Lumbar nerve root block injection

What is a lumbar nerve root block injection?

A lumbar nerve root block injection is a common treatment for pain and inflammation in the lower back (lumbar spine). The injection normally contains a solution that is a combination of local anaesthetic and corticosteroid. It targets the nerves in this area, including the spinal root nerves, medial branch nerves and sympathetic nerves. These nerves control symptoms associated with lower back conditions, from herniated discs to spinal stenosis.

What are the benefits of a lumbar nerve root block injection?

There are several key benefits of having a lumbar nerve root block injection:

• Reduced pain: Most people who are referred for a lumbar nerve root block injection are experiencing daily pain that isn’t being relieved by other medications or therapies. The steroid medication used in this treatment helps to reduce swelling and pressure on the nerves that are causing pain.
• Improved mobility: Even moderate back pain can make it difficult to move around. Lumbar nerve root injections can eliminate the pain and swelling that cause mobility issues, enabling easier and more comfortable movement.
• Delay surgery: Often, a minimally invasive treatment like a lumbar nerve root block injection can provide enough symptom relief to delay or completely avoid surgical intervention.
• Diagnosis: In some cases, a lumbar nerve root block injection is used to block specific nerves as part of a diagnostic process to find out which nerve is causing your symptoms.

What else is a lumbar nerve root block injection known as?

Like many medical treatments, there are other terms used to describe it. You may also hear a lumbar nerve root block injection called a “selective nerve root block”.

Is a lumbar nerve root block injection the same as an epidural?

No, a lumbar nerve root block injection is not the same as an epidural. The main difference between the two is that a standard epidural (like that which is given in childbirth) is where medication is delivered into the general space that is found around your spinal cord and nerve roots, providing a broad spread of medication that affects a wider area of your back.

In contrast, a lumbar nerve root block injection is delivered around one specific nerve root to target a very localised area of symptoms.

What conditions may require a lumbar nerve root block injection?

There are a variety of conditions that could mean that you’re recommended to have a lumbar root block injection. These include, but aren’t limited to:

Sciatica: Sciatica is characterised by pain, numbness, tingling and weakness that extend from the lower back into the leg. It’s caused by compression of the sciatic nerve, which is the longest nerve in your body and runs from your lower back into your leg. Sciatica is also sometimes called lumbar radiculopathy.

Spinal stenosis: this condition occurs when the empty spaces in your spine start to narrow and put pressure on your nerves and spinal cord. This happens when bone spurs form, which are little bone growths that develop and fill the spaces. It’s more common as you get older, and causes pain, numbness, weakness and feelings of heaviness in your arms, legs and feet.

Herniated/slipped disc: this is when one of the soft discs that separate the bones in your spine (vertebrae) pushes out of place and onto a nearby nerve, irritating it and causing pain and other symptoms.

Degenerative disc disease: this condition occurs when the discs in your spine start to break down, meaning that they no longer offer the same amount of cushioning for the vertebrae in your spine. With less protection, they are more likely to rub against one another, causing pain and other symptoms.

Spondylolisthesis: occurs when one or more vertebrae in the spine slip forwards or backwards over the one below it, it can cause chronic lower back pain, numbness in the legs and other symptoms.

Scoliosis: characterised by an unnatural curve in the spine, scoliosis can cause lumbar root nerve pain when the spinal curve narrows the spaces where the lower back nerves exit the spine. It’s often a congenital (from birth) condition with no known cause.

What causes lumbar nerve root pain?

Lumbar nerve root pain is primarily caused by compression or irritation. Sometimes known as lumbar root impingement, this is when the nerve becomes compressed or trapped, such as in scoliosis, where the exit for the nerves becomes much narrower. Both compression and irritation are usually caused by something pressing onto the nerves. Meanwhile, unsurprisingly, the term lumbar nerve root irritation is used to describe when bone or soft tissue rubs against the nerve to irritate it.

How serious is lumbar nerve root pain?

In the majority of cases, lumbar nerve root pain is uncomfortable, frustrating and sometimes debilitating, but rarely dangerous. Nevertheless, if it isn’t treated, there is a risk that it could lead to longer-term nerve damage.

If you have lumbar nerve root pain and suddenly experience loss of bladder/bowel function, numbness in your groin or severe weakness in your legs, it’s essential to speak to a medical professional right away. These are signs of a condition called cauda equina syndrome, which is classed as a medical emergency and requires immediate treatment.

Who is at risk of lumbar nerve root pain?

