Decreasing the inflammation of the spine can also be accomplished by injections such as lumbar epidural or facet injections. Medications, heat or cold treatment can be given through injection procedures, which involve placement of a needle or similar probe into or near a part of the spine. Injections may relieve pain and swelling and are considered an adjunct treatment that facilitates participation in an active rehabilitation program.
 Epidural Injection
Epidural injections treat pain and inflammation that is caused by a variety of spinal conditions, such as a herniated disc, spinal stenosis or degenerative disc disease. This treatment can be highly effective because it delivers anti-inflammatory medicine and pain relief directly to the problem area allowing the patient to pursue physical therapy. Using an X-ray, the doctor guides a needle into the epidural space (near the spinal nerves, but not in the spinal cord and administers a local anesthetic and a steroid.
An epidural steroid injection is generally successful in relieving pain for approximately 50% of patients. If a patient does not experience any back pain or leg pain relief from the first epidural injection, further injections will probably not be beneficial. However, if there is some improvement in back pain or leg pain, one to two additional epidural steroid injections may be recommended. In general, it is customary to perform up to three epidural injections within a six-month period.
As with all invasive medical procedures, there are potential risks associated with epidural steroid injections, including:
- Infection
- Bleeding
- Nerve damage
While rare, there are also potential side effects from the steroid medication. These side effects may become more common when steroids are taken daily for several months. They include:
- A transient decrease in immunity
- High blood sugar
- Stomach ulcers
- Severe arthritis of the hips
- Cataracts
- Increased appetite
 Facet Joint Block
Twisting injuries of the spine are the predominant cause of damage to the facet joints. A facet joint block is an injection used to diagnose and/or confirm the exact source of a patient's back or neck pain. Using fluoroscopy, the physician guides the needle to the presumed pain-causing facet joint and injects a steroid medication (to decrease inflammation) and/or a local anesthetic (to numb the area). If the patient's pain is relieved after the injection, the pain-generating facet joint is presumed to have been identified. Facet joint blocks are also used to provide pain relief.
 Radio Frequency Nerve Ablation
Radio Frequency Nerve Ablation is a procedure used to temporarily switch off minor nerves that supply the facet joints in the spine. These nerves are often the source of back pain. Under fluoroscopic (X-ray) guidance, radio frequency energy is used to heat the tissue around the affected nerve. Results can last from months to years.
Nerve Root Blocks
Nerve root blocks are a method to deliver medication via injection to the space around spinal nerve roots. In addition to locating the specific spinal nerve root causing the pain, this treatment offers pain relief in the back or leg caused by irritated spinal nerves. A nerve block may also be used therapeutically for the treatment of specific types of disc herniations.
 Spinal Cord Stimulation
Spinal cord stimulation is mostly used to reduce or modify radiating back pain after other treatments, including surgery, have failed. This procedure involved transmitting low-level electrical signals to the spinal cord or to specific nerves to block pain signals from reaching the brain. A device that delivers the electrical signals is surgically implanted in the body. A remote control is used by the patient to turn the current off and on or to adjust the intensity of the signals. Most people describe the feelings from the simulator as being pleasant and tingling. Spinal cord stimulation can help treat patients with persistent leg or arm pain after low back or neck surgery, respectively. However, this treatment is not right for every patient with this type of pain. Your doctor will evaluate the appropriateness of this procedure for you and discuss other alternatives, like medication, rehabilitation, and injections.
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