The London Spine Unit
“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?
Around 75% of individuals who undergo injections have significant relief of symptoms; 20% have mild relief and still experience some discomfort .
How long will the effect last?
The injections are only supposed 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. It 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.
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 lightly 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.
Preparation for Your Spinal Injections
Eating & drinking before your procedure
On the day of your procedure, nil by mouth (fast from food) six hours prior to your procedure. You may drink clear fluids (water, tea and coffee WITHOUT sugar or milk) up to three hours prior to the procedure.
Medications and your procedure
|Routine Medications||Take as normal.|
|Warfarin||Stop taking this three days before your procedure. Alert your GP or specialist if this applies to you.|
|Clopidogrel or Plavix||Stop taking this ten days before your procedure. Alert your GP or specialist if this applies to you.|
|Aspirin based medication||Stop taking this seven days before your procedure. Alert your GP or specialist if this applies to you.|
|Allergies||Please telephone 0844 589 2020 if you think you have an allergy to latex or any medication.|
|Pregnancy||If there is a possibility you are or may be pregnant, it is advisable you do not undergo this procedure.|
Specific Instructions for Diabetic Patients
Please inform the Ward about your diabetes.
- On the morning of your procedure,
- If you usually test your blood sugar levels, check them in the morning. Your blood sugar levels will be re-checked by the Ward nurses when you arrive.
- If you are on tablets, do not take your morning dose of tablets. Bring your tablets with you to have after the procedure. Take your tablets as soon as the nursing staff advise you are able to eat and drink safely.
- If you are on insulin, report to the nursing staff if you have needed glucose before arriving and inform them immediately if you feel ‘hypo’ at any time during your visit. Do not take your morning dose of insulin. Bring your insulin with you to have after the procedure. It can be given as soon as the nursing staff advise that you are able to eat and drink safely.
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 for the injections in your spine. 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 30-60 minutes), 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. There may be some bruising, spot bleeding and pain at the injection site and this is quite common.
It is safe to return to work the next day. If you have a physically demanding job, then it may be best to perform light duties for the next day or two. As part of a healthy back regimen it is important to have regular short breaks from prolonged sitting/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/social activities which are prohibited although caution should be taken with any activities that require awkward bending or twisting movements e.g. golf, tennis. Obviously, if a particular activity aggravates the condition, it would be sensible to stop this.
A common misconception is that Yoga is good for strengthening the back, when in fact Pilates is a much better exercise for strengthening core muscles and improving posture. Yoga is however beneficial for flexibility.
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. 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 absolutely normal to experience a mixture or even all of the symptoms above for a few days and up to a few weeks 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 Ward.
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?”
This does not necessarily mean that the injections have not worked. 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 someone to you. Keeping fit and regular exercise is important. Pilates can also be beneficial.
If you experience a return of your back pain after a period of being pain-free, it is best to have a formal assessment as soon as possible in order to detect matters early before it can progress.
“I am still concerned. What should I do?”
Should you have any problems or worries after discharge, please do not hesitate to contact either Mr Akmal’s office or the Ward for advice. Contact numbers are listed below: –
For all patients – telephone the Spine Unit Coordinator on 0844 589 4040, Mon – Fri between the times of 9:00am – 5:00pm.
For St John & St Elizabeth patients – telephone the Hospital 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.
Contact Us if:
- You have a persistent headache.
- You have uncontrollable pain.
- Feeling unwell or nauseous.
- You experience bowel or bladder problems.
- You are worried about anything.
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.
Benefits, Risks and Side effects
Spinal injections are classified as a minimally invasive procedure and carries a low risk of associated complications, although they have been documented. The risks can be associated with the procedure itself or with the administration of the sedation. Your consultant who has requested the procedure will have considered the risks and compared them to the benefits of having the procedure carried out.
The benefits of spinal injections include temporary pain relief, namely in the back and limbs, allowing greater mobilibty and increasing quality of life.
Around 75% of individuals who undergo injections have significant relief of symptoms; 25% have mild relief and still experience some discomfort.
