Neck and Back Injections - Dr Craig Harris

CT guided neck and back injections are an extremely safe and modern procedure.

These injections are typically considered when physiotherapy and oral medication have been tried and the pain is still not tolerable. CT guided injections are often performed as pain management before surgery is contemplated or if surgery is declined or not possible.

These injections deliver powerful medications directly to the area that is the source of the pain, and are usually much more effective than oral medication.

In most cases of back pain, CT guided injections may be used to simultaneously identify the cause and to treat your pain.

Dr Harris performs these injections at Synergy Radiology sites.

Types of Injections

Epidural Injection

An epidural injection is a common type of injection that is given to provide relief from certain types of back and neck pain, caused by a narrow spinal canal. The “epidural space” is the space around the spinal sac, just inside of the bony spinal canal. This space runs the entire length of your spine and thus injections here can treat multiple levels.

Perineural injections

Perineural injections deliver the medication around the affected nerve. Along the pathways where the spinal nerves exit the spinal cord, the nerves are susceptible to being compressed, impinged or “pinched” by either a bulging disc or bone spurs. This pressure on the spinal nerves causes inflammation and pain. The pain could affect the back alone or can radiate to the legs, which is known as sciatica.

Facet Joint injections

Facet joint injections are used to localise and treat lower back pain caused by problems of the facet joints. These joints are located on each side of the vertebrae. They join the vertebrae together and allow the spine to move back and forth. Facet joints cause pain from inflammation that occurs in the joint from arthritis and joint degeneration.

Sacroiliac Joint Injections

Sacroiliac joint injections are performed to diagnose and treat lower back pain. The sacroiliac joints are located at the lowest part of the spine, on either side, where the sacrum connects with the iliac (pelvic) bones. Sacroiliac joints can cause pain from inflammation, arthritis or joint dysfunction. Dr Harris performs cortisone injections into the joint as well as prolotherapy of the supporting structures of the sacroiliac joints.

Facet Joint Denervation

Facet joint denervation (also known as neurolysis or neuroablation) is performed by injecting a neurolytic substance to the nerves that supply the affected facet joint. These injections are performed for chronic pain which has not adequately responded to previous cortisone injections of that particular facet joint.

Medications used for the procedure

With most spinal injections a mixture of medications is injected. Local anaesthetic (numbing or freezing medication) is mixed with cortisone (a naturally occurring strong anti-inflammatory). This combination of drugs is injected into a specific area of the spine. The anaesthetic is a fast-acting drug, which will start working before you leave our practice. Thus, we will know if the area we have injected is the source of the pain. The local anaesthetic only lasts a few hours (up to 8 hours). Cortisone is long lasting and may not begin working for several (2-7) days following the injection, but the effects can last for months.

Preparing for a Neck or Back Injection

Please bring your referral (letter from your doctor) and your Medicare and/or Pension Health Care card with you to your appointment. It is important to bring all previous films and reports relating to the region receiving the injection.

You may eat a light meal within a few hours before the procedure. If you are an insulin dependent diabetic, do not change your normal eating pattern prior to the procedure.

Confirm with your local doctor if it is safe to continue taking all your routine medications (such as high blood pressure and diabetic medications) prior to or on the day of your procedure.

You will need a driver to accompany you on the day of the procedure and to be responsible for getting you home.

Please inform the radiographer if you are or if you suspect you may be pregnant.

The Neck and Back Injection procedure

Our highly trained radiographer will bring you into the CT scan room where you will be asked to lie down on the CT table. A quick ultra-low dose planning CT scan is performed. Dr Harris uses these images to plan the procedure.

A skin injection of local anaesthetic (freezing or numbing) is given to the area. Dr Harris then introduces a needle under CT guidance into the area that is considered the source of the pain. Medication is then injected into the area. The medications include an anaesthetic and an anti-inflammatory such as cortisone. The whole procedure usually takes about 5-10 minutes and is generally well tolerated.

After the Procedure

Patients are asked to record the relief they experience after the procedure and keep a record of their pain relief during the next week on a post injection evaluation sheet. A follow-up appointment will be made for a repeat injection if necessary. The back, legs, arms and face may feel weak or numb for a few hours, depending on the type of injection you have. It is best to have someone drive you home as driving is not permitted on the day of the procedure. Patients may return to their normal activities the day after the procedure, including returning to work.

Most patients will experience pain relief immediately after the procedure because of the anaesthetic. The anaesthetic will usually wear off within 8 hours, thus the pain often returns the evening of the procedure. The cortisone usually takes at least 2 days to begin working. Generally it is best to ease back into exercise or more strenuous activities over 1 to 2 weeks as the medication begins to work. However you should also consult your doctor for specific advice to address your individual needs.

Dr Craig Harris suggests that you return to your referring doctor 1-2 weeks following the injection.

FAQs

What is the risk of infection?

If you have a local skin or systemic infection, a spinal injection may put you at greater risk for spreading the infection into the spine. Make sure to tell your doctor if you have any infected wounds, boils, or rashes anywhere on your body.

Can I have a spinal injection if I have other medical conditions?

Injections are usually an elective procedure offered to patients without life-threatening conditions. A medically unstable patient should have his or her medical condition treated before any elective injections are given.

If you have an accompanying medical illness, you should discuss the risks of spinal injections with your physician. For instance, patients with diabetes might experience an increase in blood sugar levels after an injection with cortisone. Patients with congestive heart failure, renal failure, hypertension, or a significant cardiac disease may have problems due to the effects of fluid retention several days after an injection.

How many injections will I need?

The number and frequency of injections depends on the condition we are treating and your specific circumstances, although it is generally considered reasonable to limit the number to three times per year to avoid systemic side effects of the steroids. This is best discussed with your referring doctor, so that we can tailor your treatment to suit your individual needs.

I have seen Dr Harris for an injection in the past; do I need a new referral?

Yes, a new referral is required for each visit.

What are the side effects of spinal injections?

Side effects are minimal and consist mainly of mild tenderness in the area of injection which disappears in 1-2 days. Along with analgesics and physical therapy, spinal injections have brought relief to thousands of patients, avoiding, in the majority of cases, the need for surgery. Adverse reactions and serious complications are very rare.

What are the success rates of spinal injections?

CT guided injections are generally successful in relieving pain for most patients. While the effects of the injection tend to be temporary (one month to one year), injections can be very beneficial in providing relief to patients during an episode of severe back pain and allowing patients to progress in their rehabilitation.