A Patient’s Guide to Spinal Injection Procedures
What is a Spinal Injection?
The injection you may undergo is performed to address a painful spinal condition or injury. Following a thorough your evaluation at Newton Wellesley Interventional Spine, we will determine whether or not such an injection is appropriate for you. This determination is made by objective findings such as your physical examination, test results, and radiology studies (MRI, CT Scan, Bone Scan) as well as subjective information (the actual symptoms and pain you are experiencing). We then decide which specific injection you should receive.
We perform the spinal injections under x-ray guidance, also known as fluoroscopy. Our Fluoroscopy is a state of the art equipped with Digital Subtraction technology, necessary to perform safe and accurate needle positioning and accurate injections. The benefits of completing the injection under the new generation fluoroscopy with Digital Subtraction are the reduced risk of complications and improved chances of positive results.
What Medication Do I Get During the Procedure?
Generally, three different substances are injected during the injection procedure. Local anesthetic is used to numb the area, contrast agent or dye to outline structures in your spine, and steroid to reduce inflammation and pain. You must immediately inform the treatment team of any known allergy to one of these medications. If you are allergic to the contrast dye, or if you have a history of allergic reactions to seafood, shellfish, or iodine, we can substitute a different type of contrast agent for the procedure.
Are There Different Types of Injections?
A variety of injections are performed and each is directed at specific structures within your spine. All of the injections fall into one of two general categories: diagnostic and therapeutic. Diagnostic injections are test injections of contrast and local anesthetic designed to help pinpoint which structure in your spine is causing your pain. Sometimes the exact location of where your pain is coming from is not evident by our clinical examination and other diagnostic testing. In order to be effective, a diagnostic injection must be performed while you are experiencing your usual amount of pain or discomfort or while you are at least able to consistently provoke your pain by certain movements or positions. During the procedure, the local anesthetic will be injected at the site most likely to be causing your pain. Shortly thereafter, you will be assessed to determine whether the anesthetic reduced your level of pain. It is important to remember that diagnostic injections are tests and not intended to treat your condition.
Once the local anesthetic agent has worn off (within one hour) your usual symptoms will return.
You may require more than one diagnostic injection according to how you respond to each injection. If you have a positive response (your pain was significantly reduced within 10 minutes after the injection), you will then undergo therapeutic injections. If you do not experience pain relief, another diagnostic injection will be required.
Therapeutic injections differ from diagnostic ones in only one way. In addition to a local anesthetic and contrast dye, a therapeutic injection incorporates a steroid. The steroids used in these injections do not build muscle, and are not the kind that bodybuilders and athletes take. The purpose of the steroid is to reduce inflammation, thereby decreasing your pain. The therapeutic injection will not give immediate relief of your symptoms. The steroid effect begins anywhere from 4 to 6 hours to one week after your injection. It typically provides gradual but steady relief of your symptoms. It is not a “quick fix,” and studies have consistently shown that 2 or more injections may be necessary to successfully treat your painful symptoms.
The injections performed are just one component of a complete Spine Care Program. They are used in conjunction with oral anti-inflammatory medications, Physical Therapy, activity modification, and occasionally behavioral interventions to maximize the probability of an optimal outcome. Therefore, you should continue doing everything you were instructed to do in your initial evaluation, unless told otherwise by your care provider.
What Happens After the Injection?
After your injection is completed, you will be monitored for a short period of time to ensure that you’re safe to dress and leave the facility. It is not uncommon for some patients to experience numbness or weakness after the injection. This is due to the anesthetic and will wear off within a short period of time. If this occurs we will monitor your symptoms until they resolve.
What Can I Expect?
Patients may experience a transient increase in pain for the first 24- 72 hours after the injection. This occurs because a volume of substance is injected in close proximity to an inflamed structure. If you experience a flare of your symptoms, you should not be alarmed. Your symptoms should gradually diminish over 2 to 4 days after the injection as the steroids gain their therapeutic effect. Occasionally it takes up to 1 week for symptoms to abate. You may also notice some tenderness at the needle insertion site. Should you experience this discomfort, you can place an ice pack on the area and take extra-strength Tylenol to reduce the discomfort.
