Injections in the back

What are: Intrathecal / perineural / epidural injections?

It is a medical procedure performed in non-hospitalized patients which is basically an injection of a mixture of drugs (steroids and anesthetics) into the spine.

The drug can reduce the swelling and relieve the inflammation of the irritated spinal nerves. This procedure is performed to relieve low back pain but mainly the pain that goes down to the leg from the lower back (sciatica).

The whole process takes only a few minutes.

How exactly is the intrathecal epidural injection done?

During the preparation, the patient lies on the bed with his head down. A cushion is placed under his abdomen, which enables the spine to bend in a way that opens the spaces on the sides of the spine. These spaces are called the foramina.

Then a local anesthetic is administered to numb the area so that the patient does not feel any more stings.

When the area is completely numb, the doctor carefully guides a needle – under X-ray (or ultrasound) guidance – right next to the irritated nerve root. Reaching its target, a small amount of contrast solution is injected to outline the nerve and confirm the correct placement of the needle. Only then does the doctor inject a steroid-anesthetic medication that “bathes” the roots of the irritated nerves.

How long does the perineural injection last?

This immediately relieves patient’s pain. Some patients may need multiple injections before feeling the full benefits of this specific treatment. The benefit lasts from few weeks to several month, depending on the severity of the underlying pathology.

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Does intrathecal injection hurt?

In most patients, simple local anesthesia is sufficient. In some cases with special sensitivity to stings or with extreme fear of needles, mild sedation may be required.

Can epidural injections be repeated?

Your doctor, depending on the response to the first injection, may suggest a repeat injection. In general, it is useless to keep repeating epidural injections if the problem persists. In this case, its final (surgical) treatment is usually recommended. In case this is not possible due to poor health, up to 3 injections per year can be repeated.

What is Facet Joint Syndrome?

It is a condition of severe degeneration (arthritis and inflammation) of the small joints in the back of the spine.

Normally, these joints have two cartilage-lined surfaces surrounded by a lubrication capsule that allows the vertebrae to bend and twist.

The syndrome occurs when these joints wear out, become inflamed and eventually develop severe arthritis with osteophytes. As a consequence, back pain occurs which worsens with movements, is more intense in the morning and makes it difficult to stand up from a sitting position.

How is Facet Joint Syndrome treated?

The syndrome is initially treated conservatively with rest, warm compresses, anti-inflammatory drugs and physiotherapy.
In cases where the pain does not respond to conservative treatment, injections into the joints are recommended not only to confirm the diagnosis, but also to treat it.

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What are the Facet Joint Block Injections?

During the preparation, the patient lies on the bed with his head down. A cushion is placed under the abdomen, which causes the spine to bend in a way that opens the facet joints.

Then a local anesthetic is given to numb the area so that the patient does not feel any more stings.

When the area is completely numb, the doctor carefully guides a needle – under X-ray (or ultrasound) guidance – right into the joint. Reaching its target, a small amount of contrast solution is injected to outline the joint and confirm the correct placement of the needle. Then, the doctor injects a steroid-anesthetic medication that acts for a long time on the joint, soothing the inflammation.

How long does it take for the intra-articular injection to affect the facet joints?

The local anesthetic immediately relieves patient’s pain. The maximum benefit from the action of the corticosteroid appears 5-15 days after the infusion.

Does facet injection hurt?

For most of the patients, simple local anesthesia is sufficient. In a small percentage, with a special sensitivity to stings or with extreme fear of needles, you may need mild sedation.

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Can facet injections be repeated?

Your doctor, depending on the response to the first injection, may suggest a repeat injection. Some patients may need multiple injections before feeling the full benefits of this treatment. Up to 3 injections per year are allowed. Alternatively, the joints can be denervated using special needles for longer lasting results.

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