Spinal injections are commonly used to localize and treat painful tissues in the cervical, thoracic and lumbosacral spine. Indications for treatment with spinal injections and the type of injections differ among individual patients. The physicians at Virginia Spine Institute rely on a thorough patient history combined with a physical exam and appropriate imaging studies and diagnostic tests in order to determine if an injection is warranted.
When spinal injections are being performed, x-ray guidance (i.e. fluoroscopy) is used to ensure that the proper tissue (nerve root, nerve branch, joint, etc.) is being targeted and that the injection is performed safely. This is done to avoid injury or injection into adjacent nerves, blood vessels, and the spinal cord.
The most commonly performed spinal injections at the Virginia Spine Institute include cervical and lumbar epidurals, facet joint and sacroiliac joint injections. If we feel you may benefit from an injection, we pinpoint the most appropriate location based on your history and exam. It is important for the medication to target the right area. We do not order a series of injections, rather one at a time with follow-up to then understand how well you have responded to treatment. If joints are confirmed as a significant source of pain but benefits only last temporarily, longer term relief may come from a procedure called Radiofrequency Ablation.
- Epidural Injections - Caudal, Interlaminar, Transforaminal
- Facet Joint Injections
- Sacroiliac Joint Injections
Epidural injections are typically used to treat pain emanating from an inflamed nerve root. The epidural space is a potential space located inside the bony spinal canal but outside the dura mater. Cerebrospinal fluid surrounds the spinal cord and spinal nerves and is contained by an inside layer, called the arachnoid mater. The inflamed nerve root can be caused from multiple sources. Symptoms usually include shooting, burning, electric-like pain in the affected extremity sometimes associated with numbness, tingling and weakness along the course of the inflamed nerve root.
Epidural injections can be performed from several different approaches; these include a caudal, interlaminar, or transforaminal approach. The approach your provider chooses is based on each individual patient’s clinical presentation, the personal preference and experience of the provider performing the injection, the desired outcome, and most importantly, the risks versus benefits of performing one type of epidural over another. Clinically, the purpose of all epidural injections is to place a mixture of steroid and local anesthetic at the source of the problem to decrease inflammation causing pain, and to promote healing and clinical improvement.
There are two posterior facet joints at each vertebral level. They are synovial joints, similar to other joints in the human body and experience constant, repetitive motion. They can become worn or torn and can result in pain. If facet joints are suspected as a potential source of pain, an injection into the joint is commonly used to confirm the diagnosis and relieve pain. Learn more spinal anatomy here.
The sacroiliac (SI) joint is a strong weight bearing joint in the pelvis that connects the sacrum and pelvis. There are two joints, one on each side of the sacrum, reinforced by ligaments. Both joints normally have movement and provide shock absorption for the spine. Just like other joints in the body, this joint can become inflamed, unstable and dysfunctional. Localized steroid injections into the SI joint can provide targeted therapy to reduce pain and inflammation and allow physical therapy to make further progress.
Risks of spinal injections may include a very small chance of bleeding, infection or injury to local neurovascular structures in the vicinity of the targeted structures. You should make your physician aware of any anti-inflammatory, blood thinning and herbal medications you are taking that may increase your risk of bleeding during and immediately after the procedure. Many of these medications will need to be temporarily discontinued for the week preceding the injection to decrease the risk of bleeding.
Patients should be aware of potential side effects associated with steroid injections. Symptoms such as headache, flushing, sweating, mild temporary weight gain, dizziness and a short-lived flare-up of pain (called a post-injection flare) are commonly associated side effects of local steroid injections. Furthermore, patients with diabetes typically experience a short-term increase in blood glucose levels. Patients with congestive heart failure need to be aware that steroids may increase water retention and lead to an exacerbation of symptoms. It is imperative that your clinician is aware of these conditions to determine if you are a safe candidate for a steroid injection.
The majority of patients do extremely well and experience significant relief of pain and suffering following appropriately prescribed spinal injections. Sometimes injections need to be repeated or a different type of injection needs to be performed once your symptoms are better localized and controlled. At Virginia Spine Institute, the decision to perform additional injections is made only after careful observation and follow up regarding how prior injections have impacted the your pain and quality of life. We usually do not prescribe a series of injections.
If you are having an injection with us, please read about our common questions and our step-by-step process.