How do spinal injections work?

Why would you have a spinal injection?

Mr Richard Selway talks us through the different types and uses of spinal injections.

There are two types of spinal injections which we use:

·      To principally treat back pain

·      To principally diagnose and treat sciatic pain

Back pain injections

Usually back pain will originate from the facet joints. These are the joints at each segment in the back of the spine which articulate to allow the spine to flex, extend and bend as well as providing stability. These can become painful if they become ‘worn out’, arthritic or due to mechanical stress. This type of back pain is often characterised by pain being worse in the mornings or after a long period of sitting down, the back will feel very stiff. Long term this is treated with exercise, building core strength (including the Alexander Technique for optimum balance and posture), physical therapies as well as yoga and pilates.

Sometimes patients cannot tolerate these treatments due to the pain and in these circumstances facet joint injections can offer pain relief to give a window of opportunity to allow the patient to complete these treatments. In some cases, the back pain can return rapidly and repeatedly but the injections continue to provide relief. In these cases, patients can be considered for facet joint denervation. This is a slightly more invasive technique targeting the same area but for a longer lasting effect.

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Injections for sciatica

These are generally called perineural injections, nerve root injections or transforaminal epidural injections. As a general rule these are given to patients with specific symptoms – pain down one leg linked to irritation of one nerve root commonly known as sciatic pain.

Often these injections can also be used for diagnostic purposes if there is any doubt from the MRI scan which nerve root is responsible for the pain. These injections are also useful to help alleviate severe pain to allow the patient to complete other treatments such as physiotherapy which may work long term to treat the sciatic pain but currently the patient is unable to do so due to the pain. Injections are a useful tool when trying to avoid open surgery but it is always worth noting nothing works for everyone so it is always a good idea to discuss all options with your consultant before making a final decision.

Spinal epidural injections can on occasion be used when multiple nerve roots are involved in the source of the pain. Again it is important to discuss this with your consultant.

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This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.