General Questions about Spinal Injections
1)
What kind of injections are we talking about?
There are three different types of injections we are currently talking about.
a)midline epidural injection
b)foraminal epidural injection
c)facet joint injections
2)What is the difference between these injections?
We are really talking about two different types of injections. One is an epidural injection and the other is a facet (pronounced fa-set') injection.
The midline and foraminal (or transforaminal) are two approaches to the same epidural space. While a doctor may choose one over the other in a specific patient, as of now, there is no difference with regard to coding or charges.
The facet injection is done into a joint which may be injured or have arthritis.
3)Why are these injections done?
A)Epidural injections are performed for two main reasons
1.herniated disks when a disk is injured and protruding back toward the nerve coming out of the spine.
2.spinal stenosis (stenosis means narrowing) When the space for the spinal nerves is narrowed by overgrowth of the bone, causing impingement (pinching) on the nerves. This is frequently caused by arthritis or injury to the facet joints. Think of an elderly arthritic hand with swollen joints. The same type of swelling can take place in the spine.
B)Facet injections are performed for pain due to injury or arthritis of the facet joints. Because these joints lie close the exiting nerves, the pain may be also referred to other areas of the body, depending on where these nerves ultimately go. In other words, pain in the legs may occur in cases of herniated disk as well as in cases of facet injury.
4)How do these injections work?
These injections do not cure the disk herniation or shrink spinal stenosis. However, most of the pain is due to swelling and irritation of the nerves due to inflammation. Steroids work to decrease inflammation. It is felt that placing steroids as close as possible to the affected nerve works better than giving the steroid in the form of a pill or shot. This allows for less total medication with maximal benefit. After an injection, as the inflammation starts to decrease, a second injection may be even more effective. These procedures are frequently given in a series of three, 1-2 weeks apart.
5)Do these injections work?
Most of the time, patients improve. The longer the pain has been present, the harder it is to treat. If there is severe compression of the nerve, surgery may be the only effective treatment However, most of the time, steroid injections should be tried first, because it is not always possible at this time to predict who will benefit and avoid surgery.
6)Are these injections dangerous?
With proper technique, spinal injections are very safe. Damage to the nerves or spinal cord is very rare. A complication called a spinal headache occurs about 1% of the time, and is not serious and can be treated. Bleeding or infection around the spinal cord is very serious, but is extremely rare.
7)What drugs are given?
Steroids are what cause the decrease in inflammation that helps the symptoms. Unfortunately, pain relief may not occur for a few days. Frequently, a small dose of local anesthetic is injected which may cause immediate, but temporary pain relief. Some physicians may also start an intravenous to give fluid or sedatives. This is not usually necessary.
8)Are there side effects of the drugs?
Steroids may cause diabetics to have elevated levels of blood sugar. Diabetics may need to closely monitor this for several days after an injection. While it is rare for anyone else to have any problems from the steroids, if they develop an illness or require surgery within a few months, they should tell their physician that they had these injections. Local anesthetics may affect the patients' muscles for a short time, so they may feel less stable on their feet. Also, tingling is normal in the legs for a short time. Sedatives may cause drowsiness or lightheadedness.
9)Does the injection hurt?
Before the injection, your skin will be frozen with lidocaine. You can expect to feel moderate pressure. While sedatives can be given, this is not usually necessary.
10) When can I resume normal activities?
The day of the injection, you should not drive, operate machinery or make important decisions. This is especially true if you receive sedation. You should drink plenty of fluids and eat lightly. You can resume all activities the following day.
11) Can I eat before the injection?
Yes but lightly, and at least 2 hours beforehand. If you receive sedation, these guidelines may not be accurate. You may be required to have no solid food for 6 hours, at least.
12)How long will the entire procedure take?
The actual procedure time may be from 10-20 minutes, on average. You will probably be ready to leave within 30 to 60 minutes after the injection.
