Degenerative arthritis of the spine can be a significant disability, mainly because it can affect any level, or multiple levels, of the spinal column, from the neck to the tail bone. There are many different treatment approaches to this problem, some conservative, some surgical. Among these options are various injections that can be used to reduce pain and inflammation.
Lumbar Epidural Steroid Injection
Lumbar epidural steroid injections (LESIs) are an injection of a steroid mixture into a space within the spinal column that lies just outside the spinal sac, which encases the spinal fluid and nerves, using a spinal needle.
The patient is typically awake and/or sedated. The procedure is usually performed by a licensed pain management physician, usually an anesthesiologist. They are usually performed in a hospital or outpatient surgery center setting. The needle is gently inserted into the epidural space in the same manner as a spinal (saddle) block is administered. The patient is monitored for a short time after the injection, then allowed to go home.
The injections are used to treat pain, swelling and inflammation of the spine, secondary to causes such as degenerative arthritis, compression of nerves from spinal stenosis and herniated discs. The medication is a mixture of a type of cortisone, combined with one or more types of local anesthetics to produce immediate relief while giving the steroid time to begin working. Many treatment protocols allow for more than one injection over a period of weeks.
Facet Joint Injection
The small joints that form when two bony segments of the vertebral column join together are called facet joints. These small joints are literally the only points of direct contact between any two vertebral bodies. They are truly joints and possess joint cartilage on their surfaces. In cases of spine arthritis, these joints may be significantly affected and degenerated. Occasionally, they may be the only points of degeneration.
Injections into these small joints involve the use of fluoroscopy (live x-ray) guidance of the needle to ensure it is inserted properly and directly into the joint. They are performed to relieve pain and inflammation caused by degenerative arthritis. Once proper needle position is established, the medication, usually a steroid mixture with local anesthetic, is administered. Occasionally, more than one injection is needed, over time, to adequately treat symptoms.
Botulinum Toxin Injections
Botulinum toxin (botox) injections have recently become treatment options for muscle spasms related to degenerative arthritis of the spine. The muscles of the neck and lumbar spinal areas are frequently exposed to spasms caused by pinched nerves and overall inflammation.
Injections of this toxin into the muscle tissue helps to block painful nerve stimulus transmission, reducing the amount, severity and duration of the spasms.
Nerve Root Blocks
Occasionally, injections of medication and/or local anesthetics directly around nerves as they exit the spinal column are performed to treat symptoms of pain and spasm of the body parts the nerves serve. An example of this is a nerve block in the lumbar (low back) area to treat leg and foot pain caused by the nerve in the spinal area being pinched or inflamed. These injections can be both diagnostic and therapeutic in their outcomes.
