Spinal Injection vs. Surgery: Uses, Benefits, Side Effects & More

Mark Gurarie is a freelance writer, editor, and adjunct lecturer of writing composition at George Washington University.

Laura Campedelli, PT, DPT, is a physical therapist currently working in New York at Morgan Stanley Children's Hospital, an affiliate of New York Presbyterian.

Chronic back pain, in which symptoms are persistent and disrupt daily activities, is very common; about 16 million American adults, or 8% of the population, experience this condition.

Though spinal injection and surgery are both effective treatments for back pain, there are key differences. Injection is the less-invasive option, though results are temporary and multiple treatments are needed. Spinal surgery, correcting the causes of pain, is only attempted after other therapies have been tried.

This article discusses the differences between spinal injections and surgery. Before going ahead with any treatment for back pain, however, make sure to see a healthcare provider for a diagnosis.

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When back pain lasts longer than three months, it's considered chronic. Healthcare providers are typically conservative with treatment, with spinal injection considered only if medications, physical therapy, and lifestyle changes haven't yielded results. As part of a broader management plan, this treatment provides sustained, though not permanent, relief from symptoms.

A spinal injection may be used to diagnose back problems, or as a therapy to manage pain. The goal is to introduce a solution of local anesthetic and anti-inflammatory medications (typically corticosteroids) near affected nerves in the spine. This approach is considered in a wide range of cases, including:

The pain-managing effects of spinal injections are not permanent, and overall success rates depend on the issue being treated and the specific approach used.

One study comparing different types of spinal injections for lumbar slipped discs found between 10% and 25% of patients reported poor improvement at one year. However, the others had at least fair results, with between 9.76% and 37.5% seeing "excellent" improvement.

Generally, spinal injections are indicated along with muscle-strengthening and stretching exercises to improve stability and strength. To ensure the proper position of the injection, healthcare providers use a special kind of X-ray guidance called fluoroscopy. This involves injecting a contrast dye into the bloodstream, which provides a better, more accurate picture of the targeted area.

For back pain, the three primary types of spinal injection are:

The pain-managing effects set in within a couple of days after treatment, with pain relief typically seen for three to six months afterward (though it can last longer), depending on the case. You’ll be carefully monitored after treatment, and additional injections, or other alternatives, will be explored if the issues don't go away.

Spinal injections are generally well-tolerated, and the risk of complications is low. Common side effects, attributed to the corticosteroids used, include:

In rare cases, there's a risk of the following:

As with any medical treatment, how much you pay depends not only on your individual case but on your insurance coverage, the location of the treatment, and the healthcare provider offering it. There also may be out-of-pocket costs to consider, such as travel and lodging to a clinic. In 2021, the costs of these treatments ranged from $90 to $1,000 per injection.

Speak to an insurance company representative and your healthcare provider's office staff to understand your expenses and options. Even without insurance coverage, there may be financing options available.

Though it's the only option in some cases, about 80% of chronic back pain patients find relief without spinal surgery. There are several different types of surgery for the spine, but all aim to correct the underlying causes of back pain. The decision to go ahead should be made with careful consultation with your provider and a spinal surgeon.

Spinal surgeries are only performed when there's an identified and specific back problem. This option is only considered when symptoms haven't responded to between six weeks and six months of physical therapy, medications, and spinal injections or other treatments.

This type of surgery treats a range of spinal conditions, including:

Though the more invasive option, spinal surgeries get at the root causes of the pain. However, the surgery isn't appropriate for all patients. Some conditions or other factors increase the chances of complications or adverse events, including:

Research has consistently shown that spinal surgeries are effective in managing pain and inflammation. According to one review, over 50% of all spinal surgeries are successful, with failure rates ranging from 10% to 46% depending on the specific procedure.

In most cases, however, these treatments reduce pain but don't completely stop it. Studies have shown that pain drops by around 50% up to one year after surgery for sciatica.

There are many specific spinal surgeries, but they can be broken down into two types. More traditional, open surgeries involve longer incisions and more disruption to muscles as the affected area is exposed and operated upon.

Minimally invasive spine surgery (MISS) techniques rely on smaller incisions, lasers, endoscopic techniques, and specialized tools. This less invasive option typically leads to quicker recovery and requires shorter hospital stays.

Before surgery begins, you’ll undergo imaging, often magnetic resonance imaging (MRI) or X-rays to assess the affected area and guide the procedure. General anesthesia is often used, though some MISS techniques only require a local anesthetic.

There are several kinds of surgery, each with its own advantages and applications. Common types include:

Following surgery, you’ll generally need one to three days of recovery in the hospital. You’ll be given medication and direction on how to manage discomfort as you rehabilitate at home, with follow-up typically necessary one to two weeks after the procedure.

Robototic-assisted spinal surgery was first approved by the Food and Drug Administration (FDA) in 2004. This sophisticated technology allows the surgeon to use a robotic arm capable of very precise movements, minimizing the impact of the treatment and reducing complications.

No matter the type of spinal surgery you have, you can expect to experience some pain and discomfort as you recover. Additionally, there's a chance of complications, including:

Spinal surgeries are among the more complex procedures, and, as with other treatments, many factors determine out-of-pocket costs. Depending on the scope of the work needed, the procedure is in surgical centers or hospitals, which can influence expenses.

