Back pain is a common condition that unfortunately at some point in our lives, many of us will have to endure. In most instances, the pain is attributed to a mechanical cause (wear and tear) and is short lived, with complete resolution of the symptoms. Less frequently, the pain is severe and unrelenting, limiting general activity and work. A disc bulge or herniation (“slipped disk”) is a common cause of severe back pain and usually settles with some rest, pain relief, physical therapy followed by a graduated return to activities. If the pain doesn’t settle, then an epidural injection of cortisone may be required.
The facet joints are small joints of the spine which are designed to facilitate mobility and rotation. As significant loads on these joints may occur, inflammation and degeneration is common, resulting in lower back pain that characteristically radiates to the buttocks. Facet joint pain may be treated with physiotherapy and strengthening exercises to unload the joints and improve dynamic stabilisation of the spine, however if the pain is unabated, a facet joint injection or a medial branch block may assist in relieving the pain. Pain in the lower aspect of the lumbar spine may also be due to inflammation or arthritis of the sacroiliac joints which is often a challenging clinical diagnosis.
It is often difficult determining whether leg pain is arising from the leg itself, or indeed referred from the lumbar spine. A disc bulge or herniation may compress nerves within the spinal canal, causing leg weakness, numbness, pins and needles (paraesthesia) and severe pain. The area of the leg that is symptomatic is an important clue as to which nerve in the spine is irritated, which may then be treated with either a transforaminal epidural injection or selective nerve root block. The compression of the nerve can be further compounded by an arthritic facet joint, which increase in size due to bone growth and spur formation. Similarly, arm pain may arise from the neck (cervical spine) when a degenerated disc contacts the nerves within this region.
If a rehabilitation programme has not adequately treated the patient’s pain, a next possible step in the patient management pathway is to perform an MRI. A CT scan can be substituted for an MRI if the patient is unable to undergo MRI evaluation (for example, in the setting where a pacemaker or brain aneurysm clip is present). If the findings on either the MRI or CT scan correspond to the clinical diagnosis, then an appropriate injection may be recommended following further consultation between the referring clinician and radiologist.
Melbourne Radiology Clinic offers a number of interventional spine and back pain management injections.
More information about each of these procedures and guidelines for patients having the specific spine or back pain injection at Melbourne Radiology Clinic can be found below: