Nerve Root Injections, Epidurals and Facet Joint Injections
Nerve root injections and epidurals are used to treat pain originating from nerves and discs within the spine, and facet joint injections can settle pain coming from these small spinal joints. This can include pain coming anywhere from the cervical spine (neck) to the coccyx (tail bone); pain associated with spinal arthritis, and pain associated with nerve compression and irritation due to herniated discs and spinal stenosis, such as sciatica and low back pain. They can also be used to treat arm pain associated with stenosis or disc herniations within the cervical spine (neck).
Nerve root injections are essentially the same as nerve block injections but are targeted specifically at certain nerve roots. The injections typically contain a mix of local anaesthetic and depot cortico-steroid (steroid) and work by temporarily reducing inflammation and pain signals in the nerves being treated.
This means nerve root injections aren’t suitable for all types of pain and are generally only used if diagnostic tests, such as MRI scans, have identified a probable underlying cause that’s likely to respond well to the treatment. However, they can also be used to help determine the root cause of pain when other tests haven’t been conclusive. If the injection is effective, this can indicate which further treatments may be suitable for longer term management of the patient’s pain.
Nerve root injections are usually administered by a specialist consultant in an operating theatre. You’ll be asked to change into a surgical gown, and your consultant will talk you through what’s going to happen beforehand. X-ray or ultrasound will be used to help guide the injection into the correct location, and local anaesthetic is applied first to numb the area. Sedation is usually also used in order to make the procedure more comfortable. This will be administered by an anaesthetist and means that, while you won’t be asleep, you’ll be more relaxed during the procedure.
Afterwards, you may be groggy and will be monitored briefly before you go home. You won’t be able to drive for at least 24 hours, until the sedative has completely worn off, so you will need somebody to accompany you home. There may be some bruising and soreness at the site of the injection, but this should settle within a few days. In more rare cases, there may be some temporary weakness or floppiness in the limbs linked with the nerves being treated. Your consultant will be able to discuss side-effects with you and how to manage these.
Nerve root injections are not always 100% effective and the results aren’t always immediate. However, many people experience very significant improvements that can last anything from a number of days to many months.