Infiltration for back pain

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In the case of back pain infiltration, a mixture of a local anesthetic and an anti-inflammatory drug is usually injected where the pain originates. Irritation and inflammation are inhibited and pain is reduced. Read here how an infiltration works and what risks it entails.

What is an infiltration?

Infiltration (infiltration therapy) is used to treat back pain. Often these arise from the increasing wear and tear of the intervertebral discs and the joints of the spine. This creates pressure on the nerves and nerve roots, which can lead to inflammation and swelling of the nerves and surrounding tissue. The goal of infiltration is to break this vicious circle.

By injecting a local anesthetic (local anesthetic) and an anti-inflammatory drug such as cortisone into the affected areas, the transmission of pain can be blocked and inflammation reduced. In certain cases, the infiltration of the spine even offers a highly effective alternative to surgical procedures.

Depending on the location, different types of infiltration can be distinguished.

Facet infiltration (facet joint infiltration)

With facet infiltration, the doctor injects the mixture of active ingredients into the small joints where the bone processes of the vertebral arches lie on top of one another (facet joints). Because the "shock absorber effect" of the intervertebral discs wears off over the course of life, the natural gaps between the vertebral joints decrease.This leads to increased wear and tear on the facet joints and ultimately to back pain.

Epidural Infiltration

The medication is applied to the epidural space (also: epidural space). This is located between the outer and inner sheets of the hard membrane of the spinal cord (dura mater) and contains the spinal nerves and their roots. Using this common space, the doctor can treat pain caused by several nerves at the same time by injecting a mixture of active substances.

Periradicular infiltration

With periradicular infiltration, the doctor specifically numbs individual nerves by injecting it directly around their roots.

ISG infiltration

The sacroiliac joint (SIJ) - the connection between the sacrum and the ilium (ilium) can also be responsible for back pain. Blockages or inflammation are usually the cause of the so-called ISG syndrome. In the case of ISG infiltration, the anti-inflammatory and pain-relieving active ingredient mixture is injected into the ligamentous apparatus or directly into the joint space.

When do you do an infiltration?

The most common indications for spinal infiltration are:

• Back pain
• degenerative spinal diseases (wear and tear)
• Disc herniation (prolapse) or bulging (protrusion)
• Facet syndrome
• Lumboischialgia
• Spinal stenosis
• ISG blockages

Infiltration therapy is also used in the diagnostic field: If the pain can be significantly reduced through the infiltration, the source of the pain has been found. If it does not work, other causes must be looked for.

What do you do with an infiltration?

Infiltration is a short procedure during which you do not have to sleep and are allowed to eat and drink beforehand. Before the actual infiltration therapy, your doctor asked you about your medical history in a short conversation and explained the possible complications. An x-ray or computed tomography (CT) image may also have been taken to help the doctor orient himself. Based on the picture, he determined the puncture site.

Depending on the location of the infiltration, you lie on your back or stomach or you sit with your torso bent forward in front of the doctor. To ensure that the puncture is as painless as possible, the doctor first anaesthetizes the skin over the planned infiltration site. Infiltration into anatomically more complex regions is often carried out under CT control in order to be able to determine the exact position of the needle before the drug is injected. For a better display, a contrast agent can then first be injected. Its spread shows whether narcotics and cortisone would get to the right place.

The medication is now administered with a slow injection. Finally, the needle is removed again and the puncture site is protected from infection with a sterile plaster.

What are the risks of infiltration?

Side effects and complications are very rare during or after infiltration therapy, but they can also occur when used correctly.

As a precaution, infiltration of the spine should not take place in existing infectious diseases and, in particular, must not take place in local infections. The doctor tries to rule this out through a thorough questioning and physical examination of the patient.

The use of anticoagulant drugs (including anti-inflammatory agents such as aspirin, diclofenac or ibuprofen in high doses) or blood clotting disorders speak against infiltration, as the risk of the formation of hematomas increases.

Pregnant women, patients with poorly controlled diabetes, heart failure or glaucoma should also not undergo infiltration therapy.

If blood vessels are injured by the infiltration needle, a bruise (hematoma) can occur. Large hematomas can press on the surrounding tissue and may need to be surgically removed.

As with all surgical interventions, the introduction of pathogens can also lead to infections that must be treated with antibiotics or surgically.

In very rare cases, the spinal cord, nerves or nerve roots are injured, which can lead to pain, sensory disorders or motor failures.

If the drugs accidentally get into the bloodstream, they can lead to general reactions such as a drop in blood pressure, irregular heartbeat, headaches or severe cramps (convulsions). The Art tries to prevent such accidental “intravascular” injections by pulling the plunger back a little (aspirates) at the injection site to see if blood gets into the syringe. In this case, he stops the infiltration.

In the case of an allergy, the drug mixture can trigger a local or general allergic reaction up to and including allergic shock (anaphylactic shock), which must be treated with the rapid administration of drugs and an infusion.

What do I have to consider in the event of an infiltration?

After the infiltration, depending on the injection site, temporary sensory disturbances and muscle weakness can occur, which is why you should not run around and, in particular, not actively participate in road traffic. Instead, lie down for two hours, if possible, until the active ingredient has spread and achieved the desired effect.

If there is permanent pain at the injection site or if nausea, vomiting, headache, high blood pressure or an increased blood sugar level occur after the infiltration, you should inform your doctor as soon as possible.

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