How do spinal injections work?

Mr Richard Selway, a leading neurosurgeon, talks us through the different types and uses of spinal injections.

Why would you have a spinal injection?

There are two main types of spinal injections that we use:

1. To treat back pain
2. To diagnose and treat sciatic pain

Back pain injections:

Back pain generally originates from the facet joints which are the joints found at each segment of the spine. These allow the spine to flex, bend, extend and also provide stability. If these joints become ‘worn out’ or arthritic, they can become painful. Often this type of back pain is worse in the mornings or following a long period of sitting down when the back feels very stiff. Long-term treatment uses a combination of exercises to build core strength (e.g. using the Alexander Technique for balance and posture), physical therapies and even yoga and pilates.

However, these physical therapy treatments can sometimes be very painful for patients to tolerate. In such instances, facet joint injections can be offered to provide pain relief, allowing the patient to complete their physical treatments. For some patients, pain can be persistent and quick to return following injections, but if used regularly, injections can continue to provide relief. However, for patients who experience continuous pain, facet joint denervation can be considered. This is more invasive and targets the joints with radiofrequency energy to disrupt the nerves, and can provide longer-lasting effects.

Injections for sciatica:

Injections for treating sciatica are known as either perineural injections, nerve root injections or transforaminal epidural injections. Generally, these are given to patients with specific symptoms – pain felt down one leg which is linked to the irritation of one nerve root – this is known as sciatic pain.

As well as providing pain-relief, these injections can help in making a diagnosis if an MRI scan is not able to fully confirm which nerve root is responsible for the pain. These injections can also be used in a complementary fashion, to provide enough pain relief to allow patients to carry out their physical therapies without discomfort. Injections can also be helpful in avoiding open surgery. However, the way these injections work and the effects they have can differ from patient to patient, so it is always best to discuss the various options with a specialist before making any final decisions.

On occasion, spinal epidural injections can be used when multiple nerve roots are contributing to the source of pain, but this would also need to be discussed with a specialist.

If you are experiencing back pain, make an appointment with a specialist to discuss potential treatment options.