The cost also depends on the type of procedure needed, the surgeon performing the work, as well as your insurance plan. In a cost-analysis of lumbar spinal fusion from 2021, the direct costs of treatment ranged from $8,286 to $73,727, for an average of $22,890.

So how do spinal injections and surgeries for the spine compare? Each approach has its own set of advantages and disadvantages, as follows:

When meeting your healthcare provider, you will be given presented with options that would be most effective in treating your back pain.

Typically, spinal surgery is only considered when other options, including spinal injections, haven't yielded results. In difficult cases, surgeons may first administer a preoperative epidural injection to affected areas, often the lumbar (or lower) spine, before operating on it. While this combination hasn't been shown to increase complication risk, it did raise hospital readmission and reoperation rates according to one study.

Not only that, epidural and facet joint injections, and another type, discography, help surgeons diagnose the exact location and cause of the issue. As such, they can play an instrumental role in the process leading up to surgery.

Though side effects tend to be more severe with surgery, both spinal surgery and injections can cause side effects. Recovery and rehabilitation from these procedures mean learning how to cope with them. Here's a quick breakdown of strategies:

Spinal injection and surgery are both options for treating back pain caused by a wide range of conditions, including sciatica, herniated disc, and spinal stenosis, among others. Injection of pain medication and steroids (the less-invasive option) provides lasting but not permanent relief from symptoms. Surgery, considered only when other treatments haven't yielded results, focuses on correcting the underlying cause of back pain.

Even though back pain is common, it's never simple to live with, and there's no singular treatment for it. If you’re suffering from persistent or chronic spine issues, be proactive about taking charge of your health and getting help.

The physical and emotional burden of living with pain is massive. The pain can impact every aspect of your life, affecting you at work and at home. Fortunately, surgery and injections are two ways to get relief.

Generally, spinal surgery is a last resort option, attempted only after other means of managing back pain are not effective. Most don't end up requiring it. Other therapies for chronic pain include:

It's not uncommon for spinal injections to precede spinal surgery, such as spinal fusion, discectomy, and others. Not only might injections be used diagnostically, helping the surgeon isolate the exact location of the issue, but they may also be attempted as a means to avoid the need for surgery. Studies have found that though injections prior to surgery don't raise complication rates, they may increase the risk of reoperation.

A less-invasive option than surgery, spinal injections are well-tolerated and associated with few side effects. The procedure, itself, takes only about 30 to 45 minutes, and you'll recover for about 30 to 60 minutes at the clinic or hospital before going home. The effects set in within a couple of days, and you should be able to resume normal activities after a day. However, this therapy is most effective when paired with physical therapy and certain exercises.

Health Policy Institute. Chronic back pain.

American Academy of Orthopaedic Surgeons. Spinal injections.

Pandey R. Efficacy of epidural steroid injection in management of lumbar prolapsed intervertebral disc: a comparison of caudal, transforaminal and interlaminar routes. J Clin Diagn Res. 2016;10(5):RC05-11. doi:10.7860/jcdr/2016/18208.8127

American Society of Interventional Pain Physicians. 2022 physician proposed payment rates compared to 2021 rates.

Tyndall D. Spine surgery overview. Spine Universe.

Abduljabbar F, Makhdom A, Rajeh M et al. Factors associated with clinical outcomes after lumbar interbody fusion with a porous nitinol implant. Global Spine J. 2017;7(8):780-786. doi:10.1177/2192568217696693

Daniell J, Osti O. Failed back surgery syndrome: a review article. Asian Spine J. 2018;12(2):372-379. doi:10.4184/asj.2018.12.2.372

Bailey C, Rasoulinejad P, Taylor D et al. Surgery versus conservative care for persistent sciatica lasting 4 to 12 months. New Eng J Med. 2020;382(12):1093-1102. doi:10.1056/nejmoa1912658

American Academy of Orthopaedic Surgeons. Minimally invasive spine surgery.

American Society of Anesthesiologists. Back surgery.

D'Souza M, Gendreau J, Feng A, Kim L, Ho A, Veeravagu A. Robotic-assisted spine surgery: history, efficacy, cost, and future trends. Robot Surg. 2019;6:9-23. doi:10.2147/rsrr.s190720

Beckerman D, Esparza M, Lee SI et al. Cost analysis of single-level lumbar fusions. Global Spine J. 2020;10(1):39-46. doi:10.1177/2192568219853251

Koltsov JCB, Smuck MW, Alamin TF, Wood KB, Cheng I, Hu SS. Preoperative epidural steroid injections are not associated with increased rates of infection and dural tear in lumbar spine surgery. Eur Spine J. 2021;30(4):870-877. doi:10.1007/s00586-020-06566-6

American Academy of Orthopaedic Surgeons. Low back pain.

American Academy of Orthopaedic Surgeons. Spinal injections.

American Society of Anesthesiologists. Back surgery.

By Mark GurarieMark Gurarie is a freelance writer, editor, and adjunct lecturer of writing composition at George Washington University.