CT guided injections are often considered 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 thus are usually much more effective than tablets.
In most cases of back pain, CT guided injections may be used to simultaneously identify the cause of and to treat your pain.
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 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.
You will then be given a skin injection of local anaesthetic (freezing or numbing). The radiologist (doctor) 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.
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.
Types of Injections
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 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 localize 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.
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.
Strathfield Medical Imaging suggests you return to your referring doctor 1-2 weeks following the injection.
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 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 is debatable and 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.
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.