Nerve Root Injection: What You Need To Know

Introduction

At Complete we offer ultrasound-guided cervical (neck) and lumbar (lower back) nerve root injections in a central London GP practice.

Our ultrasound-guided injections are affordable and offer easy access. You can book your appointment directly without needing a referral, allowing for quick and straightforward treatment

It is essential that patients are provided with all the necessary information about nerve root injections before booking, ensuring they can make an informed decision.

What is a nerve root?

The nerve root is the part of a nerve that branches out from the spinal cord, extending to different areas of the body. These roots run along the entire length of the spinal cord, navigating through the spinal column, vertebrae, intervertebral discs, facet joints, and surrounding ligaments and muscles on their way to their target areas in the arms or legs.

If the spine or discs become injured or begin to go through degenerative changes (which often happens as we get older), these nerve roots can become damaged or irritated. This can lead to significant pain not only at the site of the nerve root but also in the areas that the nerve serves,

such as the arm or leg. In such cases, a nerve root injection can be an effective treatment, helping to relieve the associated pain.

What is a nerve root injection?

A nerve root injection is used to both diagnose and treat an inflamed spinal nerve in your lower back (lumbar) or neck (cervical).

The nerve root block injection administers medication, typically an anaesthetic and corticosteroid (also known as steroids or cortisone) along the affected spinal nerve root and into the epidural space at the site of pain and irritation. The use of local anaesthetics and steroids can significantly reduce the nerve root inflammation, significantly reducing the pain signals being transmitted by the nerve. It can also increase blood flow in the area leading to tissue healing.

Why would I need a nerve root injection?

Nerve root injections are used when a specific nerve in your lower back or neck is irritated or inflamed. These injections can help alleviate symptoms such as buttock pain, leg pain, arm or hand pain, changes in sensation, or feelings of weakness.

These are the most common conditions treated with a nerve root injection:

• “Sciatica”
• Herniated disc (disc bulge)
• Bone spurs
• Scoliosis
• Inflamed nerve root
• Disc degeneration
• foraminal stenosis

For the best results, injections should be combined with a completed course of physiotherapy and ongoing physiotherapy treatment to support your recovery

What is in the injection?

Your injection will consist of a local anaesthetic and a corticosteroid. The local anaesthetic provides short-term pain relief, while the corticosteroid works to reduce inflammation for longer-term pain relief. It’s important to note that the effectiveness of these injections varies from person to person depending on the severity and type of your condition or injury.

What are corticosteroids?

Corticosteroids are anti-inflammatory medications used to treat a variety of musculoskeletal conditions. When injected into the spine they can reduce pain, inflammation and swelling around a nerve. They are different from anabolic steroids, which are used illegally to build muscle mass.

The procedure: what to expect from an ultrasound guided spinal injection

Before your injection, you’ll need to fill out a medical screening and consent form which will ask you about any medical conditions that you have and any medication that you’re taking.

It’s crucial that you fill this out in full to ensure that it is safe for you to receive this treatment. There may be certain instances when it might be that we need to postpone your injection or get approval from your GP first, such as if you have a heart condition or unstable blood sugar levels due to diabetes.

Important Information

• The procedure is done as a day case in an outpatient GP setting.
• You must have someone who is able to accompany you home following the procedure.
• You should not drive for 24 hours following the injection.
• You can eat and drink as normal before the procedure
• You should take your usual medications, however please advise us if you are diabetic or are on anticoagulants (blood thinning medication).
• You will need to have had an up to date MRI scan of your back before your injection to help determine the exact cause of your pain and which area needs to be targeted with the injection..

What Areas are Injected?

The injection targets the space around the affected nerve on one side of your lower back or neck as it exits the spinal cord. This area is accessed through the lower back or neck using ultrasound guidance to ensure accurate positioning of the needle.

Multiple nerve blocks at different levels of the spine may be performed if more than one nerve is suspected of causing pain.

In certain cases, nerve root injection may be combined with other types of injections to target other spinal structures and achieve the best outcome for the patient, such as facet joint injections  or caudal epidural .

How is the injection carried out?

The appointment will take approximately 30-45 minutes. You will be positioned face down or in a side lying position with the area being treated exposed. The procedure starts with cleaning the skin with antiseptic. Firstly, the doctor will perform an ultrasound scan to accurately locate the area to be injected. Then, under ultrasound guidance, a needle will be gently inserted into the area around the nerve root, and the solution will be injected. The injection area is then recleaned and a dressing applied to the site.

Why Ultrasound-Guided?

Ultrasound guidance allows your doctor to visualise the injection site. There are anatomical variations in every patient, therefore using ultrasound ensures precise needle placement. This enhances the accuracy, effectiveness and safety of the procedure.

