What is Spinal Injections ?

Spinal Injections are pain management techniques utilized for relieving pain of spinal origin. Spinal injection techniques employ injecting medicines of varying drug composition in spine to provide pain relief caused by nerve compression, inflammation, neural edema, disc injury, facet arthritis or epidural inflammation. Most of these injections are given under C-ARM (X RAY guidance). Often the indications of giving injection are

(1.) Back pain : 3 weeks duration (of spinal origin)
(2.) Leg pain / Leg Numbness / Heaviness
(3.) Sciatica
(4.) Neck Pain
(5.) Radiculopathy
(6.) Slip Disc / Herniated Disc
(7.) Degenerative Disc Disease
(8.) Spinal Stenosis
(9.) Symptomatic Spondylolisthesis
(10.) Palliative pain relief for patients with Spinal Metastasis /Spinal Tumors

There are various techniques of delivering spinal injections :

(1.) Epidural Spinal Injection
(2.) Facet Injection
(3.) Transforaminal Root Block Injection
(4.) Caudal Block Injection
(5.) Discography
(6.) Nucleoplasty – Radiofrequency ablation of disc
(7.) IDET (Intra discal Electro therapy )
(8.) Sacroilliac Joint Injections

What is Epidural Steroid Injection ?

This is one of the most common injections.
An epidural steroid injection sends steroids—which are very strong anti-inflammatory drugs right to the nerve root that’s inflamed. This is a specialized pain management therapy, so it’s best to have a well-trained pain management specialist do the injection.

It targets the epidural space, which is the space surrounding the membrane that covers the spinal cord and nerve roots. Nerves travel through the epidural space and then branch out to other parts of your body, such as your legs. If a nerve root is compressed (pinched) in the epidural space, you can have pain that travels down your back and into your legs (commonly called Sciatica, although the technical medical term is radiculopathy). By injecting various medicine combination (Often anti-inflammatory drugs and local anaesthetic drugs) in epidural space the medicine injected traverses along the nerve roots and in space adjacent to disc giving pain relief. However in some cases the injection may not give desired pain relief or the relief may be short lasting. Consult your physician for further details. One shouldn’t have more than 1-2 injections because of the potential side effects of the steroids. Cardiac patients also take it with caution in consultation with physician

What is Facet joint injection ?

Often recommended for same indications when Back pain / leg pain / radiculopathy / Sciatica is caused by facet arthritis and inflammation in the facet joint. More often than not the facet joint injections are used for diagnostic purpose, since it is difficult to attribute pain causation factor. Facet joints in your spine help you move and provide stability and give pain when wear and tear sets in giving pain in back and leg. The injection (Often anti-inflammatory drugs and local anaesthetic drugs) will numb the joint and can reduce your pain. However in some cases the injection may not give desired pain relief or the relief may be short lasting. Consult your physician for further details. One shouldn’t have more than 1-2 injections because of the potential side effects of the steroids. Cardiac patients also take it with caution in consultation with physician

What is Nerve root Injection ?

Nerve root injection or nerve root block is often recommended when the pain is due to irritation or inflammation of a particular nerve root like in cases of Slip Disc / Sciatica OR HERNIATED DISC OR FACET ARTHRITIS LEADING TO NERVE IRRITATION. Sometimes this is also used for diagnostic purpose when there are multilevel discs. Usually a combination of steroid with local anaesthetic is injected in the affected nerve root area. However in some cases the injection may not give desired pain relief or the relief may be short lasting. Consult your physician for further details. One shouldn’t have more than 1-2 injections because of the potential side effects of the steroids. Cardiac patients also take it with caution in consultation with physician

What is Caudal Block injection ?

When injection targeted for epidural space is given through a caudal canal or sacral hiatus (Opening in the sacrum bone of spine) it is called caudal block. The Indications, drug composition (often in larger volumes to reach higher spaces), function and aim of this injection are same as that of epidural injection. However in some cases the injection may not give desired pain relief or the relief may be short lasting. Consult your physician for further details. One shouldn’t have more than 1-2 injections because of the potential side effects of the steroids. Cardiac patients also take it with caution in consultation with physician.

What is Discographyv ?

This is a technique often involved in diagnostic purpose to locate the exact source of pain when a patient has multilevel disc pathology. The source of Back pain is often difficult to ascertain, inspite of having a strong radiological co relation. Injection of radio opaque dye along with local anaesthetic helps to ascertain the concurrence of pain or relief of pain from a particular disc space. Also a dye percolating out of the region of disc space often is taken as a injury to the disc. Though highly sensitive, this diagnostic modality has very low specificity and is slowly losing its sheen as a diagnostic test.

What is Nucleoplasty ?

It’s an injection technique used for Back pain or leg pain of disc origin. When a Slipped disc, contained in the reigns of annulus fibrosus (tough ring like structure limiting the leak of soft jelly of disc) is ascertained as the cause of pain, nucleoplasty injection is indicated. This injection involves inserting a radio frequency probe into the involved disc space under C arm guidance and performing ablation (subjecting disc to very high temperatures localised to disc space) resulting in shrinkage of the disc resulting in reduction in the size of herniation . This technique has its own limitations and has very very specific indications. Consult your physician for further details Sacroilliac Joint injections

SI joints are fairly common source of back and refereed pain in legs. Injections in these joints are routine OPD procedures and and are very safe with promising results in properly indicated cases.