Elective spinal injections should be performed with imaging guidance, such as fluoroscopy or the use of a radiocontrast agent , unless that guidance is contraindicated.  Imaging guidance ensures the correct placement of the needle and maximizes the physician's ability to make an accurate diagnosis and administer effective therapy.  Without imaging, the risk increases for the injection to be incorrectly placed, and this would in turn lower the therapy's efficacy and increase subsequent risk of need for more treatment.  While traditional techniques without image guidance, also known as blind injections , can assure a degree of accuracy using anatomical landmarks, it has been shown in studies that image guidance provides much more reliable localization and accuracy in comparison.
Corticosteroid side effects may cause weight gain, water retention, flushing (hot flashes), mood swings or insomnia, and elevated blood sugar levels in people with diabetes. Any numbness or mild muscle weakness usually resolves within 8 hours in the affected arm or leg (similar to the facial numbness experienced after dental work). Patients who are being treated for chronic conditions (., heart disease, diabetes, rheumatoid arthritis) or those who cannot temporarily discontinue anti-clotting medications should consult their personal physician for a risk assessment.
A small and very rare risk is that the injected joint becomes infected (1 in 15,000). Patients who experience a very painful, red, or swollen joint after injection should seek medical attention immediately. Thankfully, the most common cause of these symptoms is not a concerning infection but a reaction to the injected steroid (called steroid flare ) that occurs in 2-5% of patients. A steroid flare usually begins 6-12 hours after the injection and can last for 2-3 days. Regardless of the cause, it is important for patients with symptoms of infection to see a doctor because infections require immediate treatment.