Introduction to Spinal Injections

Spinal injections are a non-surgical treatment option for various types of back and neck pain. These procedures are designed to deliver medication directly to the source of pain in the spinal column. Among the most common types of spinal injections are Epidural Steroid Injections (ESI) and Facet Joint Injections, each serving different purposes and targeting different tissues.

Epidural Steroid Injection (ESI)

Purpose and Diagnostic Power

The Epidural Steroid Injection (ESI) is a procedure aimed at providing temporal relief from lower back pain, which may arise from conditions such as disc herniation or degeneration. Additionally, ESIs offer diagnostic value by confirming if the pain originates from the pathology in question.

Procedure Details

1. Anesthesia: The procedure begins with administering Lidocaine as a local anesthetic to reduce pain during the injection. Lidocaine acts quickly but has a shorter duration of action, offering immediate but temporary relief.

2. Injection Goals:

   • Diagnostic and Relief: Bupivacaine, another anesthetic, is used alongside Dexamethasone sodium phosphate to reduce nerve excitation. This combination offers a longer-lasting and more potent effect than Lidocaine alone.

   • Regeneration: For cases focusing on the regeneration of the area, Platelet Rich Plasma (PRP) and stem cells may be used.

Techniques and Approaches

• Interlaminar ESI: Suitable for central stenosis, this approach involves passing through the ligamentum flavum to reach the epidural fat, with the initial target being the lamina. A noticeable loss of resistance indicates the needle has reached the epidural area.

• Transforaminal ESI: Used when pathology is located in the lateral recess, this technique involves targeting specific anatomical triangles to ensure safe and effective delivery of the injection. Contrast agents are often used to enhance safety and accuracy.

Facet Joint Injections

Indications

Facet joint injections are considered after conservative treatments have been tried for at least three months without sufficient relief. Indications include strong suspicion of facet joint etiology, characterized by focal tenderness, pain in response to certain movements, and pain scores above 4/10 on the Numeric Analogue Scale (NAS).

Procedure

1. Anesthesia: Similar to the ESI procedure, anesthesia is administered to minimize discomfort.

2. Intra-articular Access: The procedure involves injecting a mix of anesthetic and a long-acting steroid, triamcinolone, into the synovial space of the facet joint. The use of contrast ensures precise delivery, with recommended volumes being 1 to 1.5 mL to avoid joint capsule rupture.

Conclusion

Spinal injections are a valuable option for managing and diagnosing back pain, offering both therapeutic and diagnostic benefits. By targeting specific areas of the spine with precision, these procedures can provide significant relief and facilitate the path to recovery. As with any medical procedure, discussing with a healthcare provider to understand the best approach for individual conditions is crucial.