6.1 Contraindications

As with all local injections, inflammatory bacterial changes around the injection site (e.g., infected sebaceous glands) and open wounds are contraindications for spinal injection therapy. Systemic infections that are acute or have only recently subsided (e.g., urinary tract infections, tonsillitis, common colds) should also be absent. When such infections are clinically suspected, further diagnostics should exclude these infections before starting on the planned injection therapy.

Because of the possible danger of infections occurring or flaring up again, it is important to ensure complete secondary healing following surgery on the intervertebral disk, epidural abscesses, and spondylitis.

Known hypersensitivity to local anesthetics is another contraindication for minimally invasive spinal therapy. Any suspicion that substances will provoke an allergic reaction should be checked in advance.

The general contraindications to the use of steroids should also be kept in mind. The side effects of glucocorticoids are related to the main actions of the drug (see Chapter 4, “Multimodal Medication Concomitant Therapy”) and the administration of a single dose does not usually cause dangerous adverse effects. When the medical history shows that patients who require long-term treatment have conditions such as osteoporosis, diabetes, glaucoma, or ulcers, IRAP (interleukin-1 receptor antagonist protein) treatment, for example, can be used as an alternative to steroids (see Chapter 4, “Interleukin-1 Receptor Antagonist Protein”).

Orthopedic injection therapy is also contraindicated for patients with neurological seizure disorders, spinal cord diseases, or severe cardiovascular disorders, because it may require intrathecal administration, with sudden drops in blood pressure. Any injections near the spine are contraindicated for patients with internal diseases such as severe conduction defects, decompensated heart failure, or blood coagulation disorders.

Patients who are taking anticoagulants such as warfarin should be put on low-dose heparin before minimally invasive spinal therapy is undertaken. The intake of thrombocyte aggregation inhibitors, such as aspirin or ticlopidine, is also a contraindication. Patients should be taken off this medication at least a week before having any injections near the spine, in consultation with the general practitioner.

The environment plays an important role in keeping the patient calm (Grifka et al 1999). The treatment room should be a sterile environment, suitably equipped for all of the injection therapy procedures (Geiss 2002; Mutter et al 2002).

After therapy, patients should be specially monitored, so that any disorder of vital functions can be recognized in time and prevented. Equipment for venous access, oxygen supply, intravenous drips, and resuscitation must be available in case injection-related complications arise (Table 6‑1).