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Information about your injection – Spinal Injections

Following your consultation at LBSM, you may have been referred for a spinal injection.

This guide takes you through the relevant information about what to expect during this process. Please take the time to read it carefully.

Before you have your spinal injection, you will have a further opportunity to ask any further questions during the appointment.

Please feel free to contact us if you have any queries about anything to do with the process of having your spinal injection.

spinal injections Information about your injection - Spinal Injections
Image from https://www.hcahealthcare.co.uk/
  1. What is a spinal injection?
  2. What are the benefits – why should I have a spinal injection?
  3. What are the risks of a spinal injection?
  4. Can everyone have spinal injections?
  5. Are there any alternatives?
  6. How can I prepare for a spinal injection?
  7. Giving my consent (permission)
  8. What happens during the treatment?
  9. Will I feel any pain after the treatment?
  10. What happens after the procedure?
  11. What do I need to do after I go home?
  12. What should I do if I have a problem?
  13. Will I have a follow-up appointment?

1. What is a spinal injection?

Your spine is made of a number of bones called vertebrae. They are connected to one another allowing your spine to move and protecting the spinal cord and nerves. These strong interconnections are made up of intervertebral discs (which act as your spine’s shock absorbing system) and facet joints (which connect the vertebrae to one another). Due to a variety of reasons, these structures can wear down and, with time, can be a cause of pain.

Spinal injections deliver medicines into or near your spine, normally around the source of your pain. There are two medicines used in spinal injections:

  • Local anaesthetic which is used to block pain from the injected area
  • An anti-inflammatory steroid which is used to reduce swelling and inflammation in the injected area. The local anaesthetic injection gives an immediate relief while the steroid injection takes effect.

The aim of a successful spinal injection is to ease your back or leg/arm pain, or sometimes both, for a period of up to three months.

There are four injection techniques that are commonly used by your doctor:

  • Epidural injection targets the space that surrounds your spinal cord.
  • Facet or sacroiliac joint injection targets the joints that link the bones of your spine.
  • Nerve root injection targets individual nerves in your spine.
  • Discography targets the intervertebral discs between the bones of your spine.

The type of spinal injection you have will be based on your specific symptoms.

2. What are the benefits – why should I have a spinal injection?

The idea for the spinal injection is to calm the irritated structures in the spine to relieve pain and symptoms. Spinal injections are best used in conjunction with a structured rehabilitation programme. They should not be considered as a definitive treatment in isolation.
Spinal injections are used for diagnostic or therapeutic purposes.

A diagnostic spinal injection can sometimes help your doctor to plan the long-term management of your condition. It is very useful when the source of your pain has not been clearly identified before, and can determine which spinal structure is causing your symptoms.

A therapeutic spinal injection improves your symptoms with the use of local anaesthetic and steroids which reduce swelling and inflammation. This can be repeated periodically if it works well and will allow you to progress with other treatments such as physiotherapy.

3. What are the risks of a spinal injection?

In general, the risks relate to the anaesthetic and the spinal treatment itself. Spinal injections are usually done under local anaesthetic (you will be awake but will not feel any pain) with some sedation (this relieves anxiety and helps you relax).

Spinal injections are commonly performed and are generally safe. Before suggesting the treatment, your doctor will have considered that the benefits of the procedure outweigh any disadvantages. However, to make an informed decision and give your consent, you need to be aware of the possible side effects and risks/complications. If complications occur, they are usually mild and resolve after about three weeks.

Rare complications include:

  • Infection (affects around one out of every 100 patients treated): this can be serious if the infection gets into your spine. If it occurs, you will need an intense intravenous (administered directly into a vein) course of antibiotics in hospital.
  • Bleeding (affects less than one out of every 100 patients treated): Very rarely bleeding and/or bruising in the injected area may occur. This may cause increased pain for a few days. This can be serious if you take medicines that thin your blood because it can lead to an epidural haematoma (a localised collection of blood around your spinal nerves). There is a small risk of stroke in patients having spinal injections into the neck (less than one in 1000).
  • Headaches (affects less than one out of every 100 patients treated): occasionally the spinal needle may puncture the outer covering of your spinal cord causing leakage of spinal fluid (CSF). This is not serious but it can cause a dull headache for up to a week and you will need to lie flat for at least three days after the treatment.
  • Spinal nerve injury (affects around one out of every 100 patients treated): this can happen with nerve root injections or discography and is caused by the spinal needle being in contact with the nerve or more commonly the nerve sheath (protective covering of the nerves). This can lead to a temporary loss of feeling or muscle weakness in the legs or bladder/bowel dysfunction.
  • Increased pain in the treated area (affects around one out of every 100 patients treated): this is usually temporary and lasts a few hours or a few days. If you experience increased pain several days after the injections, please contact us as it may be a sign of infection.
  • An allergic reaction to the injection (affects around one out of every 100 patients treated): these will usually happen immediately so help is available. Most reactions are treated and cause no permanent harm. If you have any signs of an allergic reaction after you have left the hospital, please seek medical advice.

