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

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.  

Healthcare provider feeling the spine of his patient.

ljubaphoto / Getty Images

What to Know About Spinal Injection

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.

How Does It Work?

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:

  • Sciatica, a compression of the sciatic nerve causing pain in the lower back that radiates to the limbs
  • Herniated disc, also known as slipped or bulging disc, in which the circular cartilage between the vertebrae slides out of position and/or ruptures
  • Osteoarthritis, characterized by inflammation in the joints
  • Spinal stenosis, a compression of spinal nerves
  • Ankylosing spondylitis, an inflammatory condition causing the vertebrae to fuse together
  • Synovitis, an inflammation of the tissues surrounding the spine

How Effective Are Spinal Injections?

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.  

Spinal Injection Delivery

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:

  • Epidural spinal injection: These injections target the epidural space between the membrane surrounding the spinal cord and surrounding vertebrae, near inflamed and affected nerves.
  • Facet joint injection: Facet joints are small joints found on the back of the spine, between each vertebra. Localized anesthetic and anti-inflammatory medication are injected directly into or right around these joints.
  • Sacroiliac injection: The sacroiliac joints connect the sacrum, the large vertebrae of the lower spine with the pelvic bones. As with facet joint injections, the spaces right around these joints—or the joints, themselves—are injected with anti-inflammatory and pain medication.

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.

Side Effects

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

  • Increased appetite
  • Flushing or redness in the face
  • Dizziness
  • Fainting
  • Disrupted menstrual cycle
  • Nausea
  • Diarrhea
  • Spikes in blood sugar levels

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

  • Bleeding at the injection site
  • Infection and swelling
  • Nerve pain or injury
  • Muscle weakness
  • Increased back or neck pain
  • Arachnoiditis (inflammation of the membrane around the spine)
  • Paralysis
  • Avascular necrosis (death of the bone)
  • Spinal headache

Prices & Where to Get It

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.

What to Know About Spinal Surgery

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.

How Does It Work?

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.

Spinal Surgery Delivery

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:

  • Discectomy: This surgery involves removing a herniated disc to relieve pressure on the nerves, easing pain and symptoms. Discectomy may be followed with spinal fusion or artificial disc replacement.
  • Decompression surgeries: Laminectomy involves removing the lamina, the rear portion of the vertebra, to ease pressure on the nerve. Another decompression surgery, laminotomy, involves removing a smaller portion of this bone material.
  • Foraminotomy: This surgery involves removing bone and tissue to widen the foramen, the opening that allows nerve roots to pass from the spinal canal.  
  • Spinal fusion: To promote stabilization and prevent inflammation and pain, the surgeon works to fuse two vertebrae. Spinal fusion may be done using bone graft alone, or with the aid of specialized rods, screws, cages, or other instruments to properly support and position the spine.
  • Artificial disc replacement: In severe cases of a herniated disc, a surgeon first performs a discectomy and then implants an artificial disc. These implants are made of metal with or without plastic.   

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.

Robotic Surgery

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.

Side Effects

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:

  • Infection at the surgery site
  • Bleeding
  • Blood clot
  • Dural tear (a rip in the membrane surrounding the spine)
  • Lung problems
  • Persistent or worsening pain

Prices & Where to Get It

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.

Which Treatment Is Best for You?

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

  • Spinal injections are less invasive than surgery, making recovery much easier; they're typically a quick outpatient procedure.
  • Spinal surgery requires four to 12 or more weeks for complete recovery; the tenderness and soreness following spinal injection are gone within two days.
  • The effects of the spinal injection are seen within a few days, whereas it can take several days to six months or more before improvements are seen with surgery.
  • Complications are much rarer with spinal injections than with spinal surgery.
  • Spinal surgeries are reserved for difficult cases that spinal injections (or other therapies) can’t resolve.
  • The effects of spinal surgery are expected to be permanent, while injections typically relieve symptoms for about six months.
  • Spinal injections tend to be the less costly option when compared to spine surgeries.

Careful Consideration


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

Can Spinal Injection and Spinal Surgery Be Used Together?

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.  

Coping With the Side Effects

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:

  • Rest and recovery: As you rehabilitate from spinal surgery, you need to give your body time to heal. Follow your healthcare provider’s directions carefully. For anywhere from four to 12 weeks, you’ll need to avoid contact sports, lifting anything 10 pounds or more, twisting, or bending.  
  • Exercises/physical therapy: Throughout the recovery process from spinal surgery, you’ll gradually need to restore strength to the back. Your healthcare provider—often alongside a physical therapist—may recommend certain exercises and stretches to promote rehabilitation.
  • Pain medications: You can expect pain for three days to a week or more following surgery and up to two days after spinal injection. Your health provider may prescribe opioid pain medications, nonsteroidal anti-inflammatory drugs (NSAIDs), or other medications to help.
  • Infection control: To help prevent infection of the surgical or injection site, you may have to take antibiotics before surgery. If the incision or injection site gets infected, they may also be necessary afterward.
  • Spirometry: Spinal surgery can impact lung function and making sure your lungs restore their strength is another important aspect of rehabilitation. In the early going—and especially as you recover in the hospital—you may need to do breathing exercises using a special device called an incentive spirometer.  

Summary

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.

A Word From Verywell

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.

Frequently Asked Questions

  • Is spinal surgery the only option for treating low back pain?

    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:

    • Medications: Acetaminophen, NSAIDs, steroids, and muscle relaxers may be indicated to help with pain and inflammation.
    • Physical therapy: Working with a physical therapist, you learn certain stretches and exercises that promote strength and stability in the spine. These exercises may be paired with therapeutic icing, heating, ultrasound sessions, and using devices to electrically stimulate affected nerves.
    • Braces: Specialized braces can be worn to support the spine and promote better alignment, which can help manage pain. These go around the back and stomach to prevent poor posture.
    • Icing and heating: Sessions of icing or heating affected areas also help some manage the pain and inflammation associated with back pain.
    • Spinal injection: Injections of pain medication and steroid solutions can provide lasting pain relief in some cases. However, the effect is generally temporary (lasting about 6 months) and additional treatment may be needed.


  • If I have had a spinal injection, am I candidate for surgery?

    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.

  • How soon will I recover after spinal injection?

    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.

14 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading

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