CT guided neck and back injections are safe and modern procedure. These injections are typically considered when physiotherapy and oral medication have been tried, but the pain is still not tolerable.
CT guided injections are often considered before surgery is contemplated or if surgery is not possible. These injections deliver powerful medications directly to the area that is the source of the pain and are usually much more effective than tablets.
In most cases of back pain, CT guided injections may be used to identify the cause and treat your pain.
Preparing for a Neck or Back Injection
Please bring your referral (letter from your practitioner) and your Medicare and/or Pension Healthcare card with you to your appointment. It is important to bring all previous imaging relating to the region of interest.
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 that it’s safe to continue taking your routine medications (such as high blood pressure and diabetic medications) prior to your procedure.
You will need a driver to accompany you on the day who is responsible for getting you home safely.
Please inform the radiographer if you are or you suspect you may be pregnant.
The Neck and Back injection procedure
The radiographer will bring you into the CT room where you will be asked to lie down on the table. A quick ultra-low dose planning scan is performed.
You will be given a local anaesthetic. The radiologist then introduces a needle under CT guidance in the area of pain. The medications include an anaesthetic and an anti-inflammatory such as cortisone. The whole procedure usually takes about 10 minutes and is generally well tolerated.
Medications used for the procedure
With most spinal injections a mixture of medications is injected. The local anaesthetic is mixed with cortisone. The anaesthetic is fast-acting and will start working quickly and lasts up to eight hours. Cortisone is long lasting and may not begin working for several days following the injection, but the effects can last for months.
Types of Injections
An epidural is a type of injection which provides relief from certain types of back and neck pain caused by a narrow spinal canal. The epidural space is the area around the spinal sac, inside of the spinal canal. This space runs the entire length of your spine and injections 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 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 on a post-injection evaluation sheet. As numbness may be experienced for a few hours depending on the type of injection, it is best to have someone drive you home on the day. Patients may return to their normal activities the following.
Most patients will experience pain relief immediately after the procedure because of the anaesthetic however it will usually wear off within eight hours and the pain often returns. The cortisone takes two days to begin working. Generally, it is best to ease back into exercise or more strenuous activities over two weeks as the medication begins to work. Please also consult your doctor for specific advice to address your individual needs.
We suggest you return to your referring doctor two 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 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 potential risks of spinal injections with your physician.
How many injections will I need?
The number and frequency of injections depends on the condition and your specific circumstances, although it is generally considered reasonable to limit the number to three times per year to avoid systemic side effects. This is best discussed with your referring doctor.
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 two days. Along with analgesics and physical therapy, spinal injections have brought relief to thousands of patients. 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), they can be beneficial in providing relief to patients during an episode of severe back pain.