Spinal epidural & nerve root injections
Mr Chris Brown, Consultant Orthopaedic Spinal Surgeon at Circle Reading, walks us through the process of undergoing a Spinal Epidural or Nerve Root Injection as a treatment option for back pain.
There are a number of avenues to explore when it comes to back and neck pain, so it is my priority to make a correct diagnosis early on and start treatment as soon as possible.
I have a conservative approach to any kind of surgery or operation, and will actively try to avoid it if there are other non-invasive options available. These options will be presented to you as part of our multi-disciplinary approach, with our expert physiotherapy team on hand from your first consultation with me. Many patients are able to effectively manage their level of pain with the help of a dedicated physiotherapist, who will work with you and your specific needs in your rehabilitation.
The extensive facilities on offer at Circle Reading help to give me a wide array of diagnostic information. I’d usually request an MRI or CT scan at an early stage in order to get an accurate diagnosis promptly. MRIs are particularly good at highlighting any inflammation, giving me a clear idea whether or not an injection or epidural will be of use. One of my primary aims is to help you feel at ease, answering any questions you may have, highlighting all treatment options available to you, and offering advice on the best course of action, if you so wish. Ultimately, any decision made is yours, and I will always aim to clearly set out expectations about the success rate of any treatment and expected recovery time.
If you have already undertaken a course of physiotherapy and it hasn’t been successful in reducing your pain, I may advise you to undergo a spinal epidural or nerve root injection (depending on your specific needs).
Nerve root injections and spinal epidurals are predominantly designed to give a local anaesthetic and steroid shot as an anti-inflammatory, helping to reduce your pain. It has often proved very successful, enabling many of my patients to regain normal function and return to an active lifestyle, which may have proved difficult prior to the treatment.
A spinal epidural or nerve root injection is a simple day case with low risk. It can take between 15 and 45 minutes, with very little recovery time, although I always advise my patients to arrange for assistance in terms of transport home while any temporary numbness wears off. Numbness usually subsides within a few hours.
With the facilities provided at Circle Reading, I perform the injection under X-ray guidance, which is running throughout the operation, ensuring a high level of accuracy with the best possible outcomes.
You will be asked to lie face down, and I will clean the intended injection site with an antiseptic, as well as administering some light sedation for an epidural. If you’re suffering from a herniated disc or spinal stenosis, a spinal epidural may be the best option, where the steroid and anti-inflammatory is injected into the area around the spinal column known as the epidural space. If you have radiating pain in the arms or legs (such as with sciatica), I will likely opt for a nerve root injection to target that specific bundle of nerves, injecting into the cluster of nerves as they branch out from the spinal column.
As with any procedure, there are some small risks, such as possible infection or nerve damage, but the majority of my patients report significant improvement long term. Occasionally, patients can report increased pain around the site of the injection, but this typically goes away within 24-48 hours.
At a follow-up appointment to check on your progress, I will again work closely with our physiotherapy team, who may be able to advise on a further course if you now find that you are more mobile, as well as recommending ideas for best practice when playing sports or taking part in physical activity. This may help prevent any relapses in spinal pain.
From your first appointment with me, I always want to be clear in terms of setting any expectations, and the results of this procedure can vary. Some patients experience full pain relief without it ever returning; others may be relieved of symptoms for a few weeks or months, only for the pain to return, albeit not as severe. Under these circumstances we can look into the possibility of further injections. Sometimes, the pain relief may only be temporary and can return as bad as it was. In such cases where the nerve root injection has provided ineffective pain relief, I would potentially look towards a nerve stimulation approach, but would ask for further diagnostic information first to rule out any other issues. As always, surgical options are a last resort if necessary.
If you have been experiencing consistent back pain that hasn’t responded to over-the-counter painkillers, why not book an appointment with me? With no waiting lists at Circle, I can diagnose you promptly, offering you the best options so you can make an informed decision and start treatment at your convenience.