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Procedures

Spinal Injections

These injections can be used:

  • Diagnostically- To find the source of back pain
  • Therapeutically - To relieve pain

Injections are used in conjunction with exercise programs. Exercises help to; improve or maintain spinal mobility and stability.

Procedure

In order for medication to be effective the injections needs to be administered in the right place. A fluoroscope, which is an x-ray machine which allows the doctor to view an x-ray image during the procedure, to see where the needle goes as it is inserted. This makes the procedure safer and far more effective.

Once the doctor is in position, the liquid contrast dye is injected. This dye shows up on the x-rays and highlights the position of the needle. If contrast does not flow as it should, the needle is in the wrong place and it is repositioned. This is done until the correct position is achieved.

Types of Injections

The injection given depends on the diagnosis the doctor gives i.e. where he thinks the pain is coming from.

Epidural injection

This treats pain that start in the spine and radiates to an arm or leg. This pain is due to either and inflamed or pinched nerve in the back. It can be used for both therapeutic and diagnostic purposes.
-Therapeutic: By injecting an anaesthetic and an anti-inflammatory medicine near the affect nerve, the pain is lessened or resolved.
-Diagnostic: For this test only the anaesthetic is injected. If a particular nerve is suspected as the cause of pain the epidural will be targeted at the nerve and response to treatment is monitored. If pain is reduced, the nerve was the cause of the pain. However, if pain still persists then another source is to blame.

Facet joint injections

When pain is as a result of degenerative arthritic conditions or injury.
-Therapeutic: This is the injection of a steroid into the facet joints of the spine. The injection will reduce inflammation and or swelling. The injection consists of a mixture of local anaesthetic and steroid medication.
-Diagnostic: Injections containing anaesthetic alone is administered to the facet joint. If pain is relieved then the cause of back pain is clear and treatment of back pain due to facet joints can begin.

Sacroiliac joint Injections

The sacroiliac joints are the joints in the pelvis between the sacrum and the ileum. Usually only one of these joints is the cause of the pain in the lower back, buttocks and legs
-Therapeutic: Injections using a mixture of anaesthetic and steroid medication will provide substantial pain relief.
-Diagnostic: Injecting the joint with anaesthetic is the gold standard for diagnosing sacroiliac joint pain.

Patients with the following are not good candidates for spinal injections;

  • Active systemic infections
  • Skin infections at the site of needle puncture
  • Bleeding disorders
  • Uncontrolled high blood pressure and diabetes
  • Unstable angina or congestive heart failure
  • Allergy to contrast , anaesthetics and or steroids