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What is a nerve root and
why is a selective nerve root block helpful?
Nerve roots exit the spinal
cord and form nerves that travel into the arms or legs.
These nerves allow movement of the arms, chest 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 prove which nerve is causing
pain by placing temporary numbing medicine over the nerve
root of concern. If a patients usual pain improves 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 or denying the
exact source of pain, it 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 will be started so
that relaxation medication can be given. The patients 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 scrubbed using 2 types of sterile
scrub (soap). 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 increase the patients 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 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
Patients can eat a light
meal within a few hours before the procedure. If a patient
is an insulin dependent diabetic, they must not change their
normal eating pattern prior to the procedure. Patients may
take their routine medications. (i.e. high blood pressure
and diabetic medications). Patients should not take pain
medications or anti-inflammatory medications the day of
their procedure. Patients have to be hurting prior to this
procedure. They may 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.
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