Backaches
Injections
Spinal injections have been used to as an alternative to surgery
in treating back pain since the early 1900s. Studies have shown
injections to be effective in up to 50% of patients. They are typically
given after medication and physical treatments have been utilized, but
before surgery. Injections tend to be more effective than oral pain
medication because they deliver medicine right to the source of the
pain.
Sacroiliac (SI) joint blocks are injections used to treat low back
pain. The sacroiliac joints are located next to the spine and connect
the sacrum to the pelvis. Painful joints cause pain in the lower back,
buttocks, abdomen, groin, and legs. SI joint blocks work in three
ways: 1) they are used to determine if the SI joint is the source of
back pain (if the injection makes the pain better, that’s where the
pain is coming from), 2) the numbing medication used in the block gives
temporary relief so the patient can have chiropractic or other physical
treatments immediately after the block is administered, and 3) a
time-release steroid gives extended pain relief by reducing
inflammation.
During an SI block, the patient lies on his stomach and live x-ray,
known as fluoroscopic guidance, is used to allow the doctor to see the
joints. The skin is sterilized and numbed. The doctor then
inserts a very small needle into the joint and injects it with
lidocaine (a numbing agent) and a steroid (an anti-inflammatory). After
treatment the legs sometimes feel numb or weak for a few hours. Side
effects are rare and include allergic reaction, infection, excessive
bleeding, nerve damage, and chemical meningitis.
Thoracic Facet joints are small joints about the size of a thumbnail
and are located in pairs along the back of the spine. If they become
irritated, middle back pain occurs. Thoracic facet joint injections
have the same purpose as SI joint injections, are performed in exactly
the same manner, and have the same side effects. The only difference is
they treat middle back pain instead of lower back pain.
Epidural steroidal injections are similar to SI and thoracic facet join
injections, except the cortosteroid is injected into the spinal canal
surrounding the spinal cord. They are used to treat chronic and not
acute low back pain. This procedure has the same side effects of other
injections. Relief generally lasts anywhere from one week to one year.
Selective nerve root blocks (SNRB) are used primarily as a diagnostic
tool and secondarily as treatment for pain. Back pain can occur
when nerve roots become compressed and inflamed. While MRIs can be used
to show which nerves are causing the pain, they don’t always work
successfully. In cases when this happens, an SNRB injection can be
performed in order to isolate the source of the pain. SNRBs are also
used to treat disc that rupture outside of the spinal canal, or far
lateral herniated discs. The procedure is the same for other
types of injections. As with other injections, SNRBs should not be
performed more than three times per year. SNRBs are considered more
difficult to perform than other types of injections and should be done
only by a physician experienced in them.
Facet rhizotomy may be recommended if three facet blocks have been
performed but more pain relief is needed. Facet rhizotomy injections
disable the sensory nerves that lead to the facet joint, thereby
providing pain relief. The procedure for facet rhizotomy injections is
different from that of other injections. A needle with a probe is
inserted just outside the joint, is heated with radio waves, and
applied to the sensory nerve. This disables the nerve and keeps it from
sending pain signals to the brain.
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This information is not presented by a medical practitioner and is for educational and informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read.