Mr. Hemant Bajaj, a 45 year old IT professional, had been suffering from severe back ache, with the pain radiating to his left leg, for almost a year. He grew worried when even after many rounds of medication his condition failed to improve.
The doctor he previously consulted suggested a spinal surgery but Hemant was unwilling to take the big step. He wanted surgery to be the last option.
That’s when one of his colleagues suggested a second opinion from Dr. Manish Dalwani, senior consultant, Orthopedics at Sitaram Bhartia Hospital.
After a thorough physical examination and an in-depth analysis of Mr. Bajaj’s medical history, Dr. Dalwani advised him the trial of a nerve root block and facet block injection in the spine.
Dr. Dalwani was aware of Hemant’s reluctance in going through a surgery, so he said , “There’s nothing to worry about. Nerve root block is a minor procedure which people opt for when their condition isn’t improving through conservative treatment options. It is ideal for people not not yet ready for surgery.”
Hemant wanted to know more about the procedure.
What is a nerve root block?
A nerve root block is an injection, containing a combination of a local anesthetic and locally absorbed steroid, which is injected into the nerve root area (where the nerve exits the spinal column) or facet joint of the spine under X-Ray or fluoroscopic guidance.
What are the conditions for which nerve root block is performed?
A nerve root block is performed when a person experiences any of the following but is unable to get better with medication:
- Severe back or leg pain or both
- Pain or numbness which radiates through the limbs
“This procedure is also done in cases where the MRI shows facet/nerve degeneration in spinal joints, disk degeneration or disk prolapse,” Dr. Dalwani said.
“What happens is when a nerve root becomes inflamed or compressed, it leads to back or leg pain. In these cases, the swelling of the nerve root needs to be decreased.”
“But in case of impending paralysis, bladder or bowel involvement, surgical decompression is the first choice.”
Hemant was still unsure about why and when this procedure is performed and how it will help him get rid of his constant back pain.
Why is a nerve root block performed and how it helps?
A nerve root block is performed either for diagnostic purposes or for treating a particular ailment.
Nerve block may be performed when the exact source of the back or leg pain is unknown. It helps determine which particular spinal nerve root is causing the pain.
“This we do by numbing the suspicious nerve root and observing afterwards to see if it has relieved the pain experienced by the person,” added Dr. Dalwani.
Nerve root block is also used for effective pain management when other treatment options fail to give relief to the patient.
“The local anesthetic injected in the nerve root numbs it and the locally absorbed steroid helps reduce the inflammation in the root bringing relief from the pain. AFter the procedure, the patient is required to do back exercises daily. If the block gives you the required relief, it can be repeated. If not, then we can always go for a surgery,” Dr. Dalwani explained to Hemant.
Hemant saw this as a good option and owing to the constant reassurance given by the doctor, he decided to get the procedure done.
“I would like to know the details of this procedure,” Hemant said.
Nerve root block injection procedure – How is it performed?
“It is a small procedure which is carried out in the minor operation theater and takes only about 10-15 minutes,” Dr. Dalwani said.
The patient can usually have light meals prior to the procedure.
“On the day of the procedure, the patient lies on their back. The area, where the needle needs to be injected, is secured with sterile drapes. The skin is anesthetized with the help of a local anesthetic. Using fluoroscopic guidance, a needle is advanced towards the exact location. A mixture of local anesthetic and steroid is then injected into the area through the needle,” Dr. Dalwani explained.
“Is a nerve root block painful?” was the next question Hemant asked as he became anxious when he heard how the procedure will be carried out.
Dr. Dalwani consoled him by saying, “The procedure will not be painful as the area will be numbed with the help of a local anesthetic. General anesthesia won’t be required for the procedure. But you must note that once the needle is injected, you may feel a brief temporary sensation of pain or a shock down the leg.”
Hemant was glad he was informed about this prior to the procedure. He felt relieved to know he would be able to go home the same day.
“You may also be able to resume work the same day provided you strictly follow the instructions after the procedure.”
“Is there a 100% guarantee that I will get fully treated after the nerve root block?” Hemant asked.
“After the procedure, even though you’ll get some immediate relief from the pain, you would need regular physiotherapy and back exercises to fully recover,” said Dr. Dalwani.
After Hemant had all the information about the procedure, he felt positive and decided to go ahead with it.
The nerve root block procedure went well. Hemant started feeling a lot better after the procedure and thanked Dr. Dalwani for helping him get rid of the severe backache.
“I am glad I went for a second opinion before jumping to a surgery. My back feels better now,” Hemant said as he left for home the same day.
He also promised to be regular with his back exercises and physiotherapy.