Studies found that after therapeutic injections, approximately 10% of patients will experience a non-positional headache and/or vocal hoarseness that completely resolves within 24 hours, as well as some might experience within 24-72 hours mild nausea, facial flushing, low grade fever, sweating and difficulty sleeping. These symptoms are transient and benign side effects related to steroids. These symptoms are usually managed effectively by Tylenol every 6 hours as needed throughout the day and Benadryl
The above-mentioned side effects are not a reason to cancel your subsequent injections. Rather, your follow-up injections should be canceled if you have 85-100% symptom relief, on a consistent basis, which lasts up to the day prior to your next injection. You should then call our office and speak to us to determine whether your repeat injection should be canceled.
The expected success rate for these injections depends on your diagnosis. You should be aware that the procedure might be ineffective. It should also be noted, that the duration of the procedure’s effectiveness is largely unpredictable. However our goal with the injections is to have significant sustained improvement that enables you to resume activities of daily living and to engage in safe exercise program.
Can All Spine Problems be treated by an Injection?
The injections we perform are not appropriate for everyone. It is conceivable your condition cannot be treated by non-surgical measures. If this applies to your situation, surgery may then be recommended. Likewise, if there are no medical remedies for your condition, you will be apprised of that opinion at the time of your initial evaluation or after further diagnostic testing.
Should I Do Anything to Prepare for the Procedure?
If your procedure is scheduled for the morning, you should have a light breakfast such as fruit and toast, or cereal, nothing heavy. Those patients scheduled for afternoon procedures should eat a normal breakfast and a light lunch, such as a sandwich and soup. You make take your regularly scheduled medications, however there are a few exceptions:
- Anti-coagulant medications such as Coumadin, Heparin, Lovenox, Fragmin, or Plavix must be held prior to your injection. The appropriate timing of when to hold these medications will be decided in conjunction with your prescribing physician. There are new anticoagulants on the market, if you are not sure whether you are taking an anticoagulant or not please inform the treatment team.
- Anti-inflammatory medications and aspirin do not need to be held.
- Pain medication should be held for 12-24 hours before a diagnostic injection, but not prior to therapeutic injections.
You should arrive at the office 30 minutes prior to your scheduled injection appointment time. After checking in, for neck injections, you will change into a patient gown and be escorted to the fluoroscopy suite, where the injection is performed. You should expect to be here for approximately 45 to 60 minutes after arriving on time. You do not need to have someone else drive you home after your procedure unless you are taking pain medications that impede your concentration while driving. In general it is advisable to have arrangements for pick up just in case.
Please call scheduling prior to your appointment if you have any questions or concerns.
What are the Potential Complications?
As with any invasive procedure, there are possible complications that may arise. These potential complications include: allergic reaction, infection, excessive bleeding, lightheadedness, permanent nerve damage, dural puncture, seizure, cardiovascular collapse, fainting, spinal cord injury, stroke, and death. However, a published review of 5500 injection procedures identified 4 systemic adverse effects, each of which was self-limited. A retrospective review of 888 injection procedures performed at the University of Pennsylvania Spine Center revealed no long-term and 8 short-term complications. Two subsequent studies investigating the complications arising from fluoroscopically guided selective transforaminal cervical and lumbar injections described no long-term complications in all the patients followed. Dr. El Abd recently presented a study on acute and immediate complications at the American Academy of Physical Medicine National Meeting in 2012, there was only 2 patients out 159 that experienced side effects after 2 weeks, the first was diabetic and had elevated blood sugar and the second had persistent nerve pain. Dr. El Abd has special interest in prevention of interventional procedures complications and he lectures locally, nationally and internationally on that topic. If you have any additional questions or concerns about the potential risk factors, we will be happy to discuss them with you.
For What Reasons Should I Call After the Procedure?
A flare of your symptoms for a period of a few days after your injection, as previously outlined, may occur. However, if any of the following events develops, we should be notified at 781-489-5541:
- A temperature of 101 degrees or more
- Excruciating pain
- Loss of bowel or bladder control
- Loss of motor function in arms or legs
- Headache in the standing or sitting position, which is relieved by lying down
- Any unusual symptoms that gets you concerned
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