Like all medicines steroids may cause side effects, although not everybody will experience them. Some of the side effects you may have include hot flushes, feeling sick, mild abdominal pain, fluid retention, a temporary rise in blood sugar, and menstrual irregularities (in women). These should settle within a few days. If you have diabetes and your blood glucose level is not very well controlled, please let the person giving you the injection know. You are advised to check your blood sugar levels the evening after having the injections.

4. Can everyone have spinal injections?

No, some people are not good candidates for spinal injections. This includes those with:

  • an active systemic infection (such as blood poisoning, chest or dental infection)
  • a skin infection at the site of needle puncture
  • pregnant women
  • a bleeding disorder or patients taking medicines to thin their blood (unless advised by the haematology team)
  • a poorly controlled medical condition such as diabetes, high blood pressure or heart disease
  • an allergy to contrast, steroids or local anaesthetic.

5. Are there any alternatives?

Before your spinal injection, our team would have tried rehabilitative methods and oral medication. Spinal injections should only be considered the first line of treatment in special circumstances. Please speak to one of our team if you are unsure if this is the case for you.

6. How can I prepare for a spinal injection?

Having a spinal injection can be a daunting procedure and you need to be sure it is the right intervention for you. Make sure you have fully discussed the risks and benefits with our team and understand them. Apart from pain and symptoms, there is often no other immediate clinical indication to have a spinal injection so please take your time when deciding.

During your consultation, you should tell our team about any health conditions you have, such as diabetes or bleeding disorders, and about any medicines that you may be taking, including blood-thinning and over-the-counter medicines. You may be asked to stop taking certain medicines for several days before the procedure.

If you are a woman of child-bearing age, you must tell us if you could be pregnant. If unsure, you will be asked to have a pregnancy test. Spinal Injections are not suitable for pregnant women because x-rays are usually used during the treatment. They are safe for adults, but may harm your developing baby. If you are pregnant, your doctor will talk about alternatives to the treatment.

We want to involve you in decisions about your care and treatment. If you decide to go ahead, you will be asked to sign a consent form on the day of the procedure. This states that you agree to have the treatment and you understand what it involves.

8. What happens during the treatment?

On the day of your treatment you will be seen by a doctor who will ask you to sign the consent form. You will then be taken to the radiology suite for your treatment.

Usually you will lie on your stomach, but may also be asked to lie on your side with your knees drawn up and chin tucked in. This position helps to open up the space between the bones in your spine. For spinal injections into the neck, you will be asked to lie down facing upwards with your head turned to the side.
If you are having a sedative, the anaesthetist will inject it into a vein in the back of your hand.

After cleaning the injection site with a sterile antiseptic wipe, a local anaesthetic is injected. When the area has become numb, your doctor will carefully insert a thin, hollow spinal needle into your spine using an x-ray machine for guidance. If you are having your treatment in the radiology department, a CT machine (computerised tomography machine which creates detailed images of the inside of your body) is used to guide the spinal needle.

You will not feel the needle going in, but once it has reached your spine, you may feel some discomfort. While the needle is being inserted, it is important that you do not move. This is because any movement makes positioning of the needle more difficult. Please tell your doctor if you feel any pain or discomfort that prevents you from lying still.

Your doctor will inject a contrast solution to improve the images of the internal body structures and ensure that the needle is positioned correctly. The local anaesthetic and steroids are then injected into your spine.

If you are having a discography, please let your doctor know if you have any pain in your back or leg during the procedure.

When the treatment is finished, the doctor will take the needle out and cover the injection site with a plaster.

The treatment normally takes around 20 to 40 minutes to complete.

9. Will I feel any pain after the treatment?

You may have some tenderness at the needle insertion site. This will normally last for a few hours. You can place an ice pack on the area to reduce the discomfort, as often as you require but for no longer than 20 minutes at a time. You should never put ice directly on your skin as it can cause frostbite.

It is also common after this treatment to have an increase in pain for the first 24 to 72 hours. This occurs because the medicines are injected in an area where there is already inflammation. You should not be alarmed by this. Your symptoms should gradually improve in the days following the spinal injection.
The local anaesthetic will keep you pain-free for a while, but it is best to take things easy for the first 24 hours. After this, your back may start to feel sore again because the steroids take a few days to work.

