Injections under Fluoroscopy
Using injections for back pain relief
Spinal injections are relatively conservative procedures used in the diagnosis and treatment for low back pain and radicular (leg) pain. They are often used in conjunction with oral medicines and physical therapy, especially if the back or radicular pain is severe. They are often recommended prior to considering surgery. In the majority of cases, surgery can be avoided with the use of spinal injections along with physical therapy and oral medications.
At Orthopaedic Specialists of the Carolinas, the spinal injections are performed using fluoroscopic guidance (live x-ray). This not only increases patient safety but allows the physician to use very small gauge needles, making the procedures much more comfortable for the patients.
How injections relieve back pain
For pain relief, injections can be more effective than an oral medication because they deliver medication directly to the anatomic location that is generating the pain. Typically, a steroid medication is injected to deliver a powerful anti-inflammatory solution directly to the area that is the source of pain. Depending on the type of injection, some forms of low back pain relief may be long lasting and some may be only temporary.
Injections to diagnose causes of back pain
Diagnostically, injections can be used to help determine which structure in the back is generating pain. If an anesthetic (numbing medication) is used, and the patient feels relief after an anatomic region is injected (e.g. facet joint or sacroiliac joint), it can then be inferred that the specific region is the source of the pain. When considered in conjunction with a patient's history, physical exam, and imaging studies, injections used for diagnostic purposes can be very helpful in guiding further treatment. Some injection procedures, such as discography or nerve blocks are helpful and used in planning where the surgeon should operate, if that is a consideration.
Different kinds of injections for pain relief
Epidural steroid injections
Epidural injections are used to treat radicular pain caused by nerve irritation. This type of pain is usually caused by herniated disc or spinal stenosis. A herniated disc occurs when pressure or degeneration produces a tear in the disc's outer ring (the annulus), and some of the nucleus ruptures (squirts) into the spinal canal. The bulging disc can protrude into the spinal canal, placing pressure or causing a chemical inflammation of the spinal nerve roots. Spinal stenosis is a narrowing of the spinal canal that can cause pressure on the spinal cord and spinal nerves. It may be necessary to have more than one epidural injection over a period of a few weeks or months to see a full benefit. It is not uncommon to have up to three lumbar epidural injections, for a specific episode of back and radicular pain, although most patients require only 1-2 epidurals to relieve their radicular pain.
Facet Joint Injections and facet nerve blocks
Twisting injuries can cause damage to one or both facet joints, and cartilage degeneration associated with aging may also cause pain. Facet joint injections and nerve blocks are helpful in the evaluation and treatment of low back pain due to arthritis of the spinal facet joints. The medication is injected into and/or around the joint to reduce the inflammation in the joint. Diagnostically, the injections are sometimes aimed at the small nerves that supply the joints to see how much relief you may get. Facet blocks are a diagnostic tool used to isolate and confirm the specific source of back pain for the patient. Additionally, facet blocks have a therapeutic effect as they numb the source of pain and soothe the inflammation for the patient.
Selective nerve root block (SNRB)
Another common injection, a selective nerve root block (SNRB), is primarily used to diagnose the specific source of nerve root pain and, secondarily, for therapeutic relief of low back pain and/or leg pain. When a nerve root becomes compressed and inflamed, it can produce back and/or leg pain. Occasionally, an imaging study (e.g. MRI) may not clearly show which nerve is causing the pain and an SNRB injection is performed to assist in isolating the source of pain. In addition to its diagnostic function, this type of injection for pain management can also be used as a treatment for a far lateral disc herniation (a disc that ruptures outside the spinal canal).
Hip joint injections for pain relief
The hip joint is where the leg joins the pelvis. Arthritis, injury or mechanical stress, can cause hip, buttock, leg or low back pain. A hip joint injection may be considered for patients with these symptoms. The injection can help relieve the pain, as well as help diagnose the direct cause of pain.
Hip joint arthrograms involve injecting medicine directly into the joint under fluoroscopic guidance. These injections can help diagnose the source of pain, as well as alleviate the discomfort:
- Diagnostic function: By placing numbing medicine into the joint, the amount of immediate pain relief experienced will help confirm or deny the joint as a source of pain. If complete pain relief is achieved while the hip joint is numb it means this joint is likely to be the source of pain.
- Pain relief function: Along with the numbing medication, time-release cortisone is also injected into these joints to reduce inflammation, which can often provide long-term pain relief.
