What are spinal injections?
Some causes of back pain can be treated by injecting medications into different parts of the spine; these are known as spinal injections. They can help to relieve pain, inflammation and stiffness, and restore movement.
This is a highly technical procedure and must be performed by an experienced specialist surgeon under the guidance of X-ray imaging.
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There are two main types of spinal injections:
Facet joint injections
These go into the joints around the spine and contain both a local anaesthetic to provide pain relief and a steroid to reduce inflammation in the area.
This involves injecting directly into the root of the nerve that is causing the pain in order to block the pain signals. Sometimes these injections need repeating, but most people will experience the benefit after one to three injections.
Which conditions can be treated with spinal injections?
Spinal injections have been shown to greatly improve back pain in people with uncontrolled symptoms who wish to avoid surgery, or who are not suitable for surgery.
The main causes of back pain that can be treated with spinal injections include:
- general wear and tear or degeneration
- disc prolapse (‘slipped disc’)
- spinal stenosis (narrowing of the spaces within the spine).
What are the risks associated with spinal injections?
Spinal injections are usually performed under a local anaesthetic. The patient will be awake, but offered sedation that can help them to relax and reduce any anxiety.
This is generally a very safe procedure, however there are some risks to consider prior to having spinal injections. These include:
- Excessive bleeding or bruising around the injection site
- Headaches that can arise if the epidural needle punctures a bit deeper than it should and spinal fluid leaks through the puncture site. This headache may need to be treated with bed rest, or with a blood patch (where blood from a vein is injected into the puncture site to block the hole)
- Injury to a spinal nerve may also occur
- Pain around the treated area
- An allergic reaction to either the local anaesthetic or the injection
- The need for further injections.
Known side effects
Sometimes people can also get some general side effects related to the steroids in the injection. These can include hot flushes, nausea, mild abdominal pain and fluid retention. As the steroids are injected into one small area, these side effects are both uncommon and should not last for more than a few days.
Our specialist experts, anaesthetists and their teams are very experienced and will do their best to minimise any risks. They will discuss all the risks and benefits before surgery and be on hand to answer any questions.
Following surgery, if any unexpected symptoms are experienced, or problems persist or worsen, then patients are advised to make contact immediately with their specialist teams.
WHAT HAPPENS AFTER A SPINAL INJECTION?
The patient will be taken to their recovery suite, then either to a discharge lounge or a ward if they need to stay in hospital overnight. Overnight stays tend to be for patients who have complex medical problems and need an extended period of monitoring or if there are any rare and unexpected complications during the surgery.
During their recovery, patients will be closely monitored by our expert team of healthcare staff at The London Clinic. It is important that painkillers are taken as instructed by the specialist team and that walking and bladder and bowel control, are closely monitored.
Once the patient is feeling well enough and has passed urine, it is considered safe for them to go home. The injection site should be kept clean and dry for at least 24 hours, and most people can return to work and normal daily activities after 72 hours.
If the pain does not settle four to six weeks after the injection, or there are any further problems, patients are advised to see their GP or contact their specialist team.
What is radiofrequency denervation?
Radiofrequency denervation is a specialised injection that uses heat to reduce or stop pain being transmitted by the target nerve.
During this procedure, a needle is passed into one of the joints in the spine under image guidance. Heat then runs through the tip of the needle to the target nerve.
Like other spinal injections, this is a technical procedure requiring the experienced hands of an expert specialist.
Which conditions can be treated using radiofrequency denervation?
Radiofrequency denervation can be used to treat several causes of back pain. Pain that arises from the very small joints of the spine (facet joint) or the larger joints (sacro-iliac joints) is transmitted through some very fine nerves.
Radiofrequency denervation is a procedure which creates heat lesions at the nerves of the joints and not the joints themselves. This stops the nerves from transmitting pain and this may help reduce symptoms for longer than spinal injections with local anaesthetic and steroid.
It is a useful procedure for those who are still experiencing debilitating symptoms despite painkillers and physiotherapy, but do not wish to undergo surgery.
Are there any risks associated with radiofrequency denervation?
Similar to other spinal injections, radiofrequency denervation is a generally safe procedure performed under a local anaesthetic.
Common side effects can include:
- Pain following the procedure caused by soreness/bruising at the injection site
- A short-term increase in the pain that can last for up to 10 days.
- Haematoma - a collection of blood under the wound, causing a swelling or infection at the site
- Allergic reactions to medications used throughout the procedure
- Nerve injury causing tingling or numbness
- Worsening pain.
- Temporary or disabling nerve damage
- Convulsions (fits)
- Cardiac arrest (when the heart stops).
It is important to remember that our expert specialists in pain management and spinal injections are very experienced. They work alongside a multidisciplinary team to ensure comfort and safety are top priorities.
How successful is radiofrequency denervation?
Radiofrequency denervation has been shown to have comparable results to other spinal injections. This procedure has also shown good results in the short term, with up to three out of four patients experiencing significant improvement in their symptoms in the weeks following their injection.
This number falls to only 22% of patients experiencing symptom relief one year after their injection. This shows that radiofrequency denervation is an effective strategy for managing back pain in the short-to-medium term.
However, repeated injections or alternative treatments may be required for long-term pain control.
Why choose The London Clinic?
At The London Clinic, we pride ourselves on delivering quality, patient-centred care at the cutting edges of innovation. We offer access to leading specialists in the field of pain management, with clinical support teams second to none, and the very best facilities and equipment available.
We provide access to:
- A multidisciplinary therapies team, including: physiotherapy (physical therapies), aquatic therapy (hydrotherapy pool), occupational therapy, dietetics, and speech & language therapy
- Bespoke one-to-one assessments and treatment programmes incorporating exercise therapy, bespoke hand splinting, acupuncture, fibroendoscopic evaluation of swallow (FEES), video fluoroscopy assessment, Ai Chi, vestibular rehabilitation, falls prevention, electrotherapy, osteopathy and specialist dietary advice and nutritional support
- A wide range of rehabilitation equipment including the AlterG Anti-Gravity Treadmill , Isokinetic Biodex apparatus, and extracorporeal shockwave therapy.
Read more about the array of physical therapies available at our facility.
What The Experts Say...
These are minimally invasive day procedures that can sometimes cure and often give sustained benefit with little risk. We do hundreds of these a year as they are a popular and effective treatment.