Radiology - A guide to your Spinal Injection

This leaflet tells you about the procedure known as an image guided spinal injection (Nerve root block or Facet joint injection).

It explains what is involved and what the possible risks are.

We hope you find this information helpful, but you should still discuss any concerns you may have with your doctor before you sign the consent form.

What is an image guided spinal injection and why do I need one?

An image guided spinal injection is a diagnostic test during which a special needle is passed through the skin to inject steroid and local anaesthetic surrounding a specific area of the spine.

The doctor will use a CT scan or live x-rays (fluoroscopy) to guide the needle to the area. The injection can help identify if the targeted area is causing symptoms and, in most cases, this is the primary role for a spinal injection.

On occasion the injection may help with improving the symptoms over a longer term, however, they do not provide relief for all patients and in most cases any relief is only temporary.

Who has made this decision?

The consultant in charge of your care feels that this is the best way of getting more information about your problem. We usually plan a spinal injection in advance so you have the opportunity to discuss your options with your consultant or their team. Your opinion will be taken into account. If you do not want this procedure, you can decide not to have it at any time, even after signing the consent for.

What are the risks and complications?

An image guided spinal injection is a safe procedure and serious complications are rare. Small risks vary depending on where we are injecting.

Despite these small risks your consultant has decided to refer you for this examination. This is because they feel that the benefits of having the procedure outweigh the risks of having done. Your consultant or their team will discuss your options with you in advance.

The risks include the following:

• Discomfort or mild pain in the area where the needle was placed is possible. This can usually be controlled by painkillers
• Bleeding is usually minimal and of short duration but more serious bleeding can rarely occur. If the bleeding continues, then it is possible that you might need blood transfusion. Very rarely, an operation or another procedure is required to stop the bleeding
• Infection of the skin or deeper tissue is rare
• Injury of surrounding structures. In all spinal injections there is a tiny risk of damaging a nerve. This could worsen the pain and result in numbness and weakness in the region of the body the nerve supplies
• If the injection is in the neck (cervical spine) there is an extremely small risk of more serious complications, which include stroke, damage to the spinal cord and Horner’s syndrome (drooping of the eyelid and constriction of the pupil of the eye).

If you have any worries, please do not hesitate to discuss the possible complications or risks with staff before your spinal injection.

How do I prepare for the nerve root block?

Nerve root blocks are an outpatient procedure. There are no special preparations however, we need to know if you take some forms of medication. If you are taking warfarin, aspirin, clopidogrel or other blood thinning medications, please inform your hospital consultant or the department at least one week before your procedure. Your blood thinning medication will need stopping in advance. You can continue to take other routine medication.

What actually happens during a spinal injection?

You will be brought to the x-ray department to have your spinal injection. The radiologist (the doctor who will be performing the injection) will speak to you beforehand and answer any questions. Please let them know if you are allergic to anything.

The skin over the site will be cleaned with an antiseptic and covered with a sterile drape. The procedure will be performed under a local anaesthetic injection. The local anaesthetic will sting initially before the skin goes numb. The doctor will use a CT scan of live x-rays to guide the needle to the area. You will need to stay still for the entire procedure. You may feel some minor discomfort or pressure as the needle goes in and when the drugs are injected.

The procedure takes approximately 15 to 30 minutes from start to finish. Frequently you will experience numbness and weakness in the affected limb after the procedure. This is normal and may get worse over the next couple of hours as the anaesthetic works. The numbness may last for anything up to 36 hours. The performing doctor will notify you of any particular symptoms to look out for after your injection as these will depend on where the injection occurs.

After the spinal injection

You may be asked to wait 10-20 minutes to check you are well and there have been no untoward effects. Some patients may experience pain following this procedure. Please let the nurses and the radiographers know if you have pain or if you need any painkillers. You can eat and drink normally.

If the procedure is being carries out as a day case and there are no complications, you will be allowed home after 10-20 minutes. You must not drive or use public transport. You must have an adult tom take you home (by car or taxi) and stay with you overnight. If there is no one to stay overnight with you, you will have to stay overnight in hospital.

When will I get the results?

The results are determined by your supervising consultant who will assess the injection the next time you see them in clinic following the procedure.

What if I decide not to have the procedure done?

If you decide not to go ahead with the procedure after you have had a chance to discuss any concerns you have with the radiologist, we will notify your referring doctor of your decision so that they can discuss the options for further treatment with you.

Could you be pregnant?

If there is any chance you could be pregnant, please call 0161 206 5091 if your appointment is at Salford Royal Hospital. Please call 0161 656 1178 if your appointment is at Royal Oldham Hospital.

Is x-ray guidance dangerous?

All x-ray machines use potentially harmful x-rays. Modern equipment is designed to keep the dose you receive as low as possible. If your doctor has asked for this test, they will have decided that the benefits from the procedure outweigh the risks from the very small dose of radiation that you receive.

What if I cannot attend my appointment?

If you have any queries about your appointment or cannot attend, then please telephone the booking office on:
0161 204 2044/2404 (Salford Royal Hospital)
0161 624 0420 (Royal Oldham Hospital)
Monday to Friday 8.30am to 4.00pm.

You can also email:
salford.booking.radiology@nca.nhs.uk (Salford Royal Hospital)
bookingandscheduling.outpatients@nca.nhs.uk (Royal Oldham Hospital)
Please include name, date of birth, address and hospital number (if known) in any correspondence.

I need an ambulance. How do I arrange one?

If you need an ambulance there are contact details on your appointment letter.

Please contact us if you are arriving by ambulance so we can time your appointment with your ambulance arrival. If we are not aware that you are coming by ambulance you may miss your appointment and it may have to be rebooked.

If you need an interpreter

If you need an interpreter for your examination, please call the department so that we can try and arrange this.

Contact Details

We hope your questions have been answered by this leaflet.

If you require help or any other information regarding your appointment you can contact:
The Angiography Department, Salford Royal Hospital 
Tel: 0161 206 2206/5091

Interventional Radiology, Royal Oldham Hospital
Tel: 0161 656 1178