Cervical/Thoracic/Lumbar Selective Nerve Root Block
What is a nerve root and why is a selective nerve root block helpful?
Nerve roots exit the spinal cloumn and form nerves that travel into the arms, trunk or legs. These nerves allow movement of the arms, chest/abdominal wall, and legs. These nerve roots may become inflamed and painful due to irritation, for example, from a damaged disc or a bony spur.
A selective nerve root block provides important information to physicians but is not a primary treatment. It serves to diagnose or determine which nerve is causing pain by placing temporary numbing medicine over the nerve root of interest. If usual pain improves immediately after the injection, that nerve is most likely causing the pain. If the pain remains unchanged, that nerve is generally not the reason a patient may be experiencing pain.
By confirming the exact source of pain, this provides information allowing for proper treatment, which may include additional nerve blocks and/or surgery at a specific level.
What happens during the procedure?
An IV may be started so that relaxation medication can be given. The patient is placed on the X-ray table and positioned in such a way that the physician can best visualize the bony openings in the spine where the nerve roots exit the spine using x-ray guidance. The skin on the back is cleansed. Next, the physician numbs a small area of skin with numbing medicine. This medicine stings for several seconds. After the numbing medicine has been given time to be effective, the physician directs a very small needle, using x-ray guidance near the specific nerve being tested. A small amount of contract (dye) is injected to insure proper needle position. This may temporarily increase usual pain for about 30 minutes. Then a small mixture of numbing medicine (anesthetic) and anti-inflammatory (cortisone/steroid) is injected.
What happens after the procedure?
Immediately after the procedure, the patient will move around and try to imitate something that would normally bring about their usual pain. Patients are then asked to report the percentage of pain relief and record the relief experienced during the next week on a post injection evaluation sheet ("pain diary"). This will be given to the patient when they are discharged home.
The arm(s), chest/abdominal wall or leg(s) may feel weak or numb for a few hours following the procedure. This is fairly common and happens following a selective nerve root block.
General Pre/Post Instructions
If performed in a hospital or ambulatory surgical center setting, the patient should avoid food intake or excessive fluid intake for six hours prior to the procedure. If an insulin dependent diabetic, do not change your normal eating pattern prior to the procedure, although inform your physician of oral intake before the procedure. Patients may take their routine medications. (i.e. high blood pressure and diabetic medications). If a patient is on Coumadin or other blood thinners or Glucophage (a diabetic medicine) they must notify the office so the timing of these medications can be explained.
Patients should not take pain medications or anti-inflammatory medications the day of their procedure. Patients have to be hurting prior to this procedure so that pain can be reassessed immediately following. Do not take medications that may give pain relief or lessen their usual pain. These medicines can be restarted after the procedure if they are needed.