The spinal injection can work up to three months before you feel some of symptoms recur.

10. What happens after the procedure?

Following the treatment you will be taken to the recovery area. This is where you are monitored
for the initial post-operative period. You will then be transferred to the discharge lounge to be monitored.

Our team will make sure that you are safe to move around and that you have passed urine before going home. If you have any concerns about your walking or controlling your bladder/bowel, you must tell a member of staff.

It is advisable to have a responsible adult to accompany you home.

11. What do I need to do after I go home?

It is essential that you continue to take painkillers as advised after your treatment. We will discuss the management of you painkillers before you leave hospital.

The plaster can be removed after 24 hours and you can then have a bath or shower as normal. Before the plaster is removed, avoid getting the injection site wet.

Generally, there are no restrictions after your spinal injections once the post-treatment pain has settled down. You should be able to return to physiotherapy or other spinal exercises within a week of your injection. Depending on the nature of your employment, you may wish to return to work after 72 hours. Please ensure that your employer is happy with this arrangement.

You will have a routine follow up appointment with your consultant at an agreed time interval after your injection.

12. What should I do if I have a problem?

Some symptoms suggest that there may be a post-procedure complication. Please seek urgent medical help (through your GP or A+E) if you experience any of the following:

  • excruciating pain unlike your normal symptoms
  • increasing redness, swelling or oozing around the injection site
  • fever (temperature higher than 38.5°C)
  • sudden weakness or numbness which is not resolving
  • sudden loss of bowel or bladder control
  • severe headache which is not improved with painkillers.

13. Will I have a follow-up appointment?

You will have a routine follow up appointment with your consultant at an agreed time interval after your injection.

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    Orla Mulligan
    Administration and Social Media Manager
    Administration, LBSM

    Orla Mulligan is the administration and social media manager for LBSM. She has a strong background in sport having herself played netball at an elite standard for the U21s Northern Ireland team in the European Championships as well as the U21s competition for Saracen Mavericks.

    She understands youth sport pathways having herself played and training in the netball Kent regional pathway. She has a keen interest in most sports and a good understanding of how injury and illness can impact on the mind and body, as well as rehabilitation pathways.

    She looks forward to speaking and assisting LBSM patients and gives her best support to them during their treatment pathway.

    A day in the life of Orla involves communicating with patients via phone and email, managing and organising clinics, operations and media management.

    Outside of work, Orla is a gym enthusiast, enjoys tennis and still finds the time for an occasional game of netball.

    Maddie Tait
    BSc, MSc
    Associate, LBSM
    Musculoskeletal and Sports Podiatrist

    Maddie treats and manages complex foot and ankle injuries in London and Surrey.

    She is particularly interested in helping her patients improve their quality of life and achieve their personal goals, working closely with Foot and Ankle Consultants, Sports Medicine Doctors and Physiotherapists.

    Maddie has a sporting background herself having previously represented England in Hockey. She understands the demands of elite sport and the importance of physical and mental health. In her spare time, Maddie continues to enjoy an active lifestyle by running, cycling and attending a Pilates class.

    Having graduated from University of Brighton with a MSc (hons) in Podiatry, Maddie focused her career in Podiatric Sports Injuries and Biomechanics. Previously she completed a BSc (hons) in Sport Science at Loughborough University.

    A day in the life of Maddie involves consulting patients in clinic, performing gait and biomechanical assessments, measuring and fitting orthotics and braces. She also regularly teaches and presents at sports medicine and podiatry conferences.

    Outside of work, Maddie still finds time to play hockey and enjoys running and skiing.

    Mr Prakash Saha
    MBBS, PhD, FRCS
    Consultant Partner, LBSM
    Consultant in Vascular Surgery

    Mr Prakash Saha is a Consultant Vascular Surgeon at LBSM. He takes pride in providing the best possible results for his patients by using the most appropriate non-surgical and surgical methods based on clinical evidence, patient results and satisfaction.

    He treats fit and active people suffering with a range of cardiovascular issues, from painful leg swelling associated with exercise to venous insufficiency, post-thrombotic syndrome and leg ulcers. He also treats people with arterial system problems including poor circulation, compression syndromes and aneurysms. He carries out both endovascular and open aortic repair and has some of the best outcomes in the country.

