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Spinal Injections

What is a spinal injection?

Your doctor has recommended that you have a spinal injection to help reduce pain and improve function. This procedure can help relieve pain by reducing inflammation (swelling and irritation). An injection can also help your doctor identify the source of your pain by numbing certain areas of your back. The type of injection you receive is based on your specific symptoms and the physical examination performed by your health care provider.

Anatomy of your spine

  • Vertebrae are block-shaped bones that form your spinal column.
  • Discs are spongy shock absorbers between each of the block shaped vertebrae. A herniated disc or a disc with “wear and tear” may cause inflammation and pain.
  • Facet joints are small joints in the back of the spine that guide the bending motions of each vertebrae. These joints can be irritated or inflamed and cause pain.
  • Spinal nerves are branches from the spinal cord exiting the spinal column. They transmit signals that control the movement of your muscles and provide sensation in your arms and legs. These nerves can be irritated or inflamed and cause pain.
  • The epidural space is the space around the sheath (dura) covering the spinal nerves. Placing anti-inflammatory medicine in epidural space can help reduce spinal nerve inflammation.
  • Sacroiliac joints (SI joints) are formed by your lower spine (sacrum) and pelvic bone (ilium). Inflammation in these joints can cause low back, buttock and other pain.

Preparing for your injection

  • A spinal injection is an outpatient procedure. Before your injection, you will be asked questions about your health. You will also be given instructions on how to prepare for the procedure.
  • For your benefit, you need to bring your MRI or CT reports AND FILMS (the pictures) with you to all scheduled appointments. This includes scans done at Northwestern Memorial Hospital. (CDROMs are OK, too)
  • You will need a companion with you after the procedure. You should not drive following the procedure.
  • Unless otherwise instructed, don’t skip a meal before your procedure; eating will prevent you from feeling woozy.
  • If you are receiving sedation (“conscious sedation”), do not eat or drink anything for eight hours prior to the procedure.
  • It is a good idea to arrive at your appointment with some of your usual pain present. This will make it easier to tell if the injection blocked your pain. This is why spinal injections are sometimes called "blocks."
  • If your health changes – if there is the possibility that you have a cold, flu or other illness – it is important that you tell your doctor. He/she may want to reschedule the procedure.
  • If you need to cancel your procedure, please notify your doctor right away.
  • Notify the scheduler if you are allergic to betadine (iodine), lidocaine, contrast dye, or latex. You are at no additional risk if you are allergic to shellfish.

You will need to STOP THESE MEDICATIONS that may increase bleeding risks:

  • All aspirin products (including Bayer, Ecotrin, Alka Seltzer, baby or low-dose aspirin, etc.) seven (7) days prior to your scheduled procedure.
  • Non-steroidal anti-inflammatory (NSAIDs) medications two (2) days prior to the procedure (Advil, Motrin, Nuprin, Ibuprofen, Aleve, Naproxen, Relafen, Voltaren, Lodine, Mobic, etc).
  • Blood thinners (Coumadin, Plavix, or Ticlid). Please contact our nurse and your internist for further instructions on how to manage this.
  • ALL herbal medications, supplements, fish oil, and vitamin E two (2) days prior to the procedure.
  • You will need to STOP metformin (Glucophage or Glucovance) for two (2) days after the procedure. Although metformin does not increase bleeding risk, it may interact adversely with the contrast dye that we use.

IF YOU ARE DIABETIC, PLEASE CALL THE NURSE (312-238-7729) FOR SPECIAL INSTRUCTIONS

* Please note that it is recommended that you continue all other prescribed medications (blood pressure, insulin, water pill, etc.) as well as other prescribed pain medications not known to have bleeding effects, such as Ultram (tramadol), Vicodin (hydrocodone), and Tylenol (acetaminophen).

If you have specific questions regarding your current medications, please contact the nurse at 312-238-7729.

Checking in for your procedure

  • Your procedure may take place at any of the following locations:
    • RIC Spine & Sports Rehabilitation Center at 1030 N. Clark, 5th floor
    • RIC River Forest at 420 Thatcher Avenue (Thatcher and Lake)
    • Same Day Surgery Center at 25 East Washington St., 3rd floor
  • You should arrive 30 minutes prior to your scheduled injection time to fill out the necessary paperwork. Bring your insurance information with you.
  • If you expect any delays or need to cancel, please call 312-238-7726. For your benefit and safety, current medical information may be requested again. It is important to alert your doctor if you are experiencing any new or recent medical problems. Your doctor may give you a brief physical exam. You may receive an intravenous (IV) line before the procedure.

Risks and complications

All medical interventions have benefits and risks. Spinal injections have certain risks and complications that can include: spinal headache, increased pain, bleeding (rare), infection (rare), or nerve injury (rare). Certain procedures may carry other risks. Your doctor will discuss these with you if it pertains to your situation.

During the procedure

  • The procedure is usually brief, but your position during the procedure is important to make the injection go smoothly, with the least discomfort to you. You may have monitoring devices attached to you during the procedure to check your heart rate and breathing.
  • Your skin will be cleaned with a sterilizing solution and a sterile drape will be placed over your skin.
  • Conscious sedation (use of a calming drug while you are awake) may be used if your doctor feels it is appropriate.
  • Local anesthetic (lidocaine) is usually given near the injection site to numb the skin. This typically feels like a pin prick and some burning, like a bee sting.
  • Fluoroscopy (X-ray imaging) is used for precise placement of the injection. Contrast dye will be injected to confirm the correct placement of the needle.
  • A local anesthetic for numbing (eg, lidocaine, bupivicaine) and/or steroids (to reduce inflammation, not the kind that makes your muscles bigger) is injected.
  • A small bandage may be placed at the injection site.

After the procedure

  • You will be escorted to the recovery area and monitored.  In most cases, you will be discharged within 30 minutes after the procedure
  • After discharge
    • You may apply an ice pack 20 minutes at a time to the injection site if you experience soreness
    • You may take a shower, but AVOID getting into baths, pools, or whirlpools for 48 hours after the injection. Keep the injection site clean and dry. You may remove the adhesive bandage one (1) day following the injection
    • You will be asked to take it easy after your injection today.  You may return to your normal daily activities 24 hours after the injection.
    • You may resume your Anti-inflammatory medications or BLOOD THINNERS 24-HOURS following the injection today
    • You may start or resume your individualized exercise program or physical therapy as soon as 48 hours after the injection.  (Please check with your doctor or the nurse if you have any questions regarding this)
  • Remember, it may take a few days, even up to 14 days before you begin to notice an improvement in your symptoms, and for the steroid medicine to reduce your inflammation and pain.  Some people may experience increased pain for the first 24–48 hours.
  • Side effects that may occur, but will go away in a few days are:
    • Briefly increased pain
    • Trouble sleeping
    • Facial flushing

When to call the doctor/nurse

  • Severe pain
  • Severe headache that gets worse when sitting up or standing, and is better when you lie down
  • Fever or chills
  • Loss of bladder or bowel control
  • Redness or swelling around the injection site.