What is infiltration?
Infiltration (infiltration therapy) is used to treat back pain. This is often caused by increasing wear and tear on the intervertebral discs and joints in the spine. This causes pressure on the nerves and nerve roots, which can lead to inflammation and swelling of the nerves and surrounding tissue. The aim of infiltration is to break this vicious circle.
Depending on the localization, different types of infiltration can be distinguished.
Facet infiltration (facet joint infiltration)
In facet infiltration, the doctor injects the active substance mixture into the small joints where the bony processes of the vertebral arches lie on top of each other (facet joints). As the “shock-absorbing effect” of the intervertebral discs diminishes with age, the natural gaps between the vertebral joints become smaller. This leads to increasing wear of the facet joints and ultimately to back pain.
Epidural infiltration
Periradicular infiltration
In periradicular infiltration, the doctor specifically anaesthetizes individual nerves by injecting it directly around their roots.
ISG infiltration
The sacroiliac joint (SIJ) – the connection between the sacrum (os sacrum) and ilium (os ilium) – can also be responsible for back pain. Blockages or inflammation are usually the cause of so-called SIJ syndrome. During an SIJ infiltration, the anti-inflammatory and pain-relieving mixture of active substances is injected into the ligamentous apparatus or directly into the joint space.
When is an infiltration performed?
The most common indications for infiltration of the spine are
- Back pain
- Herniated disc (prolapse) or bulging disc (protrusion)
- facet syndrome
- Lumboischialgia
- Spinal canal stenosis
- ISG blockages
Infiltration therapy is also used for diagnostic purposes: If the pain can be significantly reduced by infiltration, the source of the pain has been found. If it does not work, other causes must be sought.
What is done during infiltration?
Depending on the location of the infiltration, you will lie on your back or stomach or sit in front of the doctor with your upper body bent forward. To make the injection as painless as possible, the doctor will first anaesthetize the skin over the planned infiltration site. Infiltration in anatomically more complicated regions is often carried out under CT control in order to be able to determine the exact position of the needle before the medication is injected. A contrast agent can then be injected first for better visualization. Its spread shows whether anesthetics and cortisone would reach the right place.
What are the risks of infiltration?
Although side effects and complications are very rare during or after infiltration therapy, they can occur even if it is used correctly.
As a precaution, infiltration of the spine should not be carried out in the case of existing infectious diseases and, in particular, must not be carried out in local infections. The doctor will try to rule this out by thoroughly questioning and physically examining the patient.
Pregnant women, patients with poorly controlled diabetes, cardiac insufficiency or glaucoma should also not undergo infiltration therapy.
Injury to blood vessels caused by the infiltration needle can result in a haematoma. Large hematomas can press on the surrounding tissue and may have to be surgically removed.
As with all surgical interventions, the introduction of pathogens can also lead to infections that must be treated with antibiotics or surgically.
If the medication accidentally enters the bloodstream, it can lead to general reactions such as a drop in blood pressure, cardiac arrhythmia, headaches or severe cramps (convulsions). The doctor tries to prevent such accidental “intravascular” injections by pulling back (aspirating) the syringe plunger slightly at the injection site to see if blood gets into the syringe. If this is the case, he stops the infiltration.
What should I be aware of during an infiltration?
Depending on the injection site, you may experience temporary numbness and muscle weakness after the infiltration, which is why you should not walk around and especially not actively participate in road traffic. Instead, lie down for two hours if possible until the active ingredient has spread and the desired effect has been achieved.
If there is persistent pain at the injection site or if you experience nausea, vomiting, headaches, high blood pressure or an elevated blood sugar level after the infiltration, you should inform your doctor as soon as possible.