    Mr Saha studied medicine at the United Medical & Dental Schools at Guy’s and St. Thomas’ Hospitals before completing his higher surgical training in London and the South East. During this time, he was awarded the prestigious NIHR Clinical Lectureship in Vascular Surgery at St. Thomas’ Hospital, giving him comprehensive training in open and endovascular techniques for treating arterial and venous disease. Prakash completed his aortic surgery training at the St. George’s Vascular Institute before carrying out a specialist fellowship at the Royal Prince Alfred Hospital, Sydney.

    Mr Saha regularly lectures and runs workshops across the globe on the latest surgical techniques to treat vascular disease. He has also been awarded a number of research grants from the Royal College of Surgeons, the Circulation Foundation, the Wellcome Trust, the Academy of Medical Sciences, and the British Heart Foundation, which has led to over 80 publications and the development of innovative technologies to help treat patients. For this work, Prakash has received a number of prizes, including the Venous Forum prize from the Vascular Society of Great Britain and Ireland, an International Young Investigator Award, and an Early Career Investigator Award from the American Heart Association.

    A day in the life of Mr Saha involves seeing patients in clinic, operating in surgical theatre or lecturing at his university. He also regularly teaches and presents at vascular and sports medicine conferences.

    Mr Saha is an avid cyclist and tennis player (although yet to get a set of Dr Seth!). Outside of work, he spends time with his family who consists of 3 children and enjoys travelling.

    Dr Gajan Rajeswaran
    MBBS, FRCR
    Consultant Partner, LBSM
    Consultant in Sports and Musculoskeletal Radiology

    Dr Gajan Rajeswaran is a Consultant Musculoskeletal Radiologist at LBSM, with an extensive background of working in elite sport. He is one of the most recognised radiologists in the sports medicine field. He provides top level imaging and medical diagnostic services for patients and athletes.

    Dr Gajan Rajeswaran completed his undergraduate medical training at Imperial College London and his radiology training at Chelsea & Westminster Hospital. He has obtained two post-CCT fellowships in musculoskeletal imaging. He was appointed as a consultant at Chelsea & Westminster Hospital in 2011.

    He has a passion for all sports having worked as a radiologist at the Glasgow Commonwealth Games and London World Athletic Championships and continues to support The Championships, Wimbledon. He also continues to work with a number of Premier League and Championship Football Clubs, Premier League Rugby Clubs, England Sevens Rugby, British Athletics and the Lawn Tennis Association.

    A day in the life of Dr Rajeswaran involves giving his expert opinion on investigations such as MRI and CT scans, x-rays and ultrasound. He also performs injection lists under ultrasound, CT and X-ray including spinal injections. He also regularly teaches and presents at sports medicine conferences.

    Dr Gajan Rajeswaran is an avid football fan and life-long fan of Tottenham Hotspur (for which he offers no apologies!). Outside of work, he spends time with his family and has a keen passion for photography.

    Dr Ajai Seth
    MBBS, BSc, MSc, MRCS, MRCGP, FFSEM
    Medical Director, LBSM
    Consultant in Sport and Exercise Medicine

    Dr Ajai Seth is a Sport and Exercise Medicine Physician. He has dedicated his career to helping people with sport and exercise related injury and illness. He consults and treats everyone from the elite athlete to the weekend warrior.

    Dr Ajai Seth is part of the British Tennis Sports Physician team at the LTA and has also provided cover to elite athletes at Wimbledon Tennis, European Tour Golf, Premier League Football, British Athletics, and the Men’s England Football academies as part of the FA.

    He also prides himself for working in disability sport and is currently the Chief Medical Officer for Team GB Wheelchair Tennis which has taken him to the Olympics and Paralympics.

    Dr Ajai Seth is dedicated to education, training and research and is a Senior Lecturer in Sports Medicine at King’s College London where he lectures in all aspects of Sports Medicine and Science.

    He also has a passion for travel and Expedition Medicine, which has seen him accompany medical, scientific and charity expeditions all around the world. He also has vast experience in treating musculoskeletal injuries from children and adolescents to veteran exercisers, both male and female.

    Dr Seth also has positions in leading Sport Medicine organisations, including the non-executive board for the UK’s largest Sports Medicine charity, BASEM and Past President for the Royal Society of Medicine. 

    A day in the working life of Dr Seth involves consulting his patients in clinic, performing diagnostics and ultrasound guided injections. He also regularly lectures and tutors students and presents at sports medicine conferences internationally. He also spends part of the working week at the National Tennis Centre, LTA, supporting British Tennis players.

    Outside of work, Dr Seth enjoys playing club tennis, triathlon, golf, running and skiing (but will give any sport a go!). He enjoys keeping fit and active and good quality family time with his wife and three children.