What is a selective nerve root block?
Frequently we will get a request from your Orthopedic Spine Surgeon or Neurosurgeon to do a Selective Nerve Root Block prior to determining if surgery is needed and if it is needed, how extensive the surgery would need to be. You may have arrived at the surgeon’s office after being found to have an extruded disc, complaining of sciatica, or left with pain after a laminectomy (post laminectomy syndrome). In this instance, we are asked to do an epidural shot that targets a specific nerve root that will eventually make up your sciatic nerve. The primary goal of this injection is to give you pain relief. However, in doing a more selective nerve root injection, we can also determine exactly where your pain is coming from and can, therefore, limit any future surgery to the least extent possible.
What is a selective nerve root block?
Frequently we will get a request from your Orthopedic Spine Surgeon or Neurosurgeon to do a Selective Nerve Root Block prior to determining if surgery is needed and if it is needed, how extensive the surgery would need to be. You may have arrived at the surgeon’s office after being found to have an extruded disc, complaining of sciatica, or left with pain after a laminectomy (post laminectomy syndrome). In this instance, we are asked to do an epidural shot that targets a specific nerve root that will eventually make up your sciatic nerve. The primary goal of this injection is to give you pain relief. However, in doing a more selective nerve root injection, we can also determine exactly where your pain is coming from and can, therefore, limit any future surgery to the least extent possible.
Epidural refers to the space in your spine that surrounds your spinal fluid and spinal cord. The epidural space is a space that can operate as a reservoir to deposit medication to help reduce pain. The medication that is in the injection is a corticosteroid, similar to cortisone that could be injected elsewhere in your body and occurs naturally in your body. The goal of the injection is to deposit a powerful anti-inflammatory medication close to the source of your spine pain. Since there are important structures such as nerves, blood vessels, and spinal fluid nearby, this procedure should be performed by a well-trained interventional back pain specialist under fluoroscopic guidance (x-ray mapping).
How is the injection performed?
The most common nerves targeted with this procedure are the lumbar or first sacral nerve roots. The level(s) targeted for your specific injection is identified after a thorough physical examination and review of imaging studies. The procedure is done with the administration of local anesthetic to numb the injection site and is done with the guidance of a fluoroscope so that the needle is placed in the exact location necessary.
What Conditions are treated with a selective nerve root block?
The conditions most commonly treated with a selective nerve root block include low back pain, herniated disc pain, extruded disc pain, sciatica, failed back surgery(post laminectomy) syndrome, or pain from spinal stenosis (spinal narrowing).
How should I prepare for the Injection?
If you need something to help with anxiety related to the procedure, you should discuss this with Dr. Irwin who will give you a pre-procedure medication to help reduce the anxiety. If you are taking any blood pressure medication, you should not skip any regular dose of this medication. However, if you are taking any medications that might thin your blood, you should discuss this with Dr. Irwin to make sure we have approval from your Cardiologist to hold this medication for the appropriate number of days prior to the injection.
On the day of your injection, you should have nothing to eat or drink for two hours prior to the injection. You should have someone who can drive you home from the procedure. You should not return to work the day of your procedure. You can safely resume your normal activity the day after your injection. It might take a couple of days for the steroid to start working to help your pain.
What should I expect after my injection?
The steroid might take up to 5 days to start to take effect. Prior to the steroid taking effect, you may actually have increased pain from injecting a volume of medication near your pain generator. If you have some injection site pain you can use ice to help reduce pain. Do not use heat until 24 hours after the injection.
Will I need to have the injection repeated?
Patients will often receive profound relief from just their first injection. If this is the case for you, and you are happy with your pain relief, then you can cancel any remaining injections. If you have a less than satisfactory level of pain relief from your first injection we may target a different level on another injection. If you have not received any relief after two injections we will likely need to change course and pursue other treatments for your pain.
Our hope is that the Selective Nerve Root Block will help with months of pain relief. If this is the case we can repeat the injection every three to six months as needed for pain relief.
Are there things I should look out for after having this procedure?
Of course, you can call our office with any question you might have. However, there are certain “red flag” warnings that you should call us for, or if after hours you should go to your nearest ER. These “red flag” warnings would include severe or worsening pain, fever over 101 degrees, new or worsening weakness, or injection site redness or drainage.
NWA interventional Pain is located just outside of Bentonville, AR in Rogers. Dr. Irwin is a pain specialist that focuses on finding a non-habit forming pain management solution to your chronic pain condition.