Infiltration therapy

What is infiltration therapy?

Infiltration therapy can be used to treat certain types of back pain. These are mostly complaints of the spine caused by wear and tear, associated with nerve irritation and inflammation of the surrounding tissue. During infiltration therapy, pain and anti-inflammatory drugs are directly injected into the painful area using a needle. This is the best way to alleviate both acute and chronic symptoms.

What procedures are available?

The term infiltration therapy comprises various medical procedures. One of these is facet joint infiltration. Degeneration caused by age and stress often results in wear and tear of the joint surfaces in the small vertebral joints (facet joints), leading to back pain. In such cases, medications can be injected directly into the facet joints for therapy. The so-called sacroiliac joint or SIJ infiltration is similar. This involves injecting medication into the sacroiliac joint and surrounding tissue to relieve irritation, blockages and pain caused by wear and tear.

An additional common method is periradicular infiltration, in which drugs are injected specifically into the immediate proximity of the nerve roots coming off the spinal cord. Depending on the patient's symptoms, the nerve roots affected can be treated individually. For example, this is done to treat symptoms related to a herniated disc or signs of bone degeneration.

Furthermore, it is possible to perform epidural/peridural infiltration. This procedure entails the injection of pain-relieving drugs into the space between the vertebrae and the lining surrounding the spinal cord and nerves. As a result, multiple irritated nerves can be treated at once.

Who is suitable for infiltration therapy?

The described infiltration therapy methods are suitable as treatment options for various diseases. Generally the procedure is only carried out as an exception for short-term back pain, for which conservative measures such as physiotherapy are the main focus. However, infiltration therapy is often used to treat long-term symptoms, oftentimes with success, to avoid or at least postpone the need for surgery, which is associated with risks like any surgical procedure. Overall, infiltration therapy is often used for spinal disorders caused by wear and tear, herniated discs, narrowing of the spinal canal or nerve exit holes or joint irritation.

Infiltration of the facet joints is used for patients with a so-called facet syndrome. This refers to a mostly chronic back pain disorder brought on by changes in the small vertebral joints due to wear and tear. The symptoms can arise in the lower back as well as in the neck, thoracic spine or near the sacrum. There are usually no sensory or motor deficits. Patients with joint blockages, for example of the sacroiliac joint, also benefit from infiltration therapy.

Periradicular therapy is administered to patients who suffer from nerve root irritation syndromes. This can be caused by herniated discs or narrowing of the spinal canal (spinal canal stenosis), for example.

Epidural infiltration is also done for chronic or acute symptoms after a disc herniation or spinal canal stenosis, as well as for chronic pain syndromes resulting from nerve root irritation. In particular, the procedure is employed in cases where several nerve roots are involved or the pain radiates across an area.

Infiltration therapy must not be carried out in the event of bacterial inflammation of the joints or surrounding tissue, certain coagulation disorders, severe systemic diseases like blood poisoning or known allergies to the medication used.

Procedure and duration

Prior to the actual infiltration therapy, there is generally a consultation about the benefits and possible risks of the procedure. Any personal risk factors should be addressed. This procedure can be carried out on an outpatient basis meaning that the patient does not have to stay in hospital for several days. Some patients are scheduled for several treatment appointments. Before the procedure, patients are allowed to eat and drink normally and no anesthesia is required.

Occasionally, an X-ray of the spine is taken beforehand, and it may also be necessary to examine blood coagulation and thyroid levels. The infiltration itself only takes a few minutes. During the procedure, the patient will lie on their stomach or sit up with their upper body bent forward.

Before the injection itself, the respective area of skin is either injected with a pain-relieving medication or anaesthetized by local cold exposure (cryotherapy). Some infiltrations are monitored radiologically ("under fluoroscopy"), meaning that the position of the needle is controlled using a CT scan, for example.

A painkiller (local anesthetic) and an anti-inflammatory, anti-swelling medication, often a cortisone agent, are often injected. Afterwards, the needle is removed and the injection site is covered with a plaster.

Side effects and risks

After infiltration therapy, blood pressure and oxygen saturation levels are often monitored for a short while. Resting for about two hours in a lying position after the treatment is of advantage. On the treatment day itself, the patient should not drive, as the arm or leg may feel slightly numb for several hours (depending on where the injection was given). In rare cases, short-term pain sensations are also possible.

In rare cases, the injection may injure blood vessels, causing bruising and local discomfort. Therefore, infiltration therapy should be carefully considered if the patient is known to have coagulation disorders or is taking blood-thinning medication. If the preparations are injected into a blood vessel by mistake, it can lead to circulatory reactions like a drop in blood pressure or cardiac arrhythmia, for example. This is, however, usually prevented by verifying the position of the needle ("aspiration") prior to injection.

It is also possible that the injection may cause an infection, which may have to be treated with medication or surgery.

Rarely, the spinal cord or nerves are injured. These injuries may result in pain, motor deficits or sensory disturbances.

The medication that is used can have side effects that vary in severity. Among these are, for example, a transient rise in blood pressure or fluctuations in blood sugar levels. For this reason, infiltration therapy should be avoided under certain circumstances, for example in pregnant women or poorly controlled diabetics. The worst case scenario is a severe allergic reaction, which could result in emergency treatment.

Which doctors specialize in infiltration therapy

Infiltrations involving the spine can be performed by different specialists. The treatment is often carried out by an orthopaedist, neurologist or radiologist or in particular neuroradiologists who specialize in diseases of the nerves.

If you're in need of a doctor, you expect the best medical care possible. So of course patients are curious to find out what clinic to go to. As there is no objective way to answer this question and a legitimate doctor would never claim to be the best, patients must rely on a doctor's experience.

Let us help you find an expert for your condition. All listed doctors and clinics have been reviewed by us for their outstanding specialization in the field of infiltration therapy and are looking forward to your inquiry or wish for treatment.

Sources:

• www.klinikum.uni-heidelberg.de/verfahren/infiltrationstherapie-bei-rueckenschmerzen-209488

• www.schulthess-klinik.ch/de/neurologie/behandlung/therapeutische-infiltration-der-wirbelsaeule&;