Calling someone “spineless” may be a good insult, but it certainly isn’t factual. You, along with every other human and mammal on this planet have a very important set of bones, which are called vertebrae, all stacked on top of one another along the entire length of your back.Your spine allows you to stand up, bend down, and twist side-to-side.
It holds up your head, shoulders, and upper body. And finally, it protects all the nerves in your spinal cord.That sounds like a lot of work, doesn’t it? That’s why problems can arise over time. The discs between your vertebrae can slip out of line, or the joints that keep the vertebrae together can wear down. This can be extremely painful, and because your spine is nearly always involved in your movement, it can impact many parts of your life.
It’s possible that you’ll experience back or neck pain at some point in your life — most people do. However, some people have back or neck pain that keeps them from going to work, doing the things they love, and simply moving around.
One option for back pain is surgery. However, some patients want a less invasive way to treat their back pain: spinal injections.
Spinal injections are used to relieve pain in your back or neck. Along with other treatments, such as physical therapy and exercise, injections can be a simple, surgery-free way to get relief from your back and neck pain.
Dr. Arthur Kitt, MD, MPH, Physician and Assistant Professor of Clinical Anesthesiology and Critical Care at the Penn Spine Center often performs spinal injections for patients who want their life back after struggling with back and neck pain.
“My patients often come in with their spouses or other family members, and I get to see the impact that their pain has on those around them,” Dr. Kitt says.
The worst-case scenario is when people start avoiding family time and family activities because they don’t want to be a burden, or they don’t want to be in pain.
“It always makes me happy to see my patients get better and return to their normal lives,” he says, “whether it be going on trips with loved ones, going back to work, or even getting a good night’s sleep.”
Here are the 5 most common questions Dr. Kitt hears about spinal injections.
1. What are spinal injections used for, and how do they work?
Dr. Kitt: Spinal injections are used to treat chronic pain in your back or neck that we believe is related to disc disease (when the discs between your vertebrae wear down) or arthritis in the facet joints in your spine. It can also be used for patients who have pain from an injury.
We try to identify the source of pain based on patient history, a physical exam, and imaging, such as X-ray magnetic resonance imaging (MRI). Then, once we’ve decided to do a procedure, we use an X-ray to guide needles to specific targets in those areas.
2. What kinds of spinal injections are there?
Dr. Kitt: There are a number of different kinds of injections for treating pain. The most common are different types of epidural injections, which you’ve probably heard of before, since they’re often given to pregnant women in labor. We inject a steroid, sometimes combined with numbing medicine, to alleviate pain and decrease inflammation.
This injection goes into the epidural space — located just outside the membrane that protects your spinal cord — sending the medicine near the discs and the nerves that may be causing pain. Some injections can go into specific joints in and around the spine, such as the sacroiliac joint in your low back, or facet joints in your neck, upper, middle, or lower back.
Other injections are diagnostic — they’re not treatment themselves, but procedures that are done to help determine where the pain is coming from. This can sometimes lead to a nerve ablation, which is a procedure to burn the nerves to relieve pain from arthritic joints.
3. How effective are spinal injections at relieving pain?
Dr. Kitt: That depends. I usually tell patients that we’ll just start with one and then tailor what comes next according to how they end up doing. Sometimes, patients get just one injection, end up developing long-term relief of their symptoms, and don’t ever have to receive another. Other times, it may take a few injections to provide significant or longstanding relief.
The hope is to do the fewest number of injections that we can in order to alleviate their pain, but if it takes more than one, we'll do what we need to.
I don’t necessarily perceive these injections as an ultimate cure. They’re a tool that can help people out of their pain flares. They’re procedures that can get patients back on their feet when they are down and out. But ultimately, the goal is to get patients well enough to actively participate in activities that promote long-term back and neck health, such as physical therapy, aquatic therapy, daily exercise, core strengthening, stretching, and weight loss.
I try to remind patients that there are likely some lifestyle factors that contributed to the development of their back or neck pain. Just because their pain is alleviated for now doesn’t mean it won’t come back if some lifestyle changes aren’t made.
4. Are spinal injections painful?
Dr. Kitt: The number one question that I get asked is if the injection will hurt, which is completely understandable.
We do give injections while patients are awake, so I’m able to tell them exactly what is happening and what they can expect to feel.
For some patients, it can be a pretty painless procedure. Others may find it somewhat uncomfortable. There is rarely severe pain.
There is usually not significant pain after the procedure. There may be some achiness or soreness for a day or so after, but generally no severe pain. Think of it like a flu shot.
5. What are the risks of spinal injections?
Dr. Kitt: Spinal injections are generally very low risk, and they’re much more conservative than undergoing surgery.
Of course, there are some risks, including the injection not relieving your pain. Numerous steroid injections over the course of several years can also weaken the bones and lead to osteoporosis, especially if you have pre-existing osteoporosis or osteopenia, conditions in which your bones are already weakened.
Steroids can also elevate blood pressure or blood sugar for a few days, so that can be a concern for patients with blood pressure or diabetes that isn’t well controlled.
An exceedingly rare risk is an epidural hematoma, where bleeding leads to a collection of blood near your spine. This typically only happens to patients who are taking blood thinners that put them at a higher risk, such as for certain heart or blood vessel diseases. It’s always important to discuss what medications you’re taking with your physician before getting an injection.
One of the biggest misconceptions is that people worry that there is a significant risk of paralysis. That is an extraordinarily rare occurrence — a one in a million type phenomenon.
Injections are generally fairly low-risk. Regardless, I want my patients to feel like they’re ready and they’re at the point where they want to try it. It’s an elective procedure, so no patient should ever feel compelled or that they have to get this done.
Spinal Injections: Is It the Right Treatment for You?
Back and neck pain can severely impact your life. If you’re unable to go about your daily routine, and you’re struggling with other treatments because of the pain, spinal injections may be the relief you need to get back on track to some long-term relief.
If surgery sounds like too much, but medications or physical therapy is not enough, spinal injections might just be the compromise you were looking for to relieve some pain and get you back to enjoying your life.