Although anyone can develop lumbar root pain, it’s more common in people aged 30 to 64. You are also more at risk if you:

• have a sedentary (non-active) lifestyle
• are overweight
• smoke, as this has been shown to accelerate degeneration of the bones in your spine
• have a job that involves frequent heavy lifting
• have a member of your immediate family with disc degeneration
• have type 2 diabetes or another metabolic disorder.

What causes nerve root compression in the lower back?

Nerve root compression in the lower back is most often caused by degenerative disc disease, a herniated disc or spinal stenosis. Your orthopaedic consultant will assess your symptoms and perform any necessary tests to determine the cause of your lower back pain and give you an accurate diagnosis. This will enable them to decide the best treatment plan for you based on your individual needs.

Can lumbar root nerve pain go away on its own?

Absolutely, yes. In fact, it’s estimated that as many as 80% of cases of lumbar root nerve pain will go away on their own within 10-12 weeks of it starting. During that time, only at-home treatments such as over-the-counter pain medications, rest and gentle movement may have been used.

What are the symptoms of lumbar root nerve impingement?

Generally speaking, the symptoms of lumbar root nerve impingement include lower back and leg pain, changes in sensation in the lower body and leg weakness. However, the specific areas where these are felt can change based on which nerve is affected.

What are the symptoms of L3 nerve root impingement?

In L3 nerve root impingement, pain radiates from the lower back down the front of the thigh and to the inside of the knee. You may experience numbness at the front of your thigh, and it may be harder than normal to straighten your leg or lift your thigh.

What are the symptoms of L4 nerve root impingement?

In L4 nerve root impingement, pain radiates from the lower back down the outer edge of the thigh, before progressing down the inner side of the shin and into the ankle. You may find that you feel numb on the inner side of your lower leg and foot and have trouble lifting your foot up from the floor.

What are the symptoms of L5 nerve root impingement?

In L5 nerve root impingement, pain radiates from the lower back down the outer edge of the thigh and calf, before extending over the top of the foot and into the big toe. Any numbness will be felt across the top of your foot and between your big and second toe. And when it comes to movement, you may find it hard to lift your big toe and the front part of your foot.

What are the symptoms of S1 nerve root impingement?

S1 nerve impingement symptoms are the ones most often associated with sciatica: sharp pain that can feel like an electric shock that starts in the lower back and/or buttock and extends down the back of the thigh and calf, often right into your foot. This is normally accompanied by tingling, or a pins-and-needles sensation, as well as numbness in the lower leg, ankle and the outer part of your foot. If you’re affected, it’s probably hard to balance on one leg or stand or walk on your tiptoes.

When might I need a lumbar nerve root block injection?

If you’ve been experiencing lumbar nerve pain for more than a few months and more conservative treatments, such as painkillers and alternative therapies such as osteopathy, aren’t providing enough relief from your symptoms, you may be referred for a lumbar nerve root block injection.

Who is not suitable for a lumbar nerve root block injection?

You may not be a suitable candidate for a lumbar nerve root block injection if you have:

• an active infection
• a known allergy to either of the medications used in the injection
• a bleeding disorder, or you are taking blood thinners
• uncontrolled diabetes.

If you’re pregnant or breastfeeding, you may not be able to have a lumbar nerve root block injection either.

What are the alternatives to a lumbar nerve root block injection?

There are several alternatives to a lumbar nerve root block injection, including:

• physical therapy exercises such as stretches and core strengthening
• osteopathy
• heat and cold therapy to try and reduce inflammation in the spine
• pain medications, including non-steroidal anti-inflammatories, nerve pain drugs like gabapentin, and muscle relaxant medications
• surgical solutions such as a discectomy, which removes the material from a herniated disc that is pressing on the surrounding nerves, or a laminectomy, which works by widening the area around the spine so that there is more space for the spinal cord and surrounding nerves.

How can I prepare for a lumbar nerve root block injection?

As a fairly minimally invasive procedure in most cases, there’s minimal preparation required for a lumbar nerve root block injection.

Your consultant will have already reviewed your medical history and given you any recommendations for the day of your procedure. These may involve temporarily stopping any routine medications that you take and arranging for someone to drive you to and from your appointment, as the anaesthetic may affect your ability to drive yourself. You will also have been told when to stop eating and drinking ahead of your procedure. Be sure to follow all the guidelines provided by your Nuffield Health medical team.

What to expect during a lumbar nerve root block procedure?

