Spinal injections are used in two ways. First, they can be performed to diagnose the source of back, leg, neck, or arm pain (diagnostic). Second, spinal injections are used as a treatment to relieve pain (therapeutic).
Most spinal injections are performed as one part of a more comprehensive treatment program. Simultaneous treatment nearly always includes an exercise program to improve or maintain spinal mobility (stretching exercises) and stability (strengthening exercises) (AAOS, 2015).
Back pain is the number-one reason people visit their doctors, and epidural steroid injections have been a mainstay of treatment for short-term pain relief for decades. The injections seem to be most effective for people who have “radicular” pain, or pain that radiates from the spine to a leg or an arm, caused by a herniated disc.
For many people, back pain goes away on its own or with nonsurgical treatments. Epidural steroid injections shouldn’t typically be used as a first-line therapy for back pain relief, but that doesn’t mean they can’t play a role in treating pain. But injections won’t cure the underlying cause of back pain, and they provide only temporary relief. Unfortunately, in many cases, chronic back pain can’t be cured, but must instead be managed, like other chronic conditions—and patients must have realistic expectations of what epidurals can do.
Epidural Injections
Epidural injections are used to treat pain that starts in the spine and radiates to an arm or leg. Arm or leg pain often occurs when a nerve is inflamed or compressed (“pinched nerve”).
Epidural injections involve injecting an anesthetic and an anti-inflammatory medication, such as a steroid (cortisone), near the affected nerve. This reduces the inflammation and lessens or resolves the pain. This type of epidural injection is a therapeutic one.
Sacroiliac Joint Injections
SI joint injections are similar to facet joint injections in many ways. The SI joints are located between the sacrum and ilium (pelvic) bones.
Problems in the SI joints have been shown to cause pain in the low back, buttock, and leg. Typically, one joint is painful and causes pain on one side of the lower body. It is less common for both SI joints to be painful at the same time.
This joint can also be injected for both diagnostic and therapeutic purposes. Anesthetizing the SI joint by injection under X-ray guidance is considered the gold standard for diagnosing SI joint pain. A diagnostic injection of the sacroiliac joint with anesthetic should markedly diminish the amount of pain in a specific location of the low back, buttock, or upper leg.
A therapeutic injection will typically include a steroid medication, with the goal of providing longer pain relief.
Facet Joint Injections
Facet joint injections can also be done for both diagnostic and therapeutic reasons. These types of injections are often used when pain is caused by degenerative/arthritic conditions or injury. They are used to treat neck, middle back, or low back pain. The pain does not have to be exclusively limited to the midline spine, as these problems can cause pain to radiate into the shoulders, buttocks, or upper legs.
For diagnostic purposes, facet joints can be injected in two ways: injecting anesthetic directly into the joint or anesthetizing the nerves carrying the pain signals away from the joint. If the majority of pain is relieved with anesthetic into the joint, then a therapeutic injection of a steroid may provide lasting neck or low back pain relief.
If anesthetic injections indicate that the nerve is the source of pain, the next step is to block the pain signals more permanently. This is done with radiofrequency ablation, or damaging the nerves that supply the joint with a “burning” technique.
Provocation Discography
Provocation discography is a type of spine injection done only for diagnosis of pain. It does not have any pain relieving effect. In fact, it is designed to try to reproduce a person’s exact or typical pain. This is to find the source of longstanding back pain that does not improve with comprehensive, conservative treatment. Discography is performed much less commonly than the other types of spinal injections reviewed above. It is often used only if surgical treatment of low back pain is being considered. The information gained from discography can assist in planning the surgery.
Discography involves stimulating and “pressurizing” an intervertebral disc by injecting a liquid into the jelly-like center (nucleus pulposus) of the disc. More than one disc is injected in order to distinguish a problem disc from one without symptoms. Criteria are used to identify a painful disc by provocation discography, including the type and location of pain and the appearance of the disc on an X-ray after the procedure.
Patients may be asked to change into a hospital gown, which allows for access to clean the injection area and to allow the physician to easily visualize the injection site. An epidural steroid injection usually takes between 15 and 30 minutes and follows a relatively standard protocol:
Meet
Dr Hamid Mir is a board certified orthopedic spine surgeon with fellowship training in combined neurosurgery and orthopedic spine surgery. He has offices in OC, Los Angeles & Riverside. Dr Mir specializes in spinal fusion, lumbar surgery and treating trauma as well as other conditions affecting the lumbar, thoracic, and cervical spine including degenerative diseases, stenosis, fracture, infection, adult scoliosis, revision, and complex reconstructions.
Testimonials
I was in a very bad situation with a herniated disc in my lower back so I made an appointment with DISC spine center and Dr. Hamid. He was very professional and made me comfortable that he understood exactly what I was going through and was able to communicate effectively exactly what it will take to get me on the road to recovery after spine surgery. It took several months as my injury was severe however I always felt I was in good hands under Dr. Hamid’s supervision…If you ever have the misfortune of injuring your circuit board of your body (spine) you need a pro, do not take advice from anyone who’s not specifically licensed to help, Dr Hamid is who I chose and I’m very thankful.
Dr. Mir saw me about 2 months before the spine procedure and indicated that I had severe stenosis or narrowing of the openings where the nerve roots exit at the L4, L5 and S1 level. He reviewed my MRI and without wasting any time, asked if I wanted or was considering spinal surgery. He was extremely clear and answered all my questions. I had the procedure done at the Disc Newport OP surgery spine center and was cared for by an incredibly competent, caring staff. I was discharged same day and my post op recovery was 2 weeks, and returned to daily activities and work July 15th. The procedure was very successful as my back pain is basically gone. Amazing relief from a procedure done by a great surgeon with a great team!
Dr Mir is an excellent spine surgeon. I had a surgery on my neck by another surgeon but I was still in pain. A friend who had prior spine surgery with Dr. Mir recommended him to me. As the treating surgeon he was very detail oriented, confident, and knowledgeable. His team is very friendly and helpful. I decided to have a second cervical spine operation on my neck. Soooo thankful I have no pain and for physical medicine doctors like him.
Dr. Mir and his entire team of specialists take the extra time and consideration to shape alternatives to meet the needs (holistically) of the patient. Everything about the experience of my surgery was positive. Dr. Mir is a patient and compassionate surgeon. His communication skills are remarkably attentive. We are six months out of the starting gate from surgical treatment, and with PT and core strengthening exercises, this 65 yr. old is back to regular training for next year’s marathon. Thank you kindly El Doc-tor….you are amazing! See you soon.
Dr. Hamid Mir is a member of American Board of Orthopedic Surgery with fellowship training in combined neurosurgical and orthopedic spine surgery at Cedars Sinai Medical Center in 2004. As a top rated spine surgeon, he specializes in cervical, thoracic, and lumbar spine diseases including degenerative, stenosis, fracture, infection, scoliosis, revision, and complex reconstructions.
Dr. Mir focused his practice on minimally invasive techniques. As Medical Director of DISC Sports & Spine Center, Dr. Mir is at the forefront of the field of minimally invasive spine surgery. The benefits of these techniques include less post-operative pain, quicker recovery reduced blood loss, less soft tissue damage, smaller surgical incisions, less scarring and improved function.
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