Long Island Spine Rehabilitation Medicine offers spinal injection treatments to identify and treat certain sources of back or neck pain. Here’s an overview of the injection procedures we offer to help you know what to expect from your appointment. We also offer a more in-depth guide for download.

What Types of Injection Procedures Do You Offer?

Our injection procedures fall into two basic categories: diagnostic injections and therapeutic injections. Each type targets a specific structure in the spine believed to be responsible for your pain, based on findings from your medical history, physical examination, imaging studies, and other diagnostic tests.

Diagnostic Injections

Diagnostic injections are used when the exact source of pain remains unclear after the initial evaluation. These injections contain a contrast agent and a local anesthetic and are designed to help identify the structure causing pain rather than treat it.

For accurate results, we must perform the procedure while you’re experiencing your usual pain, which may require you to avoid pain medications for 12 to 24 hours beforehand. During the procedure, we’ll place the anesthetic at the suspected pain source. About 20 to 30 minutes later, we’ll evaluate your pain response by comparing your pre- and post-injection pain levels and activity responses. If the injection relieves at least 80 percent of your pain, we may then treat the identified area with a therapeutic injection.

Facet injections and medial branch block injections are two of the most common types of diagnostic injections we perform at Long Island Spine Rehabilitation Medicine. Facet joints connect the vertebrae in the spine and can develop degeneration over time. When cartilage within these joints breaks down, inflammation may occur and trigger pain signals. If we suspect these joints are a pain source, we may recommend a diagnostic procedure. This can involve placing an anesthetic either directly into the joint or along the medial branch nerves that carry sensation from the joint. If the injection significantly reduces your pain, it suggests the facet joint is responsible. Although the numbing effect is temporary, the results help guide our next steps, which may include treatments such as radiofrequency ablation or steroid injections.

Therapeutic Injections

Therapeutic injections include a corticosteroid in addition to a contrast agent and an anesthetic. The steroid works to reduce inflammation, stabilize nerve membranes, and decrease pain activity.

Epidural steroid injections are the most common therapeutic procedure we perform, and are intended to gradually reduce your pain over time. We use this spinal procedure to deliver anti-inflammatory medication to irritated or compressed nerves affected by disc herniation or spinal narrowing. Our physicians determine whether this treatment is appropriate after reviewing your medical history, physical exam findings, and imaging results. We then perform the injection using fluoroscopy, a form of X-ray guidance, which helps us place the needle accurately and deliver medication to the area believed to be causing the pain.

What Medications Will You Give Me for My Procedure – and What Medications Do I Need to Stop Taking Beforehand?

Injection procedures typically involve three medications:

  • A local anesthetic numbs the skin and the targeted area
  • A contrast dye helps us confirm the accurate placement of the needle
  • A steroid decreases inflammation and pain activity

Please inform our team of any allergies, particularly to contrast dye, since we may need to make special preparations prior to your procedure.

It’s also important to pause certain medications prior to your injection:

  • Blood Thinners – We typically ask you to stop using these in advance and restart them later the same day as your procedure.
  • Aspirin and NSAIDs – Spinal injections may require you to stop using anti-inflammatory medications, although this depends on the injection site. If you’re taking aspirin for heart or stroke conditions, consult your cardiologist before pausing your medication.
  • Pain Medications – We typically ask that you avoid pain medications for 12 to 24 hours prior to a diagnostic injection so we can accurately assess pain relief from the test injection.

What Happens on the Day of My Procedure?

On the day of your procedure, inform your doctor if you’re pregnant (or may be), feeling unwell, or have recently received treatment for an infection. Arrange for someone to drive you home afterward. Morning appointments allow for a light breakfast, while afternoon procedures permit a normal breakfast and light lunch.

Arrive about 10 minutes early and expect to spend around an hour at our facility. After the injection, our staff will monitor you for about 30 minutes before sending you home with instructions. You may shower afterward, but avoid bathing, swimming, and hot tubs for 24 hours.

Are There Any Potential Complications or Side Effects I Should Be Aware Of?

Contact your physician after an injection procedure if you experience symptoms that may indicate a complication. Situations that warrant medical attention include:

  • Fever higher than 100°F
  • Loss of bowel or bladder control
  • Severe pain that continues to worsen
  • New or increasing weakness or loss of movement in an arm or leg
  • A strong headache when sitting or standing that improves when lying down

Some side effects can occur after spinal injections, and they’re usually temporary. You may notice increased pain during the first 24 to 72 hours because we place medication near already irritated tissues. Tenderness around the injection site is also possible and often improves with ice. Steroid medications may cause short-term symptoms such as facial flushing, mild headache, difficulty sleeping, or anxiety.

More serious complications are possible, but uncommon. These may include infection, bleeding, allergic reactions, nerve injury, fainting, or other rare medical events. Studies reviewing large numbers of injection procedures have reported very few complications and no lasting harm in most cases.

Which Steroids Are Used for Injections?

The steroid we use during an injection depends on the type of procedure we’re performing and the injection site. Epidural injections directly into the nerve root most often involve a non-particulate steroid because current treatment guidelines support this approach. In certain cases, we may recommend a particulate steroid after discussing potential risks and benefits with your doctor.

For injections between the vertebrae, we’ll typically use a particulate steroid. These medications are widely used for joint and epidural injections. Although rare complications have been described in medical literature, we carefully consider safety when selecting the appropriate medication.

Can Injections Work for All Spinal Problems?

While spinal injections can relieve pain for many conditions, they aren’t suitable for every patient. Some spinal problems may require surgical evaluation. In other situations, we may refer you to a neurologist or a chronic pain management specialist. Care decisions focus on accurate diagnosis and recommending treatments that are reasonably expected to help the patient.

Contact Long Island Spine Rehabilitation Medicine to Learn More

If you have any questions as you prepare for your spinal injection appointment, please don’t hesitate to reach out to our team for clarification.