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CT stands for computed tomography which is an advanced type of x-ray scanner used to create highly detailed 3D imaging of the human body. A CT guided injection uses this technology to help doctors inject small structures such as nerves and joints deep within the body.
CT guided injections are used to treat pain that is associated with nerves in your neck, lower back and in other parts of your body. CT guided injections are also used to treat joint, muscle and tendon problems deep in the body which are difficult to see with traditional fluoroscopy (x-ray) or ultrasound.
A fluoroscopy (x-ray) -guided nerve block injection is a possible alternative but will not provide the same level of detail as a CT-guided procedure.
If you are being referred for a CT-guided nerve block injection, your Doctor feels that this is the best option for you.
Wear comfortable clothing that allows access to the area being injected. Metal fastenings like zips, poppers and hooks and eyes will show up on the scan, so we may ask you to change into a hospital gown.
Please contact your referring doctor or GP if you are taking any antiplatelet medicines (such as aspirin or clopidogrel) or any medicines that thin the blood (such as warfarin or rivaroxaban), as these may need to be stopped temporarily before the procedure. The procedure may have to be cancelled if these medications have not been stopped within the appropriate time frame. Please contact us if you are on antibiotics, or have been on antibiotics within two weeks of your appointment date, as the procedure will need to be rescheduled.
If you are taking any other medicines, please continue to take these as usual unless you have been told otherwise by your doctor. If you need to bring your children with you, please bring along an adult who can supervise them while your scan is underway. We are unable to offer childcare facilities.
A CT guided injection is far more accurate than using other forms of imaging such as ultrasound and traditional fluoroscopy (x-ray). Small nerves and joints only a few mm in size can be injected with pin-point accuracy deep inside the body. It is therefore safer especially when used to performing spinal and deep tissue injections.
As with conventional x-ray pictures, CT scans use radiation. The level of radiation used is very small and the benefits of the procedure are thought to outweigh any risks. If you are or think you could be pregnant, or if you have had an allergic reaction to corticosteroids or local anaesthetic in the past, then you must tell your referring doctor or the radiologist before your procedure.
This procedure is well-established and safe when performed in a controlled setting. However, with any interventional procedure there are risks, side effects and a possibility of complications. Risks include infection, worsening of symptoms and bleeding. The most common side effect is temporary discomfort and numbness in the area injected. Please note that 1 in 10 patients undergoing lumbar (lower back) nerve root blocks may experience temporary leg weakness due to the long-acting anaesthetic, which will require hospital admission until symptoms have resolved. Side effects related to the steroid include fluid retention, weight gain, increased blood sugar (mainly in people with diabetes), raised blood pressure and mood swings.
Fortunately, these serious side effects are very rare and mainly seen in patients who take corticosteroids daily for a long period of time. Please bear in mind that your doctor or consultant has recommended you for this procedure because he/she believes that the potential benefits of an injection outweigh any potential complications. If you have any questions or concerns, please do not hesitate to speak with your doctor. Please note that we do not offer sedation or general anaesthetic for this procedure.
CT guided injections are performed by Consultant Musculoskeletal Radiologists. Musculoskeletal radiologists are highly trained medical doctors who use advanced imaging techniques and equipment to diagnose and treat a wide variety of diseases and painful conditions affecting the muscles, joints and nerves.
A CT scanner looks like a large doughnut. You will be asked to lie down on a motorised bed which then moves slowly into the opening and out the other side. As you pass through the scanner, x-rays are being taken. The x-ray machine sends thin beams of x-rays through your body, which are detected by sensors on the other side. The information then goes to a computer which produces a picture of the structures of the inside of your body.
If we are doing a nerve block injection on your lower back (lumbar spine) we will ask you to lay on your front. If we are doing a nerve block injection on your neck (cervical spine), we will ask you to lie on your back. A marker grid may be placed on the skin prior to a planning scan to find the correct position for the injection. The injection site is then marked with a pen, and the area cleaned. It is very important that you do not move until the end of your procedure. The radiologist will then inject a small amount of local anaesthetic to numb the area. Once this has taken effect, he/she will place a longer needle into the site, and another planning scan is taken. The needle may then need to be repositioned and another scan may need to be taken. Once the radiologist is happy that the tip of the needle is in the correct place, the injection will be given. This may cause a strange and painful electric shock sensation which soon passes.
CT guided injections usually involve a combination of steroid and local anaesthetic which usually take 7-10 days to reach maximal effect. Some patients get immediate relief after the injection.
Immediately after the nerve block injection, you may feel that your pain has gone or is significantly reduced. This is due to the local anaesthetic and will last for a few hours. You may resume regular activity as soon as you feel able. However, you may feel numbness and tingling on the affected side for up to 12 hours after the procedure. For this reason, you must not drive for 24 hours after your procedure.
After the local anaesthetic has worn off, you may experience a worsening of your usual symptoms. This is due to possible bruising caused by the insertion of the needle, as well as an initial irritation caused by the steroid itself. It may last for a couple of days. Most people start noticing pain relief three to five days after the procedure when the steroid begins to take effect. If the temporary flare-up caused by the injection persists beyond this time, an anti-inflammatory drug such as ibuprofen can help relieve this pain.
The response to having a CT-guided nerve block injection is variable and ranges from no benefit to improvement in symptoms for over six months. It is estimated that approximately 75% of people will benefit from having a CT-guided nerve block injection. If the injection does not alleviate your pain, please speak to the doctor who referred you. Your referring doctor will decide on further management depending on clinical assessment and your response to the injection.
You may feel numbness and tingling on the affected side for up to 12 hours after the procedure. For this reason, you must not drive for 24 hours after your procedure.
Sometimes the injection causes a very brief electric shock like sensation when the medicine is being injected around the nerve. This is does not happen in every case and is brief when and if it happens.
The cost of a CT guided injection scan will depend on your Ramsay hospital of choice, find out more about your nearest Ramsay facility here.
You will receive a formal quotation price following a referral from your GP or appropriate clinician. This formal quote for your CT scan will be valid for 60 days.
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