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| Indications |
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Nerve root blocks are
useful when an Epidural Injection has failed to
help for sciatica due to nerve root irritation. They
can be performed at the lumbar and cervical levels.
Indications for a block include:/
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| Technique |
- The injection is performed under local anaesthesia,
intravenous sedation
, with x-ray screening, while lying face
down.
- A small diameter 3.5" needle is positioned in the
Foramen , or nerve root exit hole, at the side
of the spine. X-ray contrast medium is injected to
outline the nerve root:-
- Lumbar
Radiculogram
- Cervical
Radiculogram
- Once the needle is in the correct position, and not
in the cerebro-spinal fluid (CSF), a mixture containing
2% lidocaine and triamcinolone 20 mg is injected around
the nerve root.
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| Aftercare |
- Vital signs monitoring is usual for a short time
after the procedure.
- Arm or leg weakness, numbness, and temporary loss
of use in the limb can occur in some patients,
therefore an overnight stay on Meriden Wing
is advisable.
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| Complications |
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Technical
failure - inability to insert the needle into
the nerve root foramen. This may be due to
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Obesity causing poor x-ray
pictures.
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Difficulty steering the
needle.
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Severe degrees of Spondylolisthesis in the
lumbar spine.
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Failure to
relieve the sciatic pain / this may occur if
the cause of the pain was not due to nerve root
irritation (See Non Nerve Root Sciatica and
Referred Pain).
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Total Spinal Injection / this may
occur if the spinal needle enters the CSF in the
dural cuff around the nerve root. The use of x/ray
contrast should reduce the risk of this
happening.
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Nerve
injury caused by direct needle trauma.
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Worse
pain in a very small minority of cases, cause
unknown.
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