Cortisone injections are common treatments for spine conditions. Each injection is different and has different effects. Cortisone is the most powerful anti-inflammatory in an injection. It works best for compressed or “pinched’ nerves. They do not do as well for mechanical or degenerative conditions. A single cortisone shot carries a very low risk. Diabetics can have elevated blood sugar for a few days. Hormone levels in the body will change temporarily. It is possible for allergic reactions. The effect of a one time injection usually passes in a few days without long term effect, but the benefit of the shot can last months or possibly resolve the acute episode of pain.

My preference for cortisone is to review an MRI first, confirm my physical findings, then plan the injection to be specific. X-ray guided, fluoroscopically, selective root blocks or epidural injections are safe and we know exactly where the medicine is placed. These injections are provocative for pain and confirm our diagnosis. The response after injection often gives insight to the results of surgery if it is contemplated. Most of the patients will respond to cortisone injections and are able to recover with physical therapy and half will maintain this beyond a year. Up to three injections a year can be done safely.

Epidural Steriod Injections: Injected in the midline of the spine in the same way anaesthesia is administered. The medicine goes through a needle to spread over multiple areas. The effect is generalized and is used with patients with multiple areas of nerve compression.

Caudal Epidural injections: Similar to the Epidural, but is injected through the tail bone to avoid the complication of dural puncture and head aches.

Selective Nerve Root block: A specific injection at the nerve root, guided by an x-ray, to put the maximun medicine at the exact area of root inflamation. This is best used when one or two areas of nerve root compression are identified.