Research by Haemi Jee et al 2013 suggests that ultrasound guided nerve root injections were equally as effective as the more traditional, fluoroscopy (x-ray) guided. The advantage of ultrasound guidance is that it can be performed in an outpatient setting and uses sound waves, not radiation, to produce the image, making it safer for the patient.

Is the Injection Painful?

While the injection may cause some discomfort, this usually subsides quickly. It’s common to experience some soreness around the injection site for a few days afterward, and your doctor will provide guidance on how to manage it.

The use of a local anaesthetic during the procedure helps to minimise pain, though you might feel some pressure or a mild burning sensation as the medication is injected.

Approximately one in four people may experience a temporary increase in pain, known as a post-injection flare, within the first 24 to 48 hours after the injection. However, any discomfort typically resolves within a couple of days. You can alleviate this with simple painkillers like paracetamol and by applying a cold compress to the area.

After the Injection: Recovery

We will supply you with a full report after the procedure which we suggest you forward to your GP to add to your medical records. You may also wish to share this with any other healthcare professionals that you are working with as part of your recovery such as your Consultant, Physiotherapist or Osteopath.

What happens after the procedure?

After the injection, you will be advised to rest in the waiting area for 20-30 minutes before leaving the clinic.

If your injection included a local anaesthetic, you may feel pain relief within minutes, but this usually wears off after a few hours. You might also have some soreness at the injection site, which should go away within a few days.

The steroid typically starts working within a few days to a week, but in some cases, it can take up to 2-3 weeks to feel the full effect.

Most patients can return to normal activities after a few days. However, it’s best to take it easy on the day of the procedure and avoid strenuous exercise for about two days.

Your doctor will provide you with any specific instructions on post-procedure care and how to recognise signs of complications.

How many injections will I need?

If the injection provides good pain relief, and other treatments aren’t suitable or haven’t worked, you might benefit from having a repeat injection should your symptoms return in the future. However, injections are typically used to give you a chance to focus on exercise and rehabilitation. As your pain becomes better managed, the need for injections should decrease.

Guidelines recommend limiting steroid injections to a maximum of three in the same area within a 12-month period.

What are the benefits of a nerve root injection?

Research has shown that over 50% of patients who receive a nerve root block injection at an early stage may not require further procedures.

The main benefits of a nerve root injection include:

• Significant temporary or long-term relief of back and nerve root pain.
• Improved activity level and quality of life
• Breaking the pain cycle allowing you to take a more active part in your rehabilitation
• Clarity on your diagnosis – if your pain subsides you will know that this was the specific cause of your symptoms
• A reduced need for surgery

Are there any reasons I can’t have a nerve root injection?

We take a full medical history and assess each patient individually prior to carrying out an ultrasound guided spinal injection. Below is a list of factors that may prevent you from receiving a nerve root injection.

• Infection in any part of the body, including the site of injection
• Tumours or cancer
• Bleeding disorders
• Uncontrolled diabetes
• Heart problems, such as congestive heart failure
• Pregnancy or breastfeeding mothers
• Osteoporosis
• Known allergy to steroid medication or anaesthetic

We will ask you to fill out the patient consent form, and if we have any concerns, we can discuss them with you before making the booking.

What are the risks?

Nerve root injections are generally very safe, and most people have nerve root injections without any significant side effects. However there are potential risks with any medical treatment or procedure.

Potential Side Effects:

• Local tenderness, bleeding and bruising at the site of the injection
• Weakness, tingling or numbness in limbs for a few hours to days
• Vasovagal episode (fainting)
• A temporary increase in pain for a few days.

Rare But More Serious Side Effects:

Infection

Very occasionally, the area where the injection was given may become infected. Or In rare cases (about 1 in 50,000) a joint or tissue structure inside the body can become infected.

If the area becomes more painful, hot, red, and swollen, seek medical attention immediately. Other signs of infection include feeling generally unwell, such as having a fever or nausea.

Spinal disc infections (discitis) are very rare but are considered a medical emergency and require immediate treatment.

Anaphylaxis

Allergic reactions to steroids or local anaesthetics are extremely rare (about 1 in 500,000). If a reaction occurs, it usually happens within minutes and needs immediate medical attention. Symptoms can include feeling lightheaded, breathing difficulties, fast heartbeat, clammy skin, confusion, or fainting. You’ll be asked to stay in the clinic for 20 minutes after the injection to monitor for any reactions.

Spinal Headache

Headaches after nerve root injections are uncommon (less than 1%). They occur if the needle accidentally punctures the dura. This is more common in other types of epidurals, like those used during labour, which are not performed at our clinic. These headaches are usually mild and go away on their own within 1-2 weeks.

Nerve Root Damage

Injuring the spinal nerve roots during injections is very rare. The procedure targets the area around the nerves, and the risk of directly hitting a nerve is very low. If nerve injury happens, it