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Selective Nerve Root Block for the Treatment of Radiculopathy( Sciatica)
Your spine is made up of 24 movable bony blocks called vertebrae that are stacked one on top of another. Each vertebra is separated and cushioned by an intervertebral disc composed of a gel-like material. With the normal aging process, the discs will lose their firmness and become degenerated. Degenerated discs can also weaken where they will bulge or herniate. Bone spurs, also called osteophytes, can develop with a degenerated disc. The spinal cord runs through a canal in the center of these bones. Nerve roots split from the spinal cord and exit between the vertebrae to various areas of your body such as your arms and legs. When these nerve roots become irritated, pinched or injured, the resulting symptoms are called radiculopathy. Radiculopathy is most commonly seen in the cervical( neck) and lumbar( low-back) spine. A radiculopathy of the lumbar spine is commonly referred to as sciatica.
Symptoms of Radiculopathy
When a nerve root is compressed, it becomes swollen and inflamed. This results in unpleasant symptoms such as sharp and shock-like
sensations into the arms and / or legs. Patients often complain of numbness, burning, and a“ pins and needles” sensation in the upper or lower extremities. In severe cases, weakness can result.
Causes of Radiculopathy
1. Disc pathology: spinal discs can herniate, bulge, or slip out to press on the nerve roots.
2. Bony spurs: extra bone growth due to osteoarthritis, or other degenerative disease.
3. Thickening of the spinal ligaments around where the nerve roots are leading to compression of the nerves
4. Less common causes include infection, non-cancerous or cancerous mass
Diagnosis
Radiculopathy is typically diagnosed with a patient’ s history, physical exam, or imaging studies such as X-ray, CT scan, and MRI. An EMG / nerve conduction study can also be helpful.
Treatments
1. Conservative treatments like physical therapy, chiropractic care, and / or medications such as anti-inflammatories, acetaminophen, and muscle relaxers 2. Selective nerve root block 3. Surgery to reduce the pressure on the nerve root by widening the space where the nerve roots exit the spine. This may involve removing all or parts of a disc and / or vertebrae.
What is a selective nerve root block?
It is a minimally invasive spine injection procedure used to diagnose and treat primarily low-back and neck pain associated with extremity pain. When a spinal nerve root becomes inflamed, or impinged, it can cause not only spine pain but also radiating pain into an extremity. Cervical( neck) nerve root compression can lead to radiating or shocklike pain from the neck into the arm or hand. Lumbar( low-back) nerve root compression will lead to radiating pain from the low back into the leg or foot. A nerve root block involves injecting a local anesthetic such as lidocaine with steroid onto the involved nerve root( s). This type of injection is used for two primary purposes: the first is to determine the etiology and location of the patient’ s pain; the second is to provide pain relief for the patient’ s symptoms.
Talk to your pain management physician to see if a nerve root block is right for you.
This Industry Insight was written by Stephanie H. Le, MD. Dr. Le is an interventional pain management specialist who helps treat the source of her patients’ pain using interventional spine injections and procedures, with the goal of returning them to the most functional lifestyle possible. Dr. Le is board certified in pain management and physical and rehabilitation medicine. She is a member of the International Spine Interventional Society, the American Society of Interventional Pain Physicians, and the American Medical Association.
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