Spinal Injections for Back Pain


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What are spinal injections?
Types of spinal injections
Epidural spinal steroid injections
Selective nerve root block
Facet joint injection
Sacroiliac joint injection
Stem cell for back pain
What if spinal injections don't work?

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Spinal injections are among the most popular treatments for back pain. They can provide the type of relief that lasts for days or even months, giving those who suffer from significant back problems the freedom to lead their lives without the specter of back pain hanging over them. Before you seek out these injections, though, it's important that you understand what they are and how they can work for you.

What Are Spinal Injections?

There are several different spinal injections available for individuals, each of which have their own unique benefits. These spinal injections are usually part of a two-pronged system, used both for the diagnosis of specific back issues and also for the treatment of those same issues. They are rarely the only type of treatment used, but they do tend to bring immediate relief to patients who might be in desperate need of it. When combined with a physical rehabilitation regimen, they can provide a long-term solution for back or neck pain. From spinal injections for degenerative disc disease to injections to treat sciatica, they can play a significant role in increasing an individual's quality of life.

Types of Spinal Injections

The various types of spinal injections discussed below are used to treat specific conditions, to diagnose certain types of spinal injuries or damage, and to help both doctors and patients get a better handle on back health. These treatment options include epidural spinal steroid injections for back and neck pain, selective nerve root blocks, facet joint injections, and sacroiliac joint injections. Each of these injections differ in the type of pain they are used to treat and the location in which the injection is made, but they all work to relieve the pain of those who might otherwise have few options to relieve their suffering. 

Epidural Spinal Steroid Injections for Back Pain

Epidural spinal injections for back pain are common outpatient procedures. They take place exactly where the name of the procedure indicates - in the epidural space. This space is in proximity to spinal discs and nerve roots, and using injections in the area makes for an ideal way to treat a variety of different types of pain. Individuals who make use of this type of injection tend to suffer from nerve pain, which can express itself not only in the upper and lower back but also in the neck. 

The various types of epidural injections help to treat specific causes of nerve pain and also help to deal with pain in specific parts of the back and neck. Some of these injections are used as diagnostic tools on the part of the physicians who treat the patient, while others are used simply as tools to help bring pain relief. Each, however, is valuable in its own right.

Lumbar epidural steroid injection

This type of epidural injection takes place in the lower back. This region, called the lumbar region, can often be the site of pinched or compressed nerves. The injection is given in the epidural space in order to reach the nerve canal, the region of the back that is the location of the pinched nerve in question. The procedure for the injection does tend to be brief and it is guided by advanced X-Ray imaging called fluoroscopy, as are all spinal injections. In this case, the injection is used to treat pain in either the leg or the lower back.

Lumbar transforaminal epidural steroid injection

As you might be able to tell from the name, this type of injection takes place in the same general part of the back as above. Instead of simply going into the nerve canal, though, the shot goes to an opening on the side of the spine known as the foramen. Using this location allows for the injection of a steroid close to the nerve root, which can help to reduce swelling in this area and bring relatively long-term relief when properly paired with exercise and therapy.

The lumbar transforaminal epidural steroid injection is usually used to treat both general back pain and lower back pain. In many cases, this is also the type of injection that is used to treat pain from sciatica. The treatment might involve a needle, but it is fairly revolutionary when compared to some of the older treatments that were used to deal with these issues. It only takes a few days for the steroids used here to start working, and the end result is far lower risk than those of some of the earlier invasive options.

Caudal epidural steroid injection

This type of spinal injection is given at the bottom of the back, given near the coccyx (tailbone). Like the other types of epidural steroid injections, the target is the spinal nerves. In this case, the needle is used to access an area known as the sacral hiatus that is above the coccyx, and the steroid is injected directly into the pinched nerves near the very lowest part of the spinal canal.

The pain that is targeted in this case tends to be in the lower back, though it can also be administered to deal with chronic pain in the legs. Chronic tends to be the active word here, as the injection is almost always used to deal with chronic pain in either of the areas. It typically takes a few days for the steroid to work to reduce pain in either location, though there is usually some immediate relief due to the numbing agent used during the procedure.

Cervical epidural steroid injection

This type of injection is not actually given in the back, but rather in the neck. During the procedure, the needle will be used to access the epidural space, with fluoroscopic guidance. The steroid here will be used to reduce inflammation and to provide relief for the patient, allowing improved pain level, activity and function. 

This type of injection is used to treat pain in the shoulders, neck, and arms that tend to be caused by either a compressed nerve or multiple compressed nerves in the upper spine. The pain here can actually come from issues like herniated discs or from spinal stenosis, and providing relief for the pain can be a life-changing process. As with the other types of injections, there is a waiting period between the injection itself and pain relief - generally up to a week, as the steroid goes to work reducing inflammation. 

Thoracic epidural steroid injection

Rather than targeting the spine at the lower back or up towards the neck, this is more of a mid-back injection. It's generally the same type of procedure as you'd see in any of the others listed above, but with the more specific target of the nerves that impact your thoracic region. The causes of the pain in this region are especially varied, ranging from disc herniation and injury to spinal stenosis and certain problems that occur after spinal surgery.

