Injection Techniques

Injection of various medications is done around the spine frequently during the course of treatment. Basically, these injections are divided into two types, diagnostic injections and therapeutic injections. Diagnostic injections help physicians better determine your diagnosis, and where your pain is coming from. Therapeutic injections are done to alleviate pain, decrease inflammation, facilitate therapy and exercise and accelerate recovery. In many situations, anesthetic is combined with a steroid preparation in order to obtain diagnostic information and decrease inflammation. We urge you to follow up on this brief discussion by visiting www.recoverycare.com and reading more about the role of injections in your care.

This information can never replace the time spent  face to face with one of our providers, discussing how these procedures may or may not be suitable for your particular problem. We urge you to make an appointment for consultation (901)507-2225, so that we can discuss personally how these techniques may serve to diminish you pain and improve function and quality of life.

Diagnostic Injections

Anatomic areas around the spine such as ligaments,  discs or facets that are causing pain are known as pain generators. By anesthetizing these areas very specifically with a small amount of local anesthetic then monitoring the resultant pain relief by asking a patient to keep a pain diary during their activities or by performing repeated examinations after the injection, a health care provider can determine whether these areas are really contributing to the pain experienced by a patient or not. In addition, injecting radio opaque dye into the disc (discogram) can provide good information as to the internal structure of the disc and whether there are rips or gaps in the retaining wall around the disc (annulus) that might be causing pain (annular tears).

Therapeutic Injections

These injections are most commonly performed around painful nerve roots in order to diminish inflammation, swelling and pain. There are several techniques that can be employed in delivering these medications, however these days therapeutic injections for spinal conditions should only be performed under fluoroscopic guidance where the exact location of the injection can be verified.

Interlaminar Epidural Injections- are performed by placing steroid and anesthetic directly in the midline of the back, into the epidural space between lamina through a ligament called the ligamentum flavum. This type of injection has the advantage of spreading across several segments or levels of the spine, but has the disadvantage that it is much less effective if a patient has had previous back surgery in the area, or if the patient has profound nerve compression which can inhibit the flow of medication. This type of injection can also be very dangerous if the spinal canal has been significantly narrowed by disc tissue or arthritis, in that the added pressure caused by the medication can cause nerve injury.

Transforaminal Epidural Injections- are more specific and target the actual nerve root that is causing pain. The medication is placed slightly more to the side of the spine where nerve roots exit enroute to the extremities. Flow of medication around the nerve root is verified by injecting a small amount of radio opaque dye prior to injecting the medication. An effort is made to place the needle through the "foramen" into the epidural space so that some dye and then medication flows into the spinal canal. These are more effective in postoperative patients because the deliver medication directly to the painful nerve root and avoid to some extent the scar associated with previous surgery. These injections are somewhat more dangerous in the neck because of the chance of injection too close to arteries that supply the head. These injections in the neck area have, on rare occasions caused stroke.

Selective Nerve R0ot Injections- are very similar to transforaminal injections except that the needle is left outside the spinal canal and medication is delivered to the nerve after it leaves the canal only. The volume of injectant is also smaller so that the injection is more specific as a diagnostic tool.

Facet Blocks/Medial Branch Blocks- are injections to alleviate facet pain. These small joints exist between each vertebrae, on either side, more toward the surface of your back than the discs. They often become arthritic and painful either alone or together with the disc and surrounding structures. These joints are loaded, becoming compressed when a patient leans backward or rotates, and are unloaded when they flex forward. Cortisone can be injected directly into the joint or along the course of a small nerve branch (medial branch) that provides sensation for each facet. Because of the redundancy built in to each facet, it is necessary to block several medial branches to treat each facet. It is also necessary to limit the amount of injectant as the facet joints are small, and the joint capsule can rupture if overfilled, generating additional pain and dysfunction. If this injection works temporarily but not for extended periods, a patient may become a candidate for radiofrequency ablation, in which the small medial branch is burned with a small ultrasonic needle.

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                                                    Last modified: 04/04/06