Spinal Injections cost in India

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What are spinal Injections?

Spinal injections are the procedure followed to reduce or relieve the pain in the neck, back, and legs due to spinal stenosis or disc herniation. During the process the needle is injected into your spine near the epidermal space of pain nerve and the medicine is released. There are various spinal injections (a medicine used in them) they are as follow,

• Costotransverse and Costovertebral Joint Injections.
• Costovertebral and Costotransverse Joint Injection
• Injections for Neck and Back Pain Relief.
• Epidural Steroid Injections (common spinal injection)
• Selective Nerve Root Block Injections.
• Facet Joint Injections and Medial Branch Blocks.
• Sacroiliac (SI) Joint Injections etc…

Goal of Spinal/Epidural injection

The goals of an epidural steroid injection are to:

• Control pain by reducing inflammation in and around the nerve roots       
• Improve mobility and function in the lower back and legs
• Allow the patient to participate in and make progress with a comprehensive physical therapy and rehabilitation program

The role of the injection is typically to provide sufficient pain relief to allow a return to everyday activities and to make progress in physical therapy.

Benefits of Injections

Most practitioners will agree that an epidural injection can be beneficial during an acute episode of back and/or leg pain. Typically, if the initial injection is effective, up to 3 injections may be given in one year.

• Reduce nerve pain and inflammation. Steroids decrease the production of inflammatory chemicals and reduce the sensitivity of nerve fibers to pain, generating fewer pain signals.
• Limit oral medication. Pain relief from these injections may help limit or eliminate the need for oral medications,some of which may have side effects when taken long-term.
• Continue or re-engage in physical therapy. This injection may provide sufficient pain relief to allow a patient to progress with a rehabilitative physical therapy program.
• Postpone surgery. Pain relief experienced from lumbar epidural steroid injections may help postpone surgery, and if physical therapy is effective, it may eliminate the need for surgical intervention.

Risks

Epidural steroid injections are considered a relatively safe and minimally invasive. Temporary side effects may occur in some cases and include (but are not limited to):

• Post-injection pain
• Nausea
• Headache
• Dizziness
• Fainting (vasovagal attack)
• Flushing of the face

These side effects typically resolve in a few minutes to hours. Serious complications, while rare, may include spinal cord damage, dural puncture, and/or stroke.

Injection Technique

1 of 3 techniques is used in an epidural steroid injection: transforaminal, interlaminar, and caudal. The effectiveness of a technique depends on its ability to deliver the medication closer to the target nerve roots.

Transforaminal injection

This method is considered the most effective in depositing the solution close to the affected nerve roots. It may be used if sciatica is caused by certain lower back conditions, such as a lumbar herniated disc impinging a spinal nerve. In this method, the needle is inserted through the side of the spinal canal into the intervertebral foramen to reach the epidural space. To avoid adjacent blood vessel damage, the needle is passed through a small space above the spinal nerve as it exits the neuroforamen, called the safe triangle.

Interlaminar injection

In this method, the needle is inserted through the back of the spinal canal between adjacent spinous processes (bony projection of the vertebra) or laminae (posterior wall of the vertebra) to reach the epidural space.

Caudal injection

In this technique, the needle is inserted from below the spinal canal through an opening called the sacral hiatus. The depth of penetration of the needle to reach the epidural space is more in this method. While this method is safer and easier to perform, it is also less effective. In general, the location and severity of the spinal inflammation, injection technique used, and the proximity of the medication to the affected nerve roots—all contribute to the final outcome of the injection. It is also important that the injection is delivered under the guidance of contrast-enhanced fluoroscopy (live -x-ray) for safety and accuracy.

Preparations

The injection procedure is usually scheduled for the morning. Instructions typically include no eating and drinking for about 6 hours before the procedure. A hospital gown is worn to allow better access to the injection site. Conscious sedation using relaxation medication may be given to ease the patient’s anxiety.

During Procedure    

The injection is usually given while the patient lies on their stomach (prone position) on a fluoroscopy (live x-ray) table. The procedure may take up to 30 minutes. The doctor may decide to use a transforaminal, interlaminar, or caudal route to administer the injection. An intravenous (IV) line is started if relaxation medicine is needed.

The common steps involved in the injection procedure are as follows¹:

• The skin over the injection site is marked and cleaned with betadine.
• A fluoroscopic x-ray is used to locate the correct vertebral level for needle guidance; the live images can be seen on a computer screen.
• A local anesthetic is injected into the skin and underlying tissues to numb the area.
• An epidural spinal needle is inserted into the intended injection site and guided using fluoroscopy.
• A contrast dye is injected into the epidural space to check the spread of the injected contents.
• Once the spread is confirmed, the steroid medication is injected into the epidural space.

A tingling or mild burning sensation or the feeling of pressure may be experienced as the medication enters the epidural space. When the injection is completed, the irritation and discomfort usually disappear within a few minutes. The patient is usually monitored in a recovery room for 30 minutes to an hour where vital signs are continuously monitored.

Driving and strenuous physical activities and flying in an airplane are not recommended on the same day after the procedure.

Recovery

While the local anesthetic in an epidural steroid injection usually provides immediate pain relief, it may take up to 2 weeks for the steroids to take effect. Regular activities may be resumed slowly on the day after the injection. Ice packs may be used at home if pain occurs at the injection site. Ice packs are usually used for 15 to 20 minutes at a time with a break of at least two hours in between to avoid skin injury. Hot baths, sauna, and swimming are usually not recommended for 2 to 3 days after the injection to avoid the risk of infection.

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