This is another type of injection that is not necessarily used to treat back pain. While it can be used to deal with general upper back pain, it has a tendency to be used to treat pain in the flank and the abdomen. As with the other types of injections, you'll largely look to see an improvement in your condition after a few days, though you may receive some immediate relief simply due to the use of the local anesthetic.

Selective Nerve Root Block

A selective nerve root block can be both diagnostic and therapeutic. Though it can be used as a form of treatment for nerve pain in the arm or leg, it is the procedure's utility as a diagnostic tool that tends to be the most valued. This is a fairly advanced procedure as compared to the epidural procedures listed above, as the diagnostic response to the procedure can be used to help isolate a specific root cause of the pain, and guide a spine surgeon to a specific target point for minimally invasive spine surgery.

Nerve block injection in spine tends to be very precise and diagnostic because they take place directly next to the nerve root itself, which can be the underlying source of the pain. This type of injection can also be a good alternative to epidural steroid injection when a single nerve root is suspected to be the underlying pain generator, or when epidural steroid injection has not resolved the pain in the past.

Facet joint injection

The facet joints are joints that lie on both sides of the spine. As you might imagine from the name of this particular injection, facet joint injections are made in these joints. These injections are often used for individuals who experience long-term back pain, especially when that pain occurs after some type of back injury or with age related degeneration. In many cases, this type of injection is not only a method of treatment but also a method of diagnosis when trying to determine the cause of the pain.

A facet joint injection can be a good choice for many patients who are still in the process of determining why they have back problems. Because the numbing agent itself can help to quickly and easily provide at least an initial diagnosis, the procedure is one of the few diagnostic methods that can also provide immediate relief for an individual. The longer-term, but still transient, relief that is provided by the steroid is also a good way to help an individual who might otherwise be suffering from an undiagnosed type of back pain.

In common diagnostic procedures, a medial branch nerve block is performed, targeting the individual sensory nerve that senses pain is a given joint or sets of joints in the spine. If there is temporary relief with this set of injections, the diagnosis of facet joint pain is made, and the lasting treatment recommended is radiofrequency ablation of the sensory nerve. This treatment can relieve spinal joint pain for 6 months to up to 18 months.

Sacroiliac Joint Injection

The sacroiliac joint injection is a fairly common type of injection that is used to treat low back and hip pain. As the name would suggest, this injection is given in the joint that connects the sacrum to the hip. These joins lie close to the spine and represent an ideal area for this type of injection. Though it has quite a bit in common with several other types of injections, this method does have fairly specific uses. 

This type of injection has three different uses for back pain. One of the most common is for the treatment of lower back pain, but the injection itself can also be used as a tool to diagnose the cause of such pain. Sacroiliac joint injections are fairly common procedures for those who receive treatment for chronic lower back pain, especially when they reach the point where their pain begins to interfere in their daily lives. 

The sacroiliac joint injection tends to be effective in two different ways. The first, and the most immediate, is due to the local anesthetic used in the procedure. This provides an immediate, albeit temporary, form of relief to the patient. While this does wear off quickly, the second element of the injection tends to provide much more lasting relief. Like many other injections, the use of a steroid here helps to reduce inflammation and allows for a great deal of pain relief after a few days. As such, it is considered to be a solid alternative for some individuals who experience both chronic and acute back pain.

Stem Cell Therapies for Back and Neck Pain

Regenerative medicine and stem cell therapies are the cutting edge when it comes to dealing with low back and neck pain, as well as joint pain and musculoskeletal conditions. These treatments are still emerging and being evaluated in many areas, and should be considered experimental, as they are not yet FDA approved. When utilized for the proper p

Stem cells are undifferentiated cells that haven't yet been put to a specific purpose. They may become another type of cell in the future, but in their current state they merely have potential. This, combined with their ability to repair other cells, gives them the potential to repair other damaged part of the body and take on an important role in pain management.

Two types of regenerative medicine therapy offered are amniotic tissue therapy and placental tissue matrix therapy. These products are derived from healthy donors at the time of birth, without harming the mother or baby. They are medically sterilized and “immune-privileged”, meaning they do not produce an immunologic rejection response. When injected into the targeted area at the root cause of a painful condition, these tissues, biologic proteins and growth factors have healing properties that help regenerate tissue, improving pain over the long term. Stem cell therapies have a great deal of potential when it comes to dealing with issues like herniated discs or as spinal injections for degenerative disease, but at present should be considered in only limited conditions and patients, and are new, emerging treatments considered “off label” by the FDA. While research is still ongoing, it does seem safe to say that this type of procedure will have a huge impact on future treatments. 

What if Spinal Injections Don't Work?

In some cases, getting epidural spinal injections for back pain might not help. Spinal injections for degenerative disc disease might not be for you, for example, and you'll need to look at alternatives. Choosing the right pain management options is important, and getting injections isn't your own choice. You may benefit more from therapy, for example, or from regenerative techniques that can help you to better combat the root causes of your back problems. No matter what your choice, it's important that you work with professionals like the ones here at Pinnacle Pain & Spine to help ensure that you find an adequate way to deal with both your back issues and the impact that back pain has on your life.


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