Definition
Injection of corticosteroids into tissue around the spine or spinal nerves exiting the spine. Corticosteroids are drugs that reduce painful swelling and irritation, called inflammation.
Parts of the Body Involved
- The spine and spinal nerves
- Tissue around the spine
Reasons for Procedure
- To diagnose whether a specific site in the spine is the cause of persistent pain or disability
- To reduce pain caused by swelling or inflammation around the spine
- Some conditions which cause spinal pain/inflammation are: arthritis, spine trauma, post-surgical pain, herniated discs , spinal compression fractures, spinal stenosis (narrowing of the spinal canal where the spinal cord sits), radiculopathy (inflammation or narrowing of spinal nerve root as it exits spinal canal), degenerative disc disease (which can occur due to osteoporosis or advanced age), ankylosing spondylitis (inflammation at the sacroiliac joint in the lower back) and sciatica
- Improve physical function for people with persistent low back pain and/or sciatica
Spinal injections are typically performed when persistent pain and disability are not relieved by:
RestIce and heat therapiesOral pain medicationMuscle relaxantsPhysical therapyBack exercisesChanges to the physical set-up of the work environmentChanges to physical activities, including workSpinal manipulation Risk Factors for Complications During the ProcedureCurrent infectionCertain pre-existing medical conditionsTreatment with blood thinnersGeneral ill health History of Epilepsy (if anesthetic is used with the corticosteroid) Concurrent use of the following drugs- Discuss with your doctor prior to the procedure if you use these drugs and will be receiving anesthetic along with the corticosteroid injection:Calcium antagonists Beta blockers Pethidine (meperidine) or phenytoin CimetidineAcetazolamide BaclofenFlumazenil What to Expect Prior to Procedure Your doctor or another healthcare professional will likely do the following: Perform a brief physical examReview your medications and decide if you need to stop taking some before the procedureInsert a tube into your vein to deliver a sedativeAttach sensors to your chest to monitor your heart rate and breathing (possibly) Anesthesia A local anesthetic and/or a sedative may be used to alleviate pain and anxiety associated with the procedure, but are generally not used to put you to sleep.
Description of the Procedure You will lie on your side on an x-ray table. The skin on your back will be washed with a sterile solution. The doctor will have a syringe containing corticosteroid medication and a local anesthetic. He or she will insert the needle through the skin and into a space near the spine. This space may be the epidural space or another space between bones of the spine. The doctor will likely use x-rays imaging to guide placement of the needle into the proper space near the spine. Contrast dye may also be injected to confirm that the needle is in the right place. The doctor will inject the medication and remove the needle from your back. A small bandage may be placed over the injection site after the procedure. Corticosteroid Injection 2008 Nucleus Medical Art, Inc. After ProcedureYou will spend time in a recovery area.A healthcare professional will check your vital signs and monitor your condition.You will need someone to drive you home, because you were sedated during the procedure. Potential temporary side effects: Brief period of increased painHeadachesTrouble sleepingFacial flushingHiccupsLightheadedness from low blood pressure How Long Will It Take?The procedure will take less than one hour. The entire visit is about 2-3 hours, including preparation time and monitoring in the recovery room.
Will It Hurt?The injection of the local anesthetic may burn or sting for a few seconds. After that, you should not feel pain during the procedure. Possible ComplicationsSpinal headacheAllergic reaction to the medicationBleeding (rare)Infection (rare)Nerve damage (rare) Seizure (if anesthetic is used - rare) Syncope (fainting) Average Hospital StayLess than one day. Postoperative CareRest on the day of the procedure.Apply ice packs for soreness at the injection site.Avoid baths, pools, and whirlpools for 24-48 hours. OutcomeIt will take a few days to a week, maybe longer, for the medication to reduce the inflammation and pain. You should be able to resume your regular daily activities the day after the procedure. You should be able to start exercising within one week. Call Your Doctor If Any of the Following OccursSigns of infection, including fever and chillsRedness, swelling, increasing pain, bleeding, or discharge from the injection siteSudden shortness of breath or chest painWeakness or paralysisNumbness, tingling, pain, or weakness, especially in the arms, hands, legs, or feet RESOURCES: American Academy of Orthopaedic Surgeonshttp://www.aaos.org American Association of Neurological Surgeonshttp://www.neurosurgerytoday.org CANADIAN RESOURCES:
BC Health Guidehttp://www.bchealthguide.org Canadian Orthopaedic Foundationhttp://www.canorth.org/default.asp References: American Academy of Orthopaedic Surgeons (AAOS). AAOS clinical guideline on low back pain/sciatica (acute) (phases I and II). Available at: http://www.guidelines.gov/summary/summary.aspx?doc_id=5369&nbr=003672&string=spinal+AND+fusion. Accessed September 9, 2005. Jain, KK. Neurologic complications of local anesthesia. In: Gilman S, editor. MedLink Neurology. San Diego: MedLink Corporation. Available at www.medlink.com. Accessed May 31, 2008. Manchikanti L, Staats PS, Singh V, et al. Evidence-based practice guidelines for interventional techniques in the management of chronic spinal pain. Pain Phys. 2003;6:3-81. Ramachandran, TS. Lumbar spinal stenosis and neurogenic claudications. In: Gilman S, editor. MedLink Neurology. San Diego: MedLink Corporation. Available at www.medlink.com. Accessed May 31, 2008. Spinal injections. North American Spine Society website. Available at: http://www.spine.org/articles/injections.cfm. Accessed September 7, 2005. Wheeler AH. Therapeutic injections for pain management. eMedicine. 2005. Available at: http://www.emedicine.com/neuro/topic514.htm. Accessed September 16, 2005.
Last reviewed May 2008 by J. Thomas Megerian, MD, PhD, FAAPPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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