We asked Dr. Remi Nader, the Neurosurgeon from the Texas Center of Neurosciences about the different types of injections that he injects into the spine.
Dr. Nader:
"What are the different types of injections that we use in the spine?
We talk about cortisol or steroid injections like an epidural steroid injection for example, but also there has been more and more talk about stem cell injections or PRP (Pallet Rich Plasma) injections.
What are these types of injections and how do they apply to the spine in general?
Traditionally we've used a lot of steroids derivatives, such as cortisone or other types of steroids to inject the spine to reduce pain. typically, when we do a cortisone injection.
We use some way to localize or to navigate whether it's ultrasound or x-ray.
We find the place to go in the spine. It can be the epidural space, it can be the facet joint and so forth.
Then we place a needle and we will inject some local anaesthetic at first and then will inject the mixture of some type of the steroids mixed with a local anesthetic, a little bit deeper and closer to the spine and this usually will have an almost immediate effect within a few days, two to three days the patient will feel Relief and the pain will get a lot better.
Unfortunately, the effect eventually wears off so after about on average, I would say about three months. We start seeing that affect wear off.
The patient can go on to have some other types of treatments or maybe have another injection sometimes.
So, the effect of the cortisone injection, I would say, is for short term relief, for a few months, sometimes it can last a three year if the patient is lucky enough to have a good response patient is lucky enough to have a good response all.
After two or three days. They may not see any effect.
On the other hand, we have what's called regenerative medicine. that has had more of the resurgence where we will take some stem cells, either from abdominal fat or from the patient's own bone marrow.
We do a draw and then we spin down the tissues, we harvest the stem cells and then we re inject them in certain areas.
Whether it's the Facet joints or the Sacroiliac Joints, or some part of the spine; to help regenerate tissues and to help with the healing process. So we also have done injections of PRP or platelet rich plasma, which is actually a little bit simpler to do because what we do is a blood draw where we spin the blood, we harvest the plasma in that blood and get the concentrate of plasma that is rich in platelets and we will re inject that concentrate somewhere in the spinal column again.
Could be Facet or Sacroiliac joint to help promote, relieve some of the symptoms and help with the regeneration.
So the way these injections work actually is that they promote an inflammatory response so, for the first two or three months the pain is actually increased because you have more inflammation in this area and these stem cells or plasma will essentially recruit more White cells more inflammatory cells to the area that is injured and it will promote healing of that area and regeneration of new tissue is in that area over time.
So you will typically not see the effects of the stem cell or PRP injection for three or four months, so it's actually the reverse effect than the steroid injection so with the steroid injection, you will get almost immediate relief and the relief will last three months were as with the stem cells or PRP Injection, you will actually have more pain in the beginning, but then, after three or four months, you start seeing some healing that goes on and it helps with tissue healing tissue regeneration and so forth.
Unfortunately, it is not suggested nor recommended to do for example, the steroid injection first and then a stem cell injection, because they have the exact opposite effect, so the steroid injection will reduce inflammation and Increase the healing response, but will also reduce pain. The stem cell injection or the PRP injection will increase inflammation.
So it has the exact opposite effect so it's usually not recommended to do both simultaneously or one and shortly there after the other. So really it depends on the patient and depends on their disease or their pathology or their type of injury. We may recommend one or the other type of injection or we may have a discussion with them where we discuss both and then see which one is better suited for them, specifically. "