Having an injection in your spine can be a frightening idea. However, the techniques have been developed at the London Spine Clinic to ensure that this is as safe as possible and painless for the patient. All spinal injections are performed in a sterile environment, using the facilities of an out-patient operating theatre. This allows accurate placement of the needle using a C-arm (low dose x-ray machine) and allows the anaesthetist present to sedate the patient if required. Injections can be painful, but as almost all our patients chose to have sedation, which involves an injection into a vein in the hand or arm, the patient sleeps through the procedure and wakes to find it is over.
They can be used to help diagnose where pain is coming from, or to treat pain, or both. For example, if a person is suffering from pain in the arm and an MRI scan shows that several levels (discs and/or joints) in the neck are damaged, a local anaesthetic injection at the point where just one nerve leaves the spine, would tell if that is indeed the source of pain.
Most spinal injections are performed using steroids. The aim of this is to suppress the inflammation which causes a lot of the pain and which is often responsible for "switching off" the muscles which normally support the spine. By reducing this inflammation, the muscles can be made to work again, using the right physiotherapy techniques and the patient should get good relief, long after the injections wear off.
Spinal steroid injections are an "off-label" use of these drugs, meaning that the original licensing of the medication did not include these techniques. However they have been used in this context for decades, with good results and a low side-effect profile. Please speak to your doctor if you want more information on this.
If a patient has a steroid injection and gets a good result, but the pain returns after a few weeks, it is worth considering radio-frequency (RF) treatment. This is another needle technique, but, instead of injecting through the needle, a radio-frequency probe is inserted to the necessary point. This is then connected to a pulse generator, which makes the tip of the probe vibrate at a very precise frequency and intensity. This vibration can be used either to heat the tissue and thereby kill off areas causing damage, or to pulse the treatment to assist healing. RF has been used for many years in the management of spinal pain and other related problems. The same technique is used in the functional neurosurgery in the brain, to treat Parkinson's disease and other conditions.
X-ray view of an injection into the left sided facet joint at the L5/S1 level at the base of the spine. Note the almost vertical line of contrast (Black arrow) within the joint and the leakage of the contrast under the capsule covering the joint on its right side (White arrow) and leaking out below the joint (Blue arrow). This shows how damaged the joint is.