The limited role of cortisone injections

Cortisone injections have a place in management of spinal pain, and I use them from time to time. However, they are rarely a permanent cure.

Where they are useful

Accurate diagnosis of some spinal conditions can be complicated. So, at times I recommend nerve sleeve injections in the spine to confirm my initial thoughts.

Sometimes hip disease, either arthritis or abductor tendonitis, can masquerade as sciatica; and to help determine what is going on, the degree to which the spinal cortisone injection provides pain relief can determine the most likely source of the patient’s pain.

If there is no response to the nerve sleeve injection, then perhaps the hip joint should be replaced first.

They are of little use for painful facet joints

Facet joints are small points of contact where each vertebra meets the one above and below. They enable flexion and provide stability to the spine.

As the spine ages, these joints degenerate and become arthritic and painful.

Some medical practitioners inject cortisone into the joints. At best your patient will experience temporary pain relief and so I generally do not advocate them.

For pain thought to be related to facet joint arthritis, I recommend low impact exercise and weight loss. Panadol Osteo and non-steroidal anti-inflammatory drugs may be of benefit. In addition, the patient could avoid those activities that are painful.

Referral to a pain specialist can be considered in some cases where radiofrequency ablation of the sensory nerve to the facet joint can be helpful.

As always if you have any questions about a patient, please feel free to call me on 02 9650 4893.

I will return your call and discuss how we can help.

Resources for Referrers

Further Resources available include:

• Why I only operate when it makes a difference to my patient's quality of life
• Back pain and how to manage it
• Management Regime for Lumbar Disc Herniation & Sciatica
• Why your patients might be struggling to walk (Lumbar Canal Stenosis)
• Cervical Radiculopathy – shooting pains from the neck
• Cervical myelopathy – a disease of the spinal cord that may pass unnoticed
• Adult Spinal Deformities: Symptoms & Treatments
• Vertebroplasty – worth a rethink
• Lumbar Radiculopathy and conditions that mimic it

Dr Ralph Stanford is a spinal surgeon with over 20 years’ experience. He is adept in all surgical approaches to successfully treat his patients.

Dedicated to lifelong learning and sharing his expertise with others, Ralph attends spinal conferences worldwide and regularly consults with colleagues about successful treatments.

As a teacher Dr Ralph Stanford is Conjoint Senior Lecturer at the University of New South Wales; Supervisor of Training for Orthopaedic Trainees, Prince of Wales Hospital; and Education Secretary for the Spine Society of Australia.

As a researcher and scientist, he is a well-published author and Honorary Senior Scientist at Neuroscience Research Australia (NeuRA). He is also a current member of Spinal PFET.

Posted 12 March 2021