spinal injections

Spinal Injections: What Are They and How Do They Work?

The Bureau of Labor Statistics reports that one million back injuries sustained at work account for 20% of all workplace-related injuries and illnesses. This is second only to the common cold. In general, about 80% of the population has suffered from back pain.

For people who have radiculopathy (inflammation or damage to a nerve) or a herniated disc, spinal injections have proven to be one of the most effective treatments.

Needles can be scary, especially if they are meant for the spinal column. But they can be a lifesaver when it comes to back pain management.

Read on to find out what spinal injections are and why you might need one.

What Are Spinal Injections?

Spinal injections are also known as epidural injections. They are similar to the ones pregnant women get during childbirth. These injections are introduced into your epidural space, a space just outside the membrane protecting your spinal cord.

Epidural injections are also given during or after surgery as anesthesia and for treatment of chronic pain. Different medications are administered through these spinal injections including steroids, to manage pain and reduce inflammation in the back, legs, arms, and neck.

Doctors use an X-ray and a special dye to introduce the needle in the right place. This procedure is known as fluoroscopy Depending on where you’re experiencing pain, he or she will choose a location along the length of your spine closest to the inflamed and painful nerve.

The entire procedure takes about fifteen minutes and if you’re being medicated with a steroid, you should start to see the benefits in about 3 days. Pain relief differs in different people but on average it can last for months.

Who Can Get Treated with Spinal Injections?

There’s a wide variety of treatments available for back pain management. But there are certain conditions that are treatable by an epidural injection. They include pinched nerves, radiating pain from the spine, herniated disc and spinal stenosis.

Who Can’t Get Treated with Spinal Injections?

People with certain conditions should avoid spinal injections due to the risk.

These conditions include infections, diabetes mellitus, and blood clotting disorders. Also, people with the bleeding disorder, allergies to anesthetic agents or certain medications, and drug addictions should avoid it.

Depending on your condition, another treatment or pain relief option may be sought for you. Or the doctor may defer your injection until a favorable time.

How Do Spinal Injections Work?

Spinal injections deliver steroids and anesthetic directly into the epidural space. Occasionally, doctors may use a saline solution to flush the area and rid it of inflammatory chemicals in the space that causes the back pain.

Typically, doctors use a combination of cortisone, which is an anti-inflammatory medication and lidocaine, a quick-acting local anesthetic.

In general, spinal injections have two uses.

First, they are a diagnostic tool used to find the source of the pain. This can be in the back, leg, arm or neck.

Second, they help in pain relief. They are usually part of a comprehensive therapeutic program which almost always includes physiotherapy to improve spinal mobility and stability. This can include strengthening and stretching exercises.

Types of Spinal Injections

Spinal injections come in the following categories.

Epidural Injections

These relieve pain that radiates from the spine to an arm or leg. This occurs when a spinal nerve gets compressed or pinched.

Facet Joint Injections

They have both diagnostic and therapeutic value. They are commonly used when pain results from arthritic conditions or injuries. They are also used for pain relief in the neck, middle and lower back.

As a diagnostic procedure, the anesthetic gets injected into a joint or into the nerves that carry the pain signals. If the anesthetic reveals the nerve as the source of pain, then the pain signals get blocked permanently through radiofrequency ablation.

Sacroiliac Joint Injections

These are much like the facet joint injections. The sacroiliac joints are in the lower back, between the sacrum and ilium (pelvic) bones. These joints do cause lower back pain, usually unilaterally.

This injection also has both diagnostic and therapeutic value. To diagnose the pain, the SI join gets anesthetized with X-ray guidance.

This is the gold standard for diagnosing SI joint pain. If the pain improves with the anesthetic, then the pathology is confirmed.

As a therapy, a steroid injection will be given to relieve pain.

Provocation Diskography

This is a spinal injection only used for diagnosing pain. It does not relieve pain but rather causes it. This test gets done for those who have chronic back pain which doesn’t improve with conservative treatment.

Because of its ability to worsen back pain, it’s not performed commonly. But it can be useful for providing information if a surgery is being planned on the lower back.

Risks of Spinal Injections

All invasive procedures carry a certain amount of risk. With a .01 to .001% risk, infections are rare but possible. Bleeding can occur in patients taking certain medications or in people who have clotting, bleeding, and liver disorders.

Dural punctures do occur in 0.5% of the injections, where a doctor may breach the dural space leading to a wet tap that leads to a headache.

Direct trauma from the needle can also cause nerve damage. Yet, this is very rare since the procedure is done under visual guidance.

There may be some side effects of the steroid medication depending on which ones get used instead of the injection itself.

Some of them include severe localized pain which is temporary, headaches that resolve in 24 hours, insomnia, facial flushing, and fever (usually on the day of the injection).

You may also experience elevated blood sugar, anxiety, gastric ulcers, cataracts and a decreased immunity for a brief period.

Following your injection, if you experience a headache that improves on lying down then you may have a Dural puncture. You must relay this to the doctor.

Similarly, if you spike a fever of 101 degrees or more for over 24 hours, lose function or sensation in the extremities, or lose bowel or bladder control, speak to your doctor immediately.


Injections have never been a patient’s best option for getting treatment. But when you overcome your fear, it can be your best bet at getting healed. So, make sure that you consult your doctor about the various options that you have.

If you have any questions regarding the management of your back pain or need information about spinal injections, contact us.

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