Spinal Injections

What is a Spinal Injection?

When back pain and sciatica do not respond to conservative measures to control pain, your doctor or surgeon may recommend an injection of medication into the back. This is usually a combination of local anaesthetic to numb the area and a steroid that will reduce inflammation and swelling.

The cause of your pain will determine the type, site and dose of injection your doctor recommends. Common injections include:

  • Steroid & anaesthetic combination around the facet joints (also called the ‘Z-joints’) that link the vertebrae together.
  • Steroid &/or anaesthetic into the epidural space (the area around the spinal cord).
  • Anaesthetic injections in nerves as they come out of the spine or as they travel through the body.

Injections can be very effective at relieving pain and potentially prevent an episode of low back pain developing into chronic.

Unfortunately, injections do not cure the cause of pain. Their effects begin to wear off weeks to months after the initial procedure. For this reason, many doctors prescribe injections as part of a combination of therapies rather than as a curative treatment.

Who is this procedure for? 

Injections are only recommended when symptoms are significantly affecting quality of life. An injection may be appropriate if: 

  • You have persistent back pain that is thought to be due to your spine rather than the muscles around your back. Some examples include: 
    • Sciatica
    • Disc Prolapse
    • Spinal stenosis
  • You have pain, numbness, tingling or weakness running down your legs, in your buttocks or down your arms 
  • Other methods of pain control, like anti-inflammatory medications, exercises and rest, have failed. 

Injections are typically given to patients with arthritis in their back. Alternatively, injections may be given to those with disc herniation. In these patients, the injections will not fix the disc prolapse, but will reduce the inflammation (and consequently symptoms). 

Before your doctor will recommend injections, he or she will usually need to order a MRI scan to confirm which vertebrae are causing your pain. 

While injections are usually very effective they should only be performed if your doctor is sure it is safe for you. With this in mind, you usually cannot have the injections if: 

  • You have significant heart disease including unstable angina 
  • You are on high doses of blood-thinning medications like warfarin 
  • You have an infection in the skin overlying the spine or a serious general infection 
  • You have had serious allergic reactions to anaesthetics or steroids in the past. 

Other conditions, like cancer or severe diabetes, may also make the injections inappropriate.

Complications

The risks and complications of a Spinal Injection include:

  • Headache 
  • Drop in blood pressure during the injection resulting in feelings of dizziness and nausea, and occasionally vomiting
  • Itch at the injection site
  • Infection in or around the injection site – this is rare, and you will be monitored for signs of infection. 
  • Damage to the spinal cord resulting in numbness and paralysis in the lower body. This is very rare, and symptoms of numbness are usually temporary. 
  • Retention of urine – this should be temporary. More rarely, there is some disturbance in using bowels.

Major complications following a spinal injection are extremely rare. You should discuss any concerns you have with the doctor performing the procedure.

Before the procedure

Before you have an injection, your doctor or surgeon will discuss the risks and complications of the procedure. 

The injections are usually performed in an outpatient clinic and you will not need to be admitted to hospital. 

Tests

Tests that your doctor may order include:

  • Blood tests, including a test that checks how well your blood is clotting. 

Tip

Carry a list of your medications with you including the name, dosage and how often you take it.

Medications

Our doctors will advise you which medications you should stop or can continue taking before you have the injection. 

You must tell your doctor if you are taking: 

  • Any blood-thinning medications, including warfarin and clopidogrel. You should also mention if you take aspirin daily. 
  • Any blood pressure medications. 

Get some help from your friends and family

It’s always a good idea to have a friend or family member at your appointment with you. In this case, you can probably get home on your own, however you may feel more comfortable having someone with you to drive you home.

About the procedure

You can usually have a spinal injection in the outpatient clinic, however epidural injections may require the presence of an anaesthetist. 

Your doctor or surgeon will ask you to expose your back and either lie or sit on the bed. He or she will then examine your back and may perform a number of quick tests to confirm the site that is causing your pain. Once he or she has decided where to position the needle, the area will be sterilised to reduce the risk of infection. 

Many doctors use a small injection of local anaesthetic into the skin. This helps to reduce the pain of the main injection. Once your skin is sufficiently numb, your doctor will carefully insert the needle and inject the steroid and/or anaesthetic solution. 

The injection itself can be relatively painful, and unfortunately this is unavoidable. However, this sharp pain is temporary and you should experience some relief from your back pain almost immediately after the injection.

After the procedure

After the injection your doctor will keep you in the clinic for a little while. This is to check you are not going to faint or become otherwise unwell. Once he or she is satisfied, you can go straight home. 

If you notice any of the following, your should see your doctor: 

  • Severe prolonged headaches
  • Inability to pass urine or use your bowels 
  • Fever
  • Loss of consciousness

Recovery and Rehabilitation 

Symptoms after the injection, like headaches or irritation at the puncture site, usually resolve quickly over the following days. 

Pain should be immediately relieved when the injection is performed.

F.A.Q.s | Frequently Asked Questions

What are the alternative treatments to having a Spinal Injection? 

Other methods for reducing back pain include medications (eg ibuprofen), rest and exercise regimes and other methods like hot or cold compresses.You may also wish to try: 

  • Manual therapy 
  • Acupuncture
  • Hypnosis 

If you have tried injections in the past and they have failed, you may need to consider surgery to relieve your pain. This should be discussed with your surgeon. 

Are there important things I need to tell my doctors?

  • If you develop a fever
  • If you are unable to pass urine or use your bowels 
  • If you feel persistently dizzy or nauseous, if you see stars or having any changes in your vision
  • If you develop a severe persistent headache
  • If you lose consiousness

References 

‘Evidence-based Management of Acute Musculoskeletal Pain: A Guide for Clinicians’, Australian Government, National Health and Medical Research Council, Australian Acute Musculoskeletal Pain Guidelines Group, Australian Academic Press, 2004. 

Brown, G., ‘Treatment of common non-specific back pain – a clinical review’, Trauma, Vol. 13, No. 1, Jan 2011, pp 57-64. 

Grabois, M., ‘Management of chronic low back pain’, American Journal of Physical Medicine and Rehabilitation, Vol. 84, 2005, pp. S29–S41.

Young, I. A., ‘The Use of Lumbar Epidural/Transforaminal Steroids for Managing Spinal Disease’, Journal of American Academy of Orthopaedic Surgeons, Vol. 15, No. 4, April 2007, pp. 228-238.