Spinal injections and nerve blocks

Have you been offered a “spinal block”? Clarify three things: where the medication will be injected, what it aims to achieve and how the result will be assessed. This helps you understand the recommendation and discuss the next treatment step.

More about spinal injections under X-ray guidance

Therapeutic and diagnostic injections: different aims

A therapeutic injection aims to reduce pain and, depending on the medicine, inflammation. A diagnostic block helps test a suspected source of symptoms: whether the particular movements and activities that previously provoked pain have become easier.

The response is assessed alongside symptoms, examination and investigations. Relief after one injection does not independently confirm all causes of pain.^[3]^[5]

Why X-ray or CT guidance is needed

A targeted injection is not simply a “jab in the back”: the doctor must confirm exactly where the medication is being delivered. Fluoroscopy using a C-arm is recommended for epidural and nerve root procedures; intra-articular facet injections use fluoroscopy or CT, depending on the technique.^[3]^[5]

Imaging guidance checks needle position, while contrast shows the spread of the injected solution. “Blind” injection does not confirm that medication has reached the intended nerve root or joint.

Which procedures are called a nerve block?

Epidural injection and nerve root block

Medication is injected into the epidural space or precisely around a selected nerve root. This approach may be used for nerve root pain, for example when pain travels from the lower back into a leg. The approach, level and medication are determined separately.^[1]^[4]

The facet joint and medial nerve branches

Injection into the joint and blocking the small nerve branches supplying it are different procedures. A diagnostic medial branch block may be part of the assessment before radiofrequency denervation.^[1]^[5]

The sacroiliac joint

This is a separate area between the sacrum and pelvis. An injection is planned when it is suspected to be the pain source, rather than as a substitute for any lumbar injection. Pain around the sacroiliac joint.^[3]

Muscle trigger points

These injections target selected painful areas of muscle. They do not enter the epidural space or remove a herniated disc.

Why indications matter, not just the diagnosis

The words “disc herniation” or “stenosis” in an MRI report do not by themselves determine which procedure is needed. Findings must be compared with symptoms and examination results.

NICE allows epidural local anaesthetic with steroid for acute, severe sciatica. It does not recommend spinal injections for non-specific lower back pain or epidural injections for neurogenic claudication caused by central stenosis.^[1]

For nerve root pain, the 2025 AAN review reports limited benefit from epidural steroids, predominantly in the short term. Findings on lumbar pain cannot automatically be applied to every cervical procedure.^[2]

An injection or endoscopic surgery?

An injection can affect pain and inflammation, but does not remove a herniated fragment or widen a bony spinal canal. If nerve compression matches the symptoms and previous treatment has not improved pain or function, decompression may be discussed.^[1]

My specialisation is endoscopic spine surgery. At the consultation, we establish what is causing the symptoms and how the nerve structures can be released. Endoscopic removal of a lumbar disc herniation · Endoscopic decompression for lumbar stenosis.

Radiofrequency treatment and discography are separate procedures

Radiofrequency denervation uses energy to treat specific nerve branches. It is not an ordinary medication injection or removal of a nerve root. More about facet pain and denervation.

Provocative discography involves injecting contrast into a disc for diagnostic purposes. It differs from a pain-relieving injection; its indication and the significance of the result are discussed separately.^[6]

Five questions before an injection

What is the full name of the procedure? Clarify the area, level and side of the intervention.
Is the aim diagnosis or treatment? Which symptoms are intended to change?
Which medication and guidance method will be used? How will your medical conditions and medicines be considered?
How and when will the response be assessed? What should you record after the procedure?
What is the next step? What should you do if symptoms improve, pain returns or there is no benefit?

What to prepare and how to assess the result

Send existing investigations, reports and discharge summaries; for MRI/CT, send complete DICOM series. Describe your symptoms, previous injections and their effects. A new investigation is not automatically required before every injection.

Report all medication, allergies, infection, diabetes and possible pregnancy. Do not stop medicines that affect blood clotting yourself: the decision is agreed with the prescribing doctor.^[3]

Observation is needed after an epidural procedure. Arrange transport home in advance; agree return to driving and exertion with the team. Record changes in pain, walking, sleep and usual movements. Repeating a procedure depends on the response and diagnosis, rather than a predefined “course” for everyone.^[8]^[3]^[4]

How to prepare and send CT/MRI scans in DICOM format

When not to wait for a scheduled injection

New urinary retention or loss of bladder control, saddle numbness or increasing leg weakness require urgent medical assessment. Do not wait for the procedure or a reply in a messenger.^[7]

Discuss your next step with the professor

Have you been recommended an injection or surgery? Send Professor Iakiv Fishchenko existing investigations and a brief treatment history. We will discuss the proposed plan and endoscopic surgery options. Preliminary review of materials is free.

Send your scans to Professor Fishchenko

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