The main risks of the procedure are rare and in most cases very treatable.
- Infection, <1%
- Bleeding, rare and mostly seen in patients with underlying bleeding disorders
- Nerve injury, <1%
- Dural puncture causing severe headache, 1%
- Local discomfort
- Temporary weakness
The main side effects of the procedure are commonly associated with long term exposure to steroids and it is quite rare to experience these side effects because the dose of steroid used in injections is relatively low. If you do experience any of these symptoms, they are usually temporary.
- Fluid retention, Weight gain, Elevated blood pressure, Flushing and blushing of the skin, Mood swings, Insomnia, Stomach ulcers, Cataracts, Arthritis of the hips
before your injection
- received Booking confirmation email or letter
- completed and returned Hospital admission forms
- stopped Warfarin / Clopidogrel/ Aspirin as required (see page 2)
- organised for an escort to take you home on discharge
- contacted your health insurer with procedure codes (applicable to patients with medical insurance)
- for female patients, please ensure there is no possibility that you could be pregnant (if unsure, you must perform a pregnancy test within 24 hours of admission and inform the hospital/consultant of the result)
What to bring with you:
- a method of payment or proof of insurance details i.e. membership number, pre-authorisation number (see below for payment advice)
- your latest MRI or X-ray CD
- all medications you are currently taking (preferably in their original packaging)
aFTER THE INJECTION
- collected your MRI or X-ray disc from hospital staff
- organised physiotherapy to start approximately one week later
- booked a clinic appointment in 4-6 weeks time to assess progress and determine ongoing treatment
Pay Plans at the St John & St Elizabeth Hospital
You will be liable to pay for three separate charges; hospital fee, surgeon fees and the anaesthetist fee.
Patients who have medical insurance (e.g. BUPA) are advised to contact their insurer to get authorisation for any treatment PRIOR to admission. It is the patient’s / representative’s responsibility to verify with the insurer that the condition to be treated is covered by their insurance. Any shortfalls in benefit are the patient’s or their representative’s responsibility. Should any sponsorship or guarantee fail, or insurance claim be declined in whole or in part, the patient will be required to pay the outstanding balance in full.
If you do not hold medical insurance, we will give you a fully-inclusive estimation of cost for your treatment prior to you agreeing to anything going forward.
Payment, should you choose to go ahead with treatment, will then need to be made on or before you are admitted to the St John & St Elizabeth Hospital. Any extras, such as extra tests, procedures, equipment, or extended stay will be billed to your account, payable before you are checked out.
 British Associatio of Spine Surgeons, (2007). Lumbar Discectomy and Decompression [online]. Available: http://www.spinesurgeons.ac.uk/article.asp?article=28 [accessed 12 November 2010]
Patient agreement to spinal injections treatment
Name of procedure (s) including a brief description
Injection of anti-inflammatory steroid-based medicine + local anaesthetic into the cervical or lumbar spine region.
Statement of health professional
I have explained the procedure to the patient. In particular, I have explained:
- The intended benefits of the procedure: Pain relief, increased mobility
- Any serious or frequently occurring risks from the procedure: Failure, local bleeding/bruising/ infection/discomfort, spinal anaesthesia (numbness, weakness, paraesthesia, loss of consciousness), post dural puncture, headache, tiredness
I have discussed what the treatment procedure is likely to involve, the benefits and risks of any available alternative treatment (including no treatment) and any particular concerns of this patient.
The procedure will involve: R Local anaesthesia R Sedation
Health Professional’s signature……………………………………………….. Date:………………………………….
Name (print) ………………………………………………………………………………..Job Title: Consultant
Statement of patient
You have the right to change your mind at any time, including after you have signed this form.
I have been provided with the booklet Spinal Injections – The procedure explained SIv0211.
I have read and understood the information in the corresponding booklet including the benefits and any risks.
I agree to the procedure described on this form.
Patient’s Signature…………………………………………………………… Date:………………………………………