SPINAL INJECTIONS IN LONDON

Led by Dr. Matteo Bernardotto – Consultant in Musculoskeletal, Sport and Exercise Medicine

SPINAL INJECTIONS IN LONDON

Led by Dr. Matteo Bernardotto – Consultant in Musculoskeletal, Sport and Exercise Medicine

Specialised Ultrasound Guided Spinal Injections Service in London, led by Dr. Matteo Bernardotto, a Consultant in Musculoskeletal, Sport and Exercise Medicine at University College London Hospitals (ULCH).

At Complete injections we are dedicated to providing cost effective, convenient, targeted pain relieving guided injections for a variety of spinal conditions at an affordable price. Patients can self refer to this service i.e. no referral is necessary.

The Spinal Injections Services is based in a state-of-the-art GP Practice in central London. The clinic is CQC-registered and has excellent facilities. The practice is equipped with modern treatment rooms, providing a clean and safe environment for all procedures.

WHEN ARE SPINAL INJECTIONS NEEDED?

If your back or neck problem is severe enough to stop you from performing your normal daily activities, and it has not responded to conservative measures, you may benefit from having a spinal injection. Spinal injections are only offered to patients if they have an up to date MRI scan i.e. in the last 6 months of the appropriate region. If you do not have an MRI scan then please contact the clinic and we can organise an up to date MRI prior to your appointment.

Spinal injections are used for two main reasons:

As an effective treatment for relieving severe back, neck, arm or leg pain.
To confirm an accurate diagnosis of the source of back, leg, neck, or arm pain.

Spinal injections are carried out by injecting local anaesthetic and steroid (also known as ‘cortisone’ or ‘corticosteroid’) around a specific nerve, ligament or joint to provide significant pain relief and identify if that particular area is causing your symptoms. If you get immediate relief then you know that is the primary cause of your problem.

Spinal injections are only ever performed as one part of a more comprehensive treatment program, and only in cases where conservative management such as Physiotherapy has been unsuccessful. It is not a ‘quick fix’ but provides patients with good pain relief to be able to take a more active part in their rehabilitation. Spinal injections can provide significant pain relief, providing a ‘window of opportunity’ to improve your ability to move and improve your function. Spinal injections can also provide rapid relief in night pain, allowing for a good night’s sleep. Simultaneous treatments that complement spinal injections include physiotherapy.

Physiotherapy may include hands-on manual therapy and/or an exercise program to improve spinal mobility (‘stretching’ exercises) and stability (‘strengthening’ exercises).

TYPES OF SPINAL INJECTIONS

We provide a variety of spinal injections at our London clinics, tailored to treat specific conditions and offer targeted pain relief.

CAUDAL EPIDURAL

Epidural injections are administered in the lower back to relieve leg pain from ‘sciatica’ due to a herniated or bulging disc, or from spinal stenosis in the lower back. Anaesthetic and steroid, a strong anti-inflammatory medication, is injected near the affected nerves in your back, that carry pain messages to your brain. The injected medication helps to reduce inflammation and provides significant pain relief from compressed or pinched nerves that may be giving you pain that radiates into your arm or leg.

FACET JOINT INJECTIONS

These injections target the small, facet joints located between each vertebra at the back of the spine, alleviating pain caused by lumbar or cervical facet joint issues. They are effective in reducing inflammation and improving joint mobility and are often used when pain is caused by degenerative, or arthritic conditions. They are used to treat neck, middle back, or low back pain.

NERVE ROOT INJECTIONS

Nerve root injections are used to treat conditions like sciatica and disc prolapse, these injections deliver medication directly to the affected nerve root, reducing pain and inflammation. They target specific nerves, and block pain signals, allowing the body time to continue healing naturally. They are most commonly used to treat a ‘pinched nerve’.

SACROILIAC JOINT INJECTIONS

The SI joints are located between the sacrum (bone right at the bottom of the lower back) and the ilium bone (pelvis). This type of injection is aimed at relieving pain around the sacroiliac joints, often caused by conditions like SI joint syndrome. By injecting steroids into the area it can help to reduce inflammation and provide local pain relief to the SI joint and also pain that often radiates into the lower back and buttocks. Generally only one side is affected, but on rare occasions both SI joints need to be treated.

TRIGGER POINTS

Trigger point injections are a specialised treatment designed to alleviate pain caused by tight, ‘knotted’ muscles known as ‘trigger points’. A small area within a muscle goes into permanent spasm, which results in pain. The most common areas affected are the neck and shoulders as well as the lower back area. These points are usually very sensitive to touch. These injections deliver a small amount of anaesthetic and steroid directly into the affected muscle, helping to relax the muscle fibres and reduce pain and inflammation. Trigger point injections are particularly effective for conditions such as myofascial pain syndrome, tension headaches and chronic muscle pain. By targeting specific areas of muscle tension, this treatment provides significant relief, improving mobility and overall function.

CONDITIONS THAT WE TREAT

Our spinal injections service is designed to treat a wide range of conditions, including:

Sciatica
Disc Prolapse – Cervical, thoracic and lumbar
Cervical Disc Issues
Lumbar Stenosis
Lumbar Disc Problems
Lumbar Facet Joint Pain
SI Joint Pain
Cervical Facet Joint Pain
Costochondral Pain
Thoracic Spine Pain

ARE ULTRASOUND GUIDED SPINAL INJECTIONS SAFE?

