Nerves leave the spinal cord at the
level of each vertebrae and pass through a bony window
referred to as a "Foramen". It is at this
foramen an injection can be given as a diagnostic test.
Such injections are also referred to as "Nerve
Root Block" .
Why is a selective nerve root
block via a Foraminal injection helpful?
Nerve roots exit the spinal cord and form nerves that
travel into the arms or legs. These nerves allow movement
of the arms, chest wall, and legs. These nerve roots
may become inflamed and painful due to irritation, for
example, from a damaged disc or a bony spur.
A selective nerve root block provides important information
to physicians but is not a primary treatment. It serves
to prove which nerve is causing pain by placing temporary
numbing medicine over the nerve root of concern. If
a patients usual pain improves after the injection,
that nerve is most likely causing the pain. If the pain
remains unchanged, that nerve is generally not the reason
a patient may be experiencing pain.
By confirming or denying the exact source of pain,
it provides information allowing for proper treatment,
which may include additional nerve blocks and/or surgery
at a specific level.
What happens during the procedure?
An IV will be started so that relaxation medication
can be given. The patients is placed on the X-ray table
and positioned in such a way that the physician can
best visualize the bony openings in the spine where
the nerve roots exit the spine using x-ray guidance.
The skin on the back is scrubbed using 2 types of sterile
scrub (soap). Next, the physician numbs a small area
of skin with numbing medicine. This medicine stings
for several seconds. After the numbing medicine has
been given time to be effective, the physician directs
a very small needle, using x-ray guidance near the specific
nerve being tested. A small amount of contract (dye)
is injected to insure proper needle position. This may
increase the patients usual paint for about 30 minutes.
Then a small mixture of numbing medicine (anesthetic)
and anti-inflammatory (cortisone/steroid) is injected.
What happens after the procedure?
Immediately after the procedure, the patient will move
around and try to imitate something that would normally
bring about their usual pain. Patients are then asked
to report the percentage of pain relief and record the
relief experienced during the next week on a post injection
evaluation sheet ("pain diary"). This will
be given to the patient when they are discharged home.
The arm(s), chest wall or leg(s) may feel weak or numb
for a few hours following the procedure. This is fairly
common and happens following a selective nerve root
General Pre/Post Instructions
Patients can eat a light meal within a few hours before
the procedure. If a patient is an insulin dependent
diabetic, they must not change their normal eating pattern
prior to the procedure. Patients may take their routine
medications. (i.e. high blood pressure and diabetic
medications). Patients should not take pain medications
or anti-inflammatory medications the day of their procedure.
Patients have to be hurting prior to this procedure.
They may not take medications that may give pain relief
or lessen their usual pain. These medicines can be restarted
after the procedure if they are needed.
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