What Are Selective Nerve Root Blocks?
Table of Contents
A selective nerve root block is a minimally-invasive procedure that is used to both diagnose and treat pain. It can help with pain in the cervical, thoracic, and lumbar region of the spine, as well as associated extremity pain. This procedure involves injecting a local anesthetic directly into a specific, targeted nerve root of the spine. This can help identify the exact source of a patient’s pain symptoms. Secondarily, it can also provide therapeutic relief of a patient’s symptoms.
Benefits of selective nerve root blocks
When a spinal nerve root becomes irritated, inflamed, or compressed it can cause pain in your back. Furthermore, you may even feel symptoms in your upper or lower extremities depending on where the irritated nerves are located.
For example, cervical spine nerve irritation may lead to pain, numbness, and tingling in the neck, shoulders, or arms. Thoracic spine nerve irritation can result in pain in the upper back or pain along the chest wall and ribs. Lastly, lumbar spine nerve irritation may result in pain, numbness, and tingling in the lower back, hips, buttocks, and legs.
Because nerves connect our body, the actual source of your pain may be difficult to identify. Even imaging of the affected area or utilizing magnetic resonance imaging (MRI) may not show which nerve is leading to your pain. In these cases, a selective nerve root block can help isolate the nerve root to determine if it is the source of your pain.
In addition to its’ diagnostic ability, a selective nerve root block can also provide pain relief for various conditions. This is because a selective nerve block involves injecting a local anesthetic, often combined with a corticosteroid, into the nerve root. The local anesthetic essentially numbs the nerve, while the steroid helps to decrease inflammation and pain.
A selective nerve root block is similar to an epidural injection, another common pain management technique. With a selective nerve root however, the medication is directed at the offending nerve root and not into the epidural space.
The success rate of selective nerve root blocks varies among individuals, as some nerve roots are very difficult to treat due to their location and surrounding structures.
Conditions Related To Selective Nerve Root BlocksIf you’re suffering from any of the following conditions, you may benefit from selective nerve root blocks:
- Cervical radiculopathy: Pain or sensations in the upper extremities
- Lumbar radiculopathy: Pain or sensations in the lower extremities
- Failed back surgery syndrome: Spinal pain that persists or develops following spinal surgery
- Spinal stenosis: Narrowing of the spinal canal
- Bulging intervertebral discs: Decreased structural integrity of the intervertebral discs outer layer, resulting in a bulge from the disc’s normal position
- Herniated disc: Rupture of the nucleus pulposus of an intervertebral disc through a tear in the outer layer of the disc
- Arthritis: Degeneration of the spinal joint cartilage
How Are Selective Nerve Root Blocks Performed?A selective nerve root block procedure is a minimally invasive technique that your doctor will perform in an outpatient setting. Typically, the procedure takes between 30 and 60 minutes to complete.
To start, you’ll be lying down in a prone position under a fluoroscopic X-ray. Your healthcare team will clean the skin near the injection area with an antiseptic solution. They’ll then numb the area with a local anesthetic. Your doctor will then insert the needle, using fluoroscopic guidance, into the proper position within the spine. A small amount of contrast dye is injected to confirm proper needle placement.
The final needle position for a selective nerve root block is just superior to the targeted nerve root through the foramen (which is the space between the vertebral bodies). The injection, which usually consists of a local anesthetic such as lidocaine and a steroid such as dexamethasone, is injected into the affected area. Once the injection is complete, your healthcare team will monitor you for adverse reactions.
If your pain does in fact subside after the injection, it’s generally assumed that your doctor has identified the pain-generating nerve root.
Most patients can resume normal activities the day after the injection procedure, but always follow your doctor’s orders. You may notice an immediate relief of symptoms that is due to the injection of the local anesthetic, which may be followed by a slight increase in pain until the cortisone begins to exert its effects.
The relief of symptoms from a selective nerve root block varies among patients and can last from several days to several months.
Risks and complications
Following a selective nerve root block, patients may experience increased pain at the injection site, increased radicular pain, lightheadedness, increased spinal pain, nausea, headache, and vomiting.
Risks associated with selective nerve root blocks are rare, but may include infection, bleeding, and allergic reaction to the medications used during the procedure. Additionally, serious rare complications include membrane perforation of the dura, nerve damage, and paralysis.
Always work with a highly-skilled doctor and clearly note all aspects of your personal health history to help avoid these risks as much as possible.
ConclusionA selective nerve root block is a minimally invasive procedure that can effectively diagnose and treat many conditions that result from spinal nerve root irritation and inflammation. Selective nerve root block procedures are considered a very safe and effective treatment option for many chronic pain conditions. It may help patients with radiculopathy, failed back surgery syndrome, spinal stenosis, bulging and herniated discs, spinal stenosis, and arthritis.
When using a selective nerve root block, your doctor will target the offending spinal nerve root by injecting a local anesthetic, often combined with a steroid. This combination of medication allows for pain relief as well as inflammation relief that may have also been contributing to your pain. Benefits may last anywhere from several days to several months. You can repeat the procedure, if necessary and if approved by your doctor.
Patients suffering with chronic pain conditions should speak with their physicians about the potential of using selective nerve block to diagnose, and possibly treat, their pain symptoms. If you’re not already working with a pain specialist, you can find a pain doctor in your area by clicking the button below or looking for one in your area by using the tips here: https://paindoctor.com/pain-management-doctors/.
- Chung JY, Yim JH, Seo HY, Kim SK, Cho KJ. The efficacy and persistence of selective nerve root block under fluoroscopic guidance for cervical radiculopathy. Asian Spine J. 2012;6(4):227-232.
- Huston CW, Slipman CW, Garvin C. Complications and side effects of cervical and lumbosacral selective nerve root injections. Arch Phys Med Rehabil. 2005;86(2):277-283.
- Khan KS, SAH S, Rafiq T, Dolan M, Devitt AT. The role of selective nerve root block in patients with lumbar radiculopathy. J Bone Joint Surg Br. 2004;86-B(sup II):123.
- Riew KD, Park JB, Cho YS, Gilula L, et al. Nerve root blocks in the treatment of lumbar radicular pain: a minimum five-year follow-up. Journal of Bone and Joint Surgery. 2006;88(8):1722-1725.