INFILTRATIONS

Targeted spinal injections: precision treatment in pain management in Zurich

When every movement is painful and daily life becomes a torment, patients are not looking for general advice, but for a specific solution. As a specialist pain management practice in Zurich, we understand that chronic back pain often results in a vicious cycle of inflammation, swelling and nerve irritation. Image-guided infiltration is often the decisive ‘game-changer’ here, helping to break this cycle and avoid surgery.

“Pain is often a warning sign of chemical inflammation in a nerve. With an infiltration, we don’t simply silence this warning – we tackle the cause by eliminating the inflammation right at its source. The aim is always to help your body heal itself.”
– Dr. med. Elisabeth Aschl

1. Precision rather than ‘flying blind’: the medical procedure

In modern orthopaedics, precision is paramount. In the past, injections were often administered ‘blind’ using anatomical landmarks. We rely on visual confirmation.

Infiltration involves administering medication directly to the site causing the pain during spinal treatment, with the aid of a fluoroscopy unit. This is carried out using a C-arm (image converter). This procedure allows us to guide the needle tip with millimetre precision to the affected nerve root or facet joint. We can see in real time exactly where we are. This minimises risks and maximises effectiveness.

Many patients are concerned about radiation exposure. We can reassure you on this point: compared to CT-guided infiltration, the radiation dose required to perform the infiltration is very low. Whilst a CT (computed tomography) scan produces cross-sectional images and requires a higher dose, we use short fluoroscopy pulses that release only a fraction of the radiation – often less than on a long-haul flight.

2. Indications: When is a spinal injection appropriate?

Not all back pain requires an injection. We use them specifically where mechanical or inflammatory stimuli are putting pressure on the nerves. Particularly in cases of inflammation, acute herniated discs or osteoarthritis (signs of wear and tear), targeted treatment can reduce or relieve pain and promote the healing process.

It is important to understand that, in the case of a herniated disc, the problem is often not just the pressure on the nerve, but a biochemical inflammation (‘radiculitis’) triggered by the leaked disc material. By administering the anti-inflammatory medication (cortisone) with precise targeting, the dosage can be reduced to the absolute minimum required. As we deliver the active ingredient directly to the site of action (‘targeted delivery’), we do not need high systemic doses that would put a strain on the whole body.

3. The various techniques of infiltration

We select the appropriate technique based on the nature of the pain and the MRI findings. Application Depending on the situation, a distinction is made between epidural infiltration (in cases of herniated discs or spinal canal stenosis, directly into the epidural space of the spinal canal), facet joint infiltrations (often for osteoarthritis of the joints) and nerve root infiltrations (for inflammation of the nerve roots, herniated discs with pressure on the nerve root).

Periradicular therapy (PRT) / nerve root infiltration: We specifically block a single nerve root that, for example, causes pain radiating into the big toe.
Epidural infiltration: Ideal for spinal stenosis, to reduce swelling throughout the affected area of the spinal canal.
Facet joint block: For deep-seated back pain caused by osteoarthritis of the small vertebral joints that does not radiate into the legs.

4. What happens during infiltration therapy?

Many patients are apprehensive about ‘injections in the back’. We make the whole process as comfortable and straightforward as possible. Before the treatment, we carry out a thorough examination to determine the best course of treatment for you. This involves analysing your imaging results and clinical symptoms. An infiltration takes around 20 minutes. Most of this time is spent on preparation, positioning and sterile draping. The actual procedure itself is brief.

During the infiltration procedure, the target area is identified using a fluoroscopy unit. Thanks to the use of a local anaesthetic, the procedure is usually virtually painless; patients often only feel a slight pressure. This pressure occurs as the fluid is injected. Once the local anaesthetic has taken effect, the medication is administered directly into the target area using a thin needle, under fluoroscopic guidance.

To ensure that no blood vessels have been affected, we often inject a tiny amount of contrast medium to check the placement. After the injection, you will remain in the surgery for half an hour for observation. This is for your safety, to rule out any circulatory reactions.

5. Which medication is used?

The therapeutic “cocktail” usually consists of three components. The injection involves the use of a small amount of Iopamiro (contrast medium), as well as a mixture of a local anaesthetic and a small amount of cortisone.

Myths and facts about the side effects of cortisone injections

Many patients search online for ‘side effects of infiltration’ or ‘side effects of cortisone infiltration’ and come across reports of weight gain or bone loss. It is crucial to make a distinction here: these side effects relate almost exclusively to the long-term use of tablets.

As the inflammation is quickly reduced, it is possible to return to normal daily life swiftly and undergo physiotherapy to stabilise the area. When administered in this small dose and used locally, cortisone does not cause any long-term side effects. This means that the cortisone remains where we inject it and has a local anti-inflammatory effect for weeks, without flooding the body with high levels of the drug. Possible, harmless side effects may include facial flushing for 1–2 days or temporary changes to the menstrual cycle in women.

6. How quickly does infiltration therapy work?

The effect often occurs in two stages. The injection may bring immediate relief. This is due to the local anaesthetic – once the anaesthetic wears off, the pain may return briefly. It usually takes several days for the full effect to set in. This is the time the cortisone needs to stop the inflammatory response.

The full effect will be felt after two weeks at the latest. During this time, you may take your painkillers as and when necessary.

Depending on the nature of the symptoms, a single injection may be sufficient. If necessary, a repeat injection may be required – particularly in cases of persistent symptoms.

7. What can you do after infiltration therapy?

You won’t be confined to bed after the procedure – on the contrary, it’s important to keep moving. You can resume your normal daily routine immediately after the treatment. However, as an anaesthetic has been used, you must not drive on the day of the procedure for insurance reasons. You should avoid strenuous physical activity during the week following the injection. Allow the tissue time to heal before resuming your sporting activities.

Frequently asked questions about infiltration

Here we answer our patients’ most frequently asked questions about cortisone injections and safety.

1. Is spinal infiltration dangerous?

No. As we work under imaging guidance, we can see exactly where the needle is at all times. The risk of nerve damage is extremely low when performed by experienced practitioners. Infections are also extremely rare thanks to strict sterile precautions.

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