The safety of our patients is our top priority. Historically spinal injections were performed under fluoroscopy (a type of x-ray) guidance. However, the developments in musculoskeletal ultrasound have vastly improved and the latest research demonstrates that spinal injections performed under ultrasound guidance and without fluoroscopy, are a safe, reliable and accessible option that also minimises the risk of radiation exposure for the patient and the practitioner. (Touboul, E., Salomon-Goëb, S., Boistelle, M. et al. 2022)

Elashmawy et al. (2020) also demonstrated that not only is ultrasound completely safe, it is also excellent in guiding spinal injections with very similar treatment outcomes as compared with fluoroscopy guided injections.

ARE THERE ANY COMPLICATIONS OR SIDE EFFECTS OF SPINAL INJECTIONS?

As previously mentioned, research shows that spinal injections are very safe, well tolerated procedures with an exceptionally low risk of complications.

However complications can occasionally occur but fortunately they are usually mild and short lived.

Common side effects include:

Mild bleeding at the injection site
Headache
A flushed face
Discomfort around the injection site
Nausea
Diarrhoea
Diabetics could find a temporary rise in their blood sugar.

More serious complications include:

Nerve damage
Infection at the injection site
Increased Pain
Muscle weakness
Dura puncture (a membrane in the spinal cord). – Although this affects under 1% of patients.

PATIENT REQUIREMENTS & HOW TO BOOK

Before undergoing a spinal injection procedure, patients must have an up-to-date MRI scan (within last 6 months) report to ensure accurate diagnosis and effective treatment. Additionally, patients will need to fill out a screening form to assess their eligibility for any spinal injection procedure. This helps us tailor the treatment to your specific needs and ensures the best possible outcomes.

To book for an injection you can call our booking team on 0207 482 3875 or email info@complete-physio.co.uk requesting an appointment for a spinal injection.

When booking please ensure we have your full name, date of birth, your address and GP contact details.
You will be sent a medical screening and consent form to complete and forward back to us or bring along on the day. It also asks questions about past medical history and any reasons why we may need to seek advice from your GP before proceeding with the injections. This also provides us with the information to order the prescription for your injection.

Some people with certain medical conditions are not good candidates for spinal injections. These include people with:

Uncontrolled high blood pressure or diabetes
Uncontrolled heart conditions like atrial fibrillation
A skin infection around the injection site
A bleeding or clotting disorder
An allergy to anaesthetics, or steroids drugs

On the day you will be seen, assessed and given an ultrasound scan; the findings of which will be discussed with you before proceeding with ultrasound guided injection.

INJECTION PRICES

All injections are carried out using ultrasound guidance and are all inclusive of a consultation.

Ultrasound guided Spine injections

Caudal Epidural +/- spinal nerve root injection £895

Nerve root injections (2-3 x nerve roots) £895

Facet injections (up to 4x facet joints) £895

Caudal epidural +/- Sacroiliac joint (SIJ) injections £895

Ultrasound guided Sacroiliac injections

Sacroiliac joint (SIJ) injections + 2x facet injections £895
Sacroiliac joint (SIJ) injections 2x £495
Sacroiliac joint (SIJ) injection 1x £395

Ultrasound guided trigger point injections

Cervical/lumbar or thoracic trigger point injections (4x trigger points) £695

RRFERENCES

Elashmawy, M.A., Shaat, R.M., Abdelkhalek, A.M. and El Boghdady, E., Caudal epidural steroid injection ultrasound-guided versus fluoroscopy-guided in treatment of refractory lumbar disc prolapse with radiculopathy.

Touboul, E., Salomon-Goëb, S., Boistelle, M., Danial, J.S., Deprez, V. and Goëb, V., 2022. Lumbar zygapophyseal joints injections under ultrasound guidance: an alternative to fluoroscopy guidance in the management of low back pain. Scientific Reports, 12, p.3615.

Krol, A., 2022. Ultrasound guided spinal procedures – advantages and limitations. Regional Anesthesia & Pain Medicine, 47(Suppl 1), pp.A37-A40.

Elashmawy, M.A., Shaat, R.M., Abdelkhalek, A.M. and El Boghdady, E., 2020. Caudal epidural steroid injection ultrasound-guided versus fluoroscopy-guided in treatment of refractory lumbar disc prolapse with radiculopathy. Egyptian Journal of Radiology

SPINAL INJECTIONS FAQ

What are spinal injections used for? Spinal injections are used to relieve severe back, neck, arm, or leg pain and to diagnose the source of pain.
What types of spinal injections are offered? Complete Physio offers caudal epidural, facet joint, nerve root, sacroiliac joint, and trigger point injections.
What conditions are treated with spinal injections? Conditions treated include sciatica, SI joint pain, disc prolapse, cervical and lumbar disc issues, lumbar stenosis, facet joint pain, costochondral pain, and thoracic spine pain.
Are spinal injections safe without fluoroscopy? Yes, research suggests that ultrasound-guided spinal injections are safe, reliable, and minimise radiation exposure.
What are common side effects of spinal injections? Common side effects include mild bleeding, headache, flushed face, discomfort, nausea, diarrhea, and temporary rise in blood sugar for diabetics.
What are the more serious complications? Serious complications, though rare, can include nerve damage, infection, increased pain, muscle weakness, and dura puncture.
What are the patient requirements for spinal injections? Patients need an up-to-date MRI scan report and must fill out a screening form to assess eligibility.
Where is the service located? The service is based at the James Wigg GP Practice in Kentish Town, a CQC-registered facility known for excellent patient care and state-of-the-art facilities.
How can I book an appointment? To book an injection, call 0207 482 3875 or email info@complete-physio.co.uk with your details. You’ll need to complete a medical screening and consent form prior to the appointment.