Selective Nerve Root Block, Lumbar Spine

KEY FACTS

Terminology

• Selective corticosteroid and long-acting anesthetic injection of lumbar nerve root at level of neural foramen

Preprocedure

• Imaging

  • Single or multilevel involvement

Procedure

• Carefully determine correct level(s) for injection

  • Nerve root exits below pedicle of same numbered vertebral body

• 2 approaches for lumbar selective nerve root block

  • Angle C-arm toward side to be injected and target beneath pedicle/“eye” of “Scotty dog”

  • Using AP projection, mark skin 6-8 cm lateral to neural foramen and determine trajectory to foramen

• Assess pain score/reproduction of pain before, during, and after injection

• Findings and reporting

  • Pain before, during, and after injection

  • Was pain reproduced by procedure?

  • Level(s) injected including injectate volume and medications injected

Post Procedure

• Expectation

  • Significant reduction in pain following injection (may take 48-72 hours)

Outcomes

• Most feared complications

  • Dural puncture (spinal cord injury, meningitis, CSF leak)

  • Vascular injury/intravascular injection (spinal cord ischemia)

• Problems

  • Failure of pain relief

  • Vasovagal reaction

TERMINOLOGY