What is Nerve Root injection for neck pain?
It is a small procedure that is very useful to control neck and arm pain performed under local or intravenous sedation. This nerve root injection helps to reduce the pain and inflammation due to the nerve root compression. The nerve roots that come out of the spinal cord exits through small holes (foramen) in your spine. These nerve roots can be pinched by a herniated disc, narrowing of the holes (foramen)due to wear and tear of the spine.
Why is Nerve root Injection procedure recommended?
Nerve root injection is recommended for control of your neck and arm pain. Inflammation caused by the wear and tear of your spine produces chemicals around your spinal nerves that irritates these nerves. This is the cause of neck and arm pain.
Where is Nerve root injection for neck pain given?
The spinal column is made of bones and the soft cushion between these bones. It has a central canal (passage) that contains and protects the solid spinal cord. There are branches coming out of the spinal cord at regular intervals on each side. These are called nerve roots. These nerve roots come out of the spinal cord exits through small holes (foramen) in your spine. These nerve roots can be pinched by either a herniated disc or by the narrowing of the small exit holes (foramen)due to wear and tear of the spine. The nerve root injection is given close to the trapped or pinched nerve.
What does a Nerve root injection do?
Nerve root injection contains a mixture of numbing solution (local anaesthetic) and corticosteroid (steroid). The local anaesthetic will improve the pain immediately and the steroid in the solution will act on the inflammation around the nerve roots and control the pain in the long term. This improvement in the pain will help you move around better and mobilise your neck. This increase in the movement of the small joints of your spine will further reduce the stiffness around the bones, ligaments and muscles.
ABOUT THE PROCEDURE
You will be admitted for Day Case surgery just for a day. You will need to come in starved for at least 6 hours. This is because we have to give you a sedative in your arm to make you sleep for a short duration. It will help you cope with the anxiety and pain from the procedure. Your will be required to lie on your tummy comfortably. After the sedation, your skin on the back of the neck will be cleaned with an antiseptic solution.
A spinal needle is used to inject the solution into the epidural space. X-rays will be taken to make sure that the needle placement is accurate. Further a dye is injected into the space to outline the epidural space before the anaesthetic and steroid solution is injected. You will recover from the procedure and sedation very quickly.
After the injection, you will be taken to the recovery room from theatre and monitored for an hour. You will be able to leave hospital once you are safe.
What happens after the Nerve root injection?
You must be aware that the local anaesthetic may cause a temporary numbness or weakness of the arm for a few hours. Your arm may give way when you try getting out of bed due to the weakness. But this will settle with time. Once the effect of the anaesthetic wears off, your arm and neck pain may return, occasionally slightly worse than before for a short period until the steroid in the solution takes effect. It takes a few days or even weeks for the steroid to take effect on your pain.
You must continue to take your usual pain relief medication that your doctor had prescribed for you till you begin to feel benefit. Some medications like morphine, gabapentin, pregabalin or amitriptyline need to be continued and not stopped abruptly.
What are the benefits of a Nerve root injection?
70% of patient will have significant benefit from a nerve root injection for neck pain. But the duration of this pain control varies between a few weeks to a few months. Sometimes the pain relief can last for a year. The disc swelling will reduce naturally due to your increase in mobility and activity. However, there is an increased risk of having a further episode of neck and arm pain.
REPEAT INJECTIONS: If the initial nerve root injection was helpful in controlling your arm and neck pain, you will be offered a repeat injection.
How many nerve root injections can you have?
Most experts recommend not more than 2 injections over a 12-month period. There are concerns about the adverse side effects of repeated steroid injections on the nerve root and on your metabolism. There is a very small risk of diabetes, raised blood pressure, decreased immunity, recurrent infections and weight gain.
What are the risks and complications of Nerve root injection?
This is rare but there is an increased risk in skin conditions like psoriasis or eczema.
There is very little chance that you will bleed from a tiny puncture wound with a needle. But there is an increased risk of bleeding if you are taking medications to ‘thin your blood’ like warfarin, rivaroxaban or clopidogrel. You will be advised to stop these medications at least a week in advance of the procedure for safety.
WORSENING OF SYMPTOMS
Occasionally, the needle can touch the nerve root. This can cause your symptom to worsen like pins and needles down the arm, increased area of numbness and occasionally weakness of
ALLERGIC REACTION TO THE CONTRAST DYE
In rare instances, you may be allergic to the dye that is used to check the exact needle position. People who are allergic to seafood are found to be more prone to this reaction. These include skin rash, itching and flushing of the face.
This is a temporary side effect from the steroid injection and settles down very quickly.
RISE IN BLOOD SUGAR
In people with diabetes or at risk of diabetes, their blood sugar is found to rise immediately after the caudal epidural injection. This will settle after a few days without treatment.
When can I get back to work?
You are advised to take the next day off work as you had an intravenous sedation. If your neck pain persists or is worse, you may need a few days off work. Usually, it can take several weeks before you feel the full benefit of the injection. There are no limitations for work if your pain settles after a day.
When is my follow up appointment?
This is booked in 4 weeks after the injection. It allows you to explain the progress of you neck and arm pain to Mr Rajesh and he may arrange physiotherapy to build on the gains from the injection. Repeat injections or possible the need for surgery only if necessary, can be discussed.