Spine : Nerve root injection

Ashley Cole describes a nerve root injection

This procedure is done for many reasons but is usually done to help your surgeon diagnose the cause of your leg and/or buttock pain or as an attempt to treat it.

Procedure

The procedure is done under local anaesthetic as a day case. There is no need to starve before the procedure. You will come into hospital on the day of the procedure and it is advised you bring a dressing gown and comfortable shoes to walk to theatre in.

After initial nursing checks will be taken to theatre. Here you will be helped onto a theatre ‘table’ lying on your tummy. This special table will allow the surgeon to use the x-ray equipment. Once you are comfortable in this position, the surgeon will wash his/her hands and prepare the equipment necessary to perform the injection.

The surgeon will then prepare the skin of your back with a cleaning solution - please inform us if you are allergic to anything. Local anaesthetic will then be placed in the skin and a needle guided down close to the nerve root using the x-ray machine. It is important for you to inform the surgeon if you experience any leg pain during the needle insertion as this may indicate that the needle is close to the nerve and may need repositioning.

For ladies of child bearing age, it is very important for you to tell us if there is any chance you might be pregnant.

Once the surgeon is happy the needle is correctly placed, a dye (contrast) will be injected to confirm the correct position of the needle. This may reproduce the symptoms in your leg and/or buttock. Once the surgeon is happy with the needle position, steroid and local anaesthetic (kenalog and bupivacaine) will be injected and again may reproduce your leg and/or buttock pain. This is the end of the procedure and you will be helped down from the theatre table and into a wheelchair and taken back to the ward.

The steroid is not absorbed into your blood and will not produce any of the generalised side effects of long term oral steroids.

After the procedure

After a short period of observation on the ward you will be allowed to go home and an appointment will be made for you to see your surgeon between 2 and 8 weeks after the procedure. You should not drive on the day of the procedure but in most cases will be fine to drive and return to work the next day.

What are the results?

The injection improves the leg and/or buttock symptoms in 80% of cases and can start to work anytime after the procedure up until 2 weeks. It works for between a few hours and forever with most patients getting between 6 weeks and 6 months of significant pain relief. One in 12 injections will give good pain relief for more than a year.

The risks of this procedure include:


  • Infection - approximately 1 in 2000

  • Nerve injury resulting in some pain and weakness in the affected leg - 1 in 5000

  • Tearing the lining of the nerve (dural tear) requiring a period of bed rest and possible a further injection - 1 in 3000

  • Initial worsening of symptoms for a few days - 1in 20

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