Diagnostic & Therapeutic Injections

Some of the diagnostic and/or therapeutic options available at SpineOne in the management of pain that originates from the spine are the use of epidural injections, facet injections and discography. These techniques have proven to be very successful in the conservative management of certain types of pain originating from the spine.

Epidural Injections

Epidural injections using corticosteroids have been found to be an effective treatment for people who are suffering from some types of low back pain, neck pain and radicular pain (pain in the upper or lower limb due to nerve inflammation in the spine). Lower limb radicular pain is also known as “sciatica.” Commonly, nerves that supply the neck/upper limbs or the low back/lower limbs are compressed and irritated inside the spine by a bulging or herniated disc, an arthritic bone spur, scar tissue or a combination of these factors. This causes the nerve to become irritated, inflamed and swollen; the more swollen it becomes, the more it pushes against local structures setting up an inflammatory reaction/vicious cycle. A corticosteroid is a powerful anti-inflammatory medication that acts to decrease the inflammation and swelling of this nerve, thereby breaking this vicious cycle of swelling and irritation and providing pain relief. The epidural space is an air pocket that surrounds the spinal cord and the spinal nerves. This space can be accessed effectively for depositing anti-inflammatory or other pain relieving medication around the spinal nerves, thereby producing more effective and long-lasting reprieve from some types of debilitating pain. With the use of newly developed x-ray equipment, we can enter the epidural space safely and more precisely from several directions and thus provide more effective coverage of the inflamed nerves.

Facet Injections

Facet injections are effective for some cases of localized low back and neck pain. Small amounts of steroid and/or local anesthetic medication are injected into these small joints on either side of the spine.

If these joints move more easily, allowing the spine to rotate without restriction and without pain, then the diagnosis is made and the injections, if steroid is used, prove therapeutic. If these results are only temporary, then there is a more permanent way to relief using radio waves to burn and destroy the small nerve endings that innervate these joints. These techniques of using radio waves can provide long-lasting relief from pain emanating from these facet joints.

Discography

Discography allows us to understand the role of the disc or “shock absorber” as a pain producer.

Discography is performed via injecting a disc with small amounts of fluid and observing the results along with obtaining pictures of the discs (discograms). By measuring the pressure recorded in the disc at time of injection, how much fluid the disc can hold, and whether the injection allows a build up of pressure reproducing one's pain, we can determine what is generating pain. This pain is produced via pressure on certain types of internal tears of the disc that will cause pain independent of the local structures surrounding the disc (such as the spinal nerves and facets previously discussed). There can be tears inside the disc caused from degeneration or trauma. These tears can weaken the disc and lead to bulging, or these tears can enlarge and allow for herniation of the internal contents of the disc to occur. Bulging discs and herniations of the inner disc materials put pressure on the surrounding nerves and, in the case of the herniation, chemically irritate the surrounding nerves. Discs can eventually flatten with subsequent loss of liquid. People with disc pain can have surgery as an option, but newer less invasive treatments can be offered.

As one can see, we are able to use spinal injections to both diagnose and treat pain of spinal origin through the use of carefully guided needle positioning, proper solutions and deposition of these solutions at precise locations. The use of injections (anesthetic and/or steroid) is also quite useful for many painful musculoskeletal conditions.