Selective nerve root block vs epidural steroid injection

In a retrospective study, Narozny and associates (2001) investigated the clinical effectiveness of nerve root blocks (., peri-radicular injection of bupivacaine and triamcinolone) for lumbar mono-radiculopathy in patients with a mild neurological deficit.  These researchers analyzed 30 patients (aged 29 to 82 years) with a minor sensory/motor deficit and an unequivocal MRI finding (20 disc herniations, 10 foraminal stenoses) treated with a SNRB.  Based on the clinical and imaging findings, surgery (decompression of the nerve root) was justifiable in all cases.  Twenty-six patients (87 %) had rapid (1 to 4 days) and substantial regression of pain, 5 required a repeat injection.  Furthermore, 60 % of the patients with disc herniation or foraminal stenosis had permanent resolution of pain, so that an operation was avoided over an average of 16 months (6 to 23 months) follow-up.  The authors concluded that SNRBs are very effective in the non-operative treatment of minor mono-radiculopathy and should be recommended as the initial treatment of choice for this condition.

All of our procedures begin by injecting a small amount of local anesthetic through a very small needle. It feels like a little pinch and then a slight burning as the local anesthetic starts numbing the skin. After the skin is numb, the procedure needle feels like a bit of pressure at the injection site. If you experience any pain during the procedure, your doctor will inject more local anesthetic as needed. The actual placement of the needle is not painful. However, keep in mind the nerve root is pinched and irritated. If the needle tip brushes against the nerve during placement, you may feel a “zing” down the nerve root, similar to striking your “funny bone”. During the injection of the local anesthetic, there may be a temporary achiness along the nerve root until the local anesthetic sets in, usually in about 15 seconds. These sensations are normal.

At most, you will feel some minor discomfort in the back. As local anaesthetic has been injected into the spine most patients will be pain free. Since local anaesthetic is also administered around a nerve, your arm or leg (depending on whether the nerves in the neck or lower back have been injected) may feel numb, heavy, clumsy, weak or even cold. This usually reverses in approximately 20-40 minutes. Most patients are observed in the clinic for at least 30 minutes and are discharged after this point only if walking safely and feeling well. You should not drive for the rest of the day. The following day you may return to work and gradually increase your activities.

He received his undergraduate degree in Kinesiology and Exercise Physiology from CU Boulder. He earned his MD and MBA degrees from University of Colorado, Denver where he was class president as a medical student. He performed his internship in Indianapolis and went on to serve as chief resident of Physical Medicine and Rehabilitation at the prestigious Mayo Clinic in Rochester, Minnesota. His tour of the Midwest ended in Milwaukee where he trained in the Department of Anesthesia at the Medical College of Wisconsin, completing an Interventional Pain Medicine fellowship. He is currently double boarded in both PM&R and Pain Medicine through the American Board of Physical Medicine and Rehabilitation.

Possible Complications
Spinal injections, like other medical procedures, have risks. Complications include risk of infection, low blood pressure, headache, and injury to nerve tissue. These risks are low. Conclusion
We perform the full range of injection therapies to provide the best possible pain management for your condition. The skilled medical team at SDCSD will carefully discuss the options with you, and we'll give you detailed instructions for before and after the procedure so that you are well prepared.

No high-quality evidence has proved the effectiveness of manipulative therapy in the treatment of cervical radiculopathy. However, limited evidence suggests that manipulation may provide short-term benefit in the treatment of neck pain, cervicogenic headaches, 3 , 17 and radicular symptoms. 18 Rare complications, such as worsening radiculopathy, myelopathy, and spinal cord injury, may occur. 3 , 19 Because of these risks and the lack of high-quality evidence to support its effectiveness, manipulative therapy cannot be recommended for the treatment of cervical radiculopathy.

Selective nerve root block vs epidural steroid injection

selective nerve root block vs epidural steroid injection

He received his undergraduate degree in Kinesiology and Exercise Physiology from CU Boulder. He earned his MD and MBA degrees from University of Colorado, Denver where he was class president as a medical student. He performed his internship in Indianapolis and went on to serve as chief resident of Physical Medicine and Rehabilitation at the prestigious Mayo Clinic in Rochester, Minnesota. His tour of the Midwest ended in Milwaukee where he trained in the Department of Anesthesia at the Medical College of Wisconsin, completing an Interventional Pain Medicine fellowship. He is currently double boarded in both PM&R and Pain Medicine through the American Board of Physical Medicine and Rehabilitation.

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