Nerve Root and Spinal Joint Injections
Nerve root and spinal joint injections (blocks) are a minimally invasive treatment option that provides targeted pain relief without the need for open surgery.
They are used both for therapeutic purposes and for diagnostic evaluation of the source of pain, and represent an important tool in the overall management of spinal conditions.
What are spinal injections?
These are injections performed using a fine needle, always under fluoroscopic (X‑ray) guidance, so that the drug mixture reaches precisely the structure responsible for the pain.
The mixture usually consists of a corticosteroid, which reduces swelling and inflammation around the nerve, and a local anaesthetic, which offers immediate relief.
Fluoroscopic guidance is essential for the accuracy and safety of the procedure, as it allows the surgeon to monitor the course of the needle in real time and confirm its exact position.
The three main types of injections
Epidural injection
An epidural injection is performed within the spinal canal, around and outside the nerve roots. The drug spreads through the epidural space and exerts an anti‑inflammatory effect over a broader segment of the neural structures.
It is indicated mainly in patients with low back and leg pain due to lumbar disc herniation or spinal canal stenosis.
When are injections indicated?
Spinal injections are used in a wide range of conditions and clinical scenarios. The main indications include disc herniation with radiculopathy, spinal canal stenosis, degenerative changes that compress nerve roots and cause pain in the legs, arms or back, as well as arthritic pain due to degeneration of the facet joints.
Injections are also used as adjunctive treatment alongside physiotherapy and medication, and as a preparatory step before surgery, providing relief during the waiting period.
The diagnostic value of injections
One of the most important advantages of injections, which is often overlooked, is their diagnostic value. When blocking a specific nerve root leads to significant symptom relief, this strongly supports that this particular root is responsible for the patient’s clinical picture.
This information is extremely valuable for surgical planning, as it allows precise targeting of the procedure at the pathological level.
In other words, injections do not only relieve the patient’s pain – they also help the surgeon to make better‑informed decisions.
How is the procedure performed?
The patient is positioned prone, and local anaesthetic is administered to the skin and soft tissues at the planned entry point. The surgeon then uses real‑time fluoroscopy to guide the needle accurately to the target and to deliver the mixture of corticosteroid and local anaesthetic.
The procedure takes between 10 and 30 minutes, is almost painless, and the patient returns home the same day.
In some cases, transient weakness or numbness in the limbs may be observed, which resolves within 24 hours.
One to three sessions may be required to achieve the optimal result, with pain relief lasting from several months to over a year.
Benefits and limitations
Injections provide rapid pain relief, avoiding or postponing the need for surgery. They are safe, minimally invasive, and do not require hospital admission. At the same time, as mentioned above, they also have significant diagnostic value.
It is important to emphasise that injections relieve the pain but do not correct the underlying structural problem.
They do not replace the effectiveness of a surgical procedure when surgery is clearly indicated. However, in many cases they provide sufficient relief and markedly improve quality of life, making them a valuable option within the conservative treatment arsenal for spinal disorders.
Injections and surgery – two complementary treatments
Injections and surgery are not competing options but two complementary tools in modern management of spinal conditions.
In many patients, a targeted injection can provide substantial pain relief and delay, or even avoid, the need for surgery. In other cases, injections have important diagnostic value, helping to pinpoint the exact source of pain and to plan a possible surgical intervention more effectively.
The choice of the most appropriate treatment is always individualised, based on the symptoms, imaging findings and the needs of each patient.
This comprehensive, personalised approach is a key element of Dr Mazarakis’ clinical philosophy, and he sees patients in both Athens and Thessaloniki.