“Why has my surgeon recommended I have Spinal Injections?”
Most commonly, patients undergo injection therapy beause they have back, leg and/or arm pain caused by inflammation and irritation of the nerves. Inflammation of the nerves can be caused by a disc prolapse – when a disc in the spine ruptures (due to wear and tear or trauma) and its contents press on the nerve root, resulting in muscle spasm and pain or a disc bulge.
The medication delivered via the injections is a potent anti-inflammatory steriod (corticosteroid) and an anaesthetic, intended to reduce inflammation and thus create temporary relief of pain, allowing the patient to pursue a rehabilitation program. Injections coupled with a physiotherapy program is integral in laying the foundations for a healthy spine. The injections can serve as a therapeutic (by relieving pain) and diagnostic (by confirming cause and location of problem) tool.
How effective are spinal injections?
In a study of 107 ambulatory care centers who performed approximately 139,000 low back injection for pain management annually and submitted data on 2,227 routine, uncomplicated procedures for the study, 78 percent of patients undergoing the procedure reported their pain had improved and 82 percent reported the ability to perform daily activities, although only 53 percent said they were able to reduce their pain medications. 
How long will the effect last?
The injections are intended to provide temporary relief until your body heals the disc prolapse or your muscles can be re-activated to improve your strength and posture via physiotherapy. It is impossible to determine how much benefit they will have for each individual. The effect may only provide you relief for a few weeks however several of our patients have reported being pain-free for up to nine months. It is therefore imperative not to delay your physiotherapy program as the steroid effect may be relatively short-lasting.
Anaesthesia – Intravenous Sedation
This procedure is commonly performed under sedation. If you are having sedation, a cannula (small plastic tube) will be inserted into the back of your hand through which the sedation medication will be administered. This will make you drowsy and relaxed but not unconscious. You will be in a state called cooperative sedation. Although drowsy, you will still hear what is said to you and be able to follow simple instructions during the investigation. Sedation makes it unlikely that you will remember anything about the examination.
Please note that if you have had sedation, the drug remains in your blood system for about 24 hours and you may feel drowsy later on, with intermittent lapses of memory. During this period, you must not drive, use public transport, take alcohol, operate heavy machinery or sign any legally binding documents. You will need a responsible adult to accompany you home. If you live alone, try to arrange for a responsible adult to stay with you.
On the day of Admission
When you report to 1st Floor Reception, Brampton House you will be greeted by the Spine Unit Coordinator who will arrange for you to be seen by the consulting anaesthetist. The anaesthetist will ensure you understand the procedure and discuss any outstanding concerns or questions you may have. The consultant or anaesthetist will countersign your Consent Form, a routine part of all procedures. You will be then asked to take a seat in the waiting area while your room is being prepared. A staff member from the Admissions Team will meet you at the waiting area to confirm your insurance details or take a payment. You will then be escorted to your room on the Ward. The nurse will carry out a brief medical assessment regarding your medical and surgical history to confirm that you are fit to undergo the procedure. Please inform the nurse if you are diabetic, have a cough or cold or any kind of infection. All necessary tests will be performed at this stage.
Patients with diabetes or other medical conditions will be prioritised on the list as will elderly patients and you may have to wait. Every effort will be made to inform you of your position on the list and of any delays. You should use this time to relax in your room before you are taken down to theatres.
In theatres, you will be met by the anaesthetic assistant. Your consultant, the anaesthetist, a radiographer and a team of nurses will form part of your care team. A radiographer is required because your injections are done under X-ray control, meaning the surgeon can target the exact location to insert the needle. You will be positioned lying face down or on your side. Sedative medication will be given to you via the cannula thoughout your procedure to minimise the pain and make you as comfortable as possible.
You may feel some discomfort or pressure on your back as the injections occur, but this should resolve quickly. The procedure takes up to 20 minutes. When the procedure is complete, the nursing staff will apply small plasters over the injection sites. Immediately following, you may experience a tingling or slight numbness in the lower part of your body and arms or legs. This is a temporary effect caused by the local anaesthetic.
