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Selective Nerve Root Block for the Treatment of Radiculopathy ( Sciatica )
Your spine is made up of 24 movable bony blocks called vertebrae that are stacked one on top of another . Each vertebra is separated and cushioned by an intervertebral disc composed of a gel-like material . With the normal aging process , the discs will lose their firmness and become degenerated . Degenerated discs can also weaken where they will bulge or herniate . Bone spurs , also called osteophytes , can develop with a degenerated disc . The spinal cord runs through a canal in the center of these bones . Nerve roots split from the spinal cord and exit between the vertebrae to various areas of your body such as your arms and legs . When these nerve roots become irritated , pinched or injured , the resulting symptoms are called radiculopathy . Radiculopathy is most commonly seen in the cervical ( neck ) and lumbar ( low-back ) spine . A radiculopathy of the lumbar spine is commonly referred to as sciatica .
Symptoms of Radiculopathy
When a nerve root is compressed , it becomes swollen and inflamed . This results in unpleasant symptoms such as sharp and shock-like
sensations into the arms and / or legs . Patients often complain of numbness , burning , and a “ pins and needles ” sensation in the upper or lower extremities . In severe cases , weakness can result .
Causes of Radiculopathy
1 . Disc pathology : spinal discs can herniate , bulge , or slip out to press on the nerve roots .
2 . Bony spurs : extra bone growth due to osteoarthritis , or other degenerative disease .
3 . Thickening of the spinal ligaments around where the nerve roots are leading to compression of the nerves
4 . Less common causes include infection , non-cancerous or cancerous mass
Diagnosis
Radiculopathy is typically diagnosed with a patient ’ s history , physical exam , or imaging studies such as X-ray , CT scan , and MRI . An EMG / nerve conduction study can also be helpful .
Treatments
1 . Conservative treatments like physical therapy , chiropractic care , and / or medications such as anti-inflammatories , acetaminophen , and muscle relaxers 2 . Selective nerve root block 3 . Surgery to reduce the pressure on the nerve root by widening the space where the nerve roots exit the spine . This may involve removing all or parts of a disc and / or vertebrae .
What is a selective nerve root block ?
It is a minimally invasive spine injection procedure used to diagnose and treat primarily low-back and neck pain associated with extremity pain . When a spinal nerve root becomes inflamed , or impinged , it can cause not only spine pain but also radiating pain into an extremity . Cervical ( neck ) nerve root compression can lead to radiating or shocklike pain from the neck into the arm or hand . Lumbar ( low-back ) nerve root compression will lead to radiating pain from the low back into the leg or foot . A nerve root block involves injecting a local anesthetic such as lidocaine with steroid onto the involved nerve root ( s ). This type of injection is used for two primary purposes : the first is to determine the etiology and location of the patient ’ s pain ; the second is to provide pain relief for the patient ’ s symptoms .
Talk to your pain management physician to see if a nerve root block is right for you .
This Industry Insight was written by Stephanie H . Le , MD . Dr . Le is an interventional pain management specialist who helps treat the source of her patients ’ pain using interventional spine injections and procedures , with the goal of returning them to the most functional lifestyle possible . Dr . Le is board certified in pain management and physical and rehabilitation medicine . She is a member of the International Spine Interventional Society , the American Society of Interventional Pain Physicians , and the American Medical Association .
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