Other spinal injections
Spinal Injection Therapies: Medial Branch Blocks, Facet Joint Injections and Sacroiliac Joint Injections
Damage or inflammation of joints in the neck and back can cause pain. Facet joints are small joints between each of the bones in the spine. The sacroiliac joints are where the lower spine joints to the pelvis.
Different kinds of injections have been used to reduce pain coming from joints. Medial branch blocks are an injection that aims to block the nerve to the joints. Facet joint or sacroiliac joint injections can be given straight into or around the joint. A few different medications have been injected, but these are usually steroids and local anaesthetics.
This report looked at the research studies to see whether spinal injections are safe and useful.
Some research studies are specifically designed to test whether a treatment is helpful or not and the results are trustworthy. These studies are called high level evidence. Other studies are not designed to test the treatment, but just observe what happened to patients who received it or those who did not. These studies can provide some information, but it is not as certain as the information from high level evidence. These studies are referred to as low level evidence, sometimes called observational studies.
1. Medial branch blocks
Medial branch blocks are an injection that aims to block the nerve to the spinal joints. No relevant studies were found that assessed the usefulness of medial branch blocks for persistent neck or back pain. This does not mean that they are not helpful; it just means that no research studies have proven that they are.
2. Facet joint injections
Facet joint injections are injections of steroid directly into the facet joint. Facet joints are small joints between each of the bones in the spine. No relevant studies that assessed the helpfulness of facet joint injections (FJIs) for persistent pain in the neck or upper back were found.
Three trials that assessed the usefulness of FJIs for persistent pain in the lower back (lumbar spine) were found. One of these trials provides good quality high level evidence. Although the other two were lower quality, the results were very similar.
These trials found that lumbar FJIs with steroid and local anaesthetic did not help in the first three months. Patients who had this treatment did not have less pain or more ability to function compared with patients who did not have the treatment. One trial found that there may be less pain and more function six months after treatment. Other factors related to the research may have influenced this result.
Patients who had lumbar FJIs with steroid and local anaesthetic had no improvement in return to work at three months compared with patients who did not have this treatment.
The effect of FJIs on quality of life, use of medication or use of health care services has not been studied.
The risks of FJIs are not clear from the information available.
There is too little information to decide about the safety and helpfulness of FJIs. This does not mean that they are not helpful; it just means that no research studies have proven that they are.
3. Sacroiliac joint injections
Sacroiliac joint (SIJ) injections are injections of steroid directly into the SIJ. The sacroiliac joints are where the lower spine joins to the pelvis. No studies that assessed the usefulness of SIJ injections for persistent back pain were found. This does not mean that these injections are not helpful, it just means that no research studies have proven that they are.