Afterwards, you will rest for as long as is necessary in the Recovery area. Once you have recovered from the initial effects of sedation (which normally takes up to one hour), your Ward nurse will transport you back to your room where you will be monitored further. You will be provided with a meal and refreshments before being discharged. The Spine Unit Coordinator will visit you on the Ward to arrange a follow up appointment for you.
You may feel weak or tired after your injection so we advise you rest for the remainder of the day. You may remove the plasters the following morning. You can expect some bruising, spot bleeding and pain at the injection site.
You may return to work the next day. If you have a physically demanding job or a job that demands heavy lifting, then it may be best to perform light duties for the next few days. As part of a healthy back regimen, it is important to have regular short breaks from prolonged sitting and standing and remain active during the day.
Social and sporting activites
You may return to your normal exercise regime the day after your injections. There are no sporting or social activities which are prohibited. Obviously, if a particular activity aggravates the condition, it would be sensible to stop this for the timbeing.
You should try to incorporate Pilates into your exercise regime. Pilates is good for strengthening core muscles and improving posture.
Driving & Travel
Please note that if you have had sedation, the drug remains in your blood system for about 24 hours. During this period you must not drive. You should organise an escort to collect you from the hospital. Alternatively the hospital can arrange a taxi for you on discharge. If you need to travel by plane within a few days of discharge, ensure you take regular breaks from prolonged periods of sitting.
“My back felt great when I left the hospital, but the next morning I was in pain again…is this normal?”
All patients are given a local anaesthetic during the procedure. This can take anywhere up to 12 hours to leave your spine. It is likely that you were not feeling any pain because of the anaesthetic, but once this wears off it is normal to experience some tenderness or stiffness at the site of injection. If you are in discomfort, you can take over-the-counter painkillers. If you require stronger medication, you should see your GP who will give you a prescription if appropriate.
“I am experiencing headache and tingling or numbness in my arms & legs after my procedure. What should I do?”
It is normal to experience a mixture or even all of the symptoms above for a few days after your injections.
If you are experiencing headache, you should drink plently of fluids and take painkillers if you need to. You may find lying down regularly can help. If your symptoms get progressively worse and pain medication does not provide any relief, you should contact Mr Akmal’s office or the Hospital.
Mild tingling or numbness in the limbs is normal and may even persist until you have a few sessions of physiotherapy. However, all of these symptoms should subside within a few weeks.
“It has been a few days since my injections and my back still hurts…is this normal?”
The steroid medication which is injected into your back does not have an immediate effect. The medication has a gradual effect and it can take up to fourteen days for you to notice the benefits from the corticosteroid.
It is therefore important to attend your routine follow up in clinic so we can assess the effectiveness of the injections. If the pain has persisted, then a further set of injections may be required Other treatment options such as surgery can be discussed. Please contact Mr Akmal’s office to arrange your follow-up appointment.
“What should I do after the injections to maintain my back?”
Ideally you should start a physiotherapy program approximately one week following your injections. Physiotherapy will teach you the skills and knowledge to keep your back healthy and strong. You should make arrangements with your own physiotherapist or we can recommend a therapist to you. Keeping fit and regular exercise is important. Pilates can also be beneficial.
Contact Us if:
- You have a persistent headache, uncontrollable pain, feeling unwell or nauseous, experience bowel or bladder problems.
For St John & St Elizabeth patients – telephone the Hospital ward on 020 7806 4000, ext 3317/4085. If the ward is closed, please ask for the Duty Manager on Bleep 08.
For St Mary’s Hospital patients – telephone the Hospital on 020 3312 6018. The ward is open 24 hours.
For BMI Garden Hospital patients – telephone the Hospital on 020 8457 4500. Ask for the ward manager.
For all other matters, you should make a further appointment with Mr Akmal’s team in clinic to discuss any concerns. Often it is impossible to judge the severity of your concern without a physical examination so a face-to-face consultation is best.