.

Trigger point injections :

The tender spots in the spinal muscles indicate muscle fatigue. These points are important sources of pain due to local inflammation I the muscles. Injections help deliver the local anaesthetic and steroid in the painful spots to block the pain from these trigger points. The pain relief usually lasts a few weeks to a few months. Once pain is relieved, the physiotherapist advises specific exercises to improve the muscle strength and techniques to correct the posture. Patient education about postural strain and certain lifestyle modifications help prevent recurrence of the muscle strain symptoms.

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Facet joint injections :

Facet joints are a pair of small joints in each segment in the back of the spine. The facet joints are a common source of back or neck pain. These joints undergo age related wear and tear changes along with the discs. Arthritis in these joints may lead to inflammation and pain. Sometimes the facet joints may sustain an acute injury while bending or twisting movements. Typically the facet joint pain is more in the mornings while getting out of bed after sleep, while bending backwards or twisting the torso.

We perform these injections under x-ray guidance or ultrasound guidance, most often as a day care procedure, in the operation theatre under c-arm image guidance. Depending on patients clinical picture, we target two or three levels of facet joints on one side or both sides. Most often the injection aims to block the small nerve that supplies these facet joints (known as Medial branch blocks). We often use these injections as diagnostic test to confirm the source of back pain.

The pain relief usually lasts a few weeks to months and the response may vary from person to person. One must follow adequate physiotherapy, exercises and posture precautions after the procedure.

Epidural injections – nerve root blocks :

Nerve root block injections are given in the epidural space of the spine. They are usually effective in reducing nerve related pain in cases of disc prolapse or herniation, with nerve root compression. The procedure is performed under local anaesthesia with x-ray guidance. The medication consisting of local anaesthetic and the steroid is delivered near the disc prolapse area. It helps in reducing the inflammation around the nerve ans thus reduces the radiating pain.

This procedure is helpful in early phase after a disc prolapse or in patients who are having moderate symptoms not responding to medical management. Elderly patients with high risk factors for surgical treatment may benefit with these injection procedures as they may be able to avoid surgery in some situations.

We perform epidural root block injections most commonly for the lumbar spine. Cervical root block injections are also performed in similar manner, under CT scan guidance.

However, there are some situations when the injection procedures may not be effective and surgery might be the only option. The spine surgeon makes an appropriate decision for each patient based on the clinical features and imaging studies.

Sacroiliac joint block injections :

Sacroiliac joints are located at the junction of the lumbar spine with the pelvis. The SI joints are an important source of lower back pain. We can perform these injections to block the pain from the SI joints in the same manner as facet joint blocks. Sometimes the injections are given inside the joints as well. Additionally, these injection procedures can also be used as a test to confirm the source of back pain.

Safety concerns :

There is a common apprehension amongst the patients about the use of steroids in the injection procedures. However, these locally administered steroids do not have any significant general side effects as one may see with oral intake of steroid medication. Diabetic patients need to make sure their blood sugar levels are under control before these injection procedures. We always take adequate precautions to prevent infection while performing these injections. Infections due to the injection procedures are extremely rare. Overall, the injection techniques are very safe when performed by the experts in the field in carefully selected patients for whom the benefits outweigh the small risks.

Newer technology in form of biological therapies are emerging rapidly. One can use some specific factors isolated from the patients own blood instead of steroids. As further evidence emerges, we may be able to use the newer technology in these injection procedures in order to avoid steroids.

So, if you are suffering from a persistent spine related pain, do visit your spine specialist for a clinical evaluation. After a thorough clinical evaluation, you can understand the cause for your symptoms and discuss the treatment options.

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Dr Phani Kiran S

Experience and Professionalism

With years of experience in spine surgery, Dr Phani Kiran SSenior Consultant Spine Surgeon will assess you and suggest the treatment option that is right for you.

We at Medspine clinics, understand the importance of educating all our patients about the spinal problems and the most effective ways to take care of their spine.

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