Your procedure will normally be carried out using local anaesthetic. You’ll be asked to lie face down on the table, and your lower back will be cleaned using antiseptic to help minimise the risk of infection. A local anaesthetic will then be administered to numb the area where the lumbar nerve root block will be injected. This is usually in the form of an injection too.

Once the area is numb, your doctor will use imaging technology such as CT or live X-ray to visualise your spine and administer the injection precisely to the nerve root that is being targeted. Sometimes contrast dye will be injected first, and this further helps guide the placement of the needle to ensure the medication is delivered as accurately as possible.

You shouldn’t feel any pain while the medicine is being injected into the root, but some people report sensations of pressure. Once the injection is complete, there may be a small dressing placed over the injection site.

How long does a lumbar nerve root block procedure take?

The actual lumbar nerve root block injection itself usually takes less than 15 minutes, but you’ll need to allow time for the local anaesthetic to work beforehand, and to be monitored briefly afterwards. Therefore, you should allow at least an hour for your appointment.

Is a lumbar nerve root block injection painful?

You’ll be given a local anaesthetic to numb the area before you are given the nerve root block injection. This means that you shouldn’t experience any pain. However, you may still feel sensations like pressure and heaviness while the injection is being administered.

Do I need to stay awake during a lumbar nerve root block procedure?

Most lumbar nerve root block procedures are performed under local anaesthetic. If you’re particularly anxious about the treatment, it may be possible for you to have some sedation. Performing it under general anaesthetic would add a degree of risk to the procedure, so yes, you will be awake throughout.

What kind of anaesthetic or numbing is used in a lumbar nerve root block treatment?

There are two different local anaesthetics that may be used in a lumbar nerve root block treatment. These are lidocaine and bupivacaine. Lidocaine is the preferred option and is used in the majority of cases.

How long does it take to recover after a lumbar nerve root block injection?

Recovery from a lumbar nerve root block injection is usually quick and straightforward, with most people able to get back to their usual activities within just a couple of days. However, it may take several weeks before you’re able to undertake any vigorous exercise or heavy lifting. You should always follow the recommendations of your medical team.

How soon can I go home after a lumbar nerve root block injection?

You’ll be able to go home the same day as your treatment, but you will need to arrange for someone to drive you. This is because your leg may feel numb or weak, and the local anaesthetic could impair your judgement.

What activities should I avoid after a lumbar nerve root block injection?

You’ll be told to avoid any intense exercise or heavy lifting for at least a few days following your nerve root block treatment. You’ll also be told not to have a bath for at least 24 hours so that you don’t soak the injection site. This will help to reduce the risk of infection.

How long before I feel the results of a lumbar nerve root block injection?

The results of your lumbar nerve root block injection will take place in two stages.

Stage one: Your injection will contain a local anaesthetic, and this will provide immediate pain relief, as well as numbing the area. This effect will normally last for a few hours, meaning you may notice some improvement before you even get home.

Stage two: The steroid part of your treatment will take a few days to start working and reach the peak of its effectiveness within a couple of weeks.

What are the risks and complications of a lumbar nerve root block injection?

As with any treatment, there are a number of risks and potential complications associated with a lumbar nerve root block injection. These will be explained to you at your consultation, but it’s advisable to familiarise yourself with what these are in case you need to seek medical advice.

What are the most common side effects of a lumbar nerve root block injection?

The most common side effects of a lumbar nerve root block injection include mild discomfort and bruising at the injection site. You may also have a few spots of blood from where the injection pierced the skin. Some people also experience a temporary increase in their pain as a result of the nerve being irritated during the injection, but this eases as the medication starts to work.

Numbness or weakness in the legs caused by the anaesthetic is also common, with some people experiencing minor dizziness.

Serious complications of lumbar nerve root block injections

Serious complications/side effects are rare. However, you should seek immediate medical attention if you notice:

• any loss of bladder or bowel control
• worsening, persistent numbness in the legs
• severe or persistent headaches
• warmth or redness at the injection site, along with a fever.

What is the success rate of a lumbar nerve root block injection?

Studies show that exact success rates of lumbar nerve root block injections can vary quite significantly, often depending on which nerves are being targeted. One study found that 68% of patients receiving a spinal nerve root block reported a positive outcome, while another reported a 76.8% success rate for using it as a treatment for acute lumbar disc herniation.

How much does a lumbar nerve root block injection cost at Nuffield Health?

For pricing information, please contact your local hospital. The hospital or your healthcare team will give you a fixed, all-inclusive price for the treatment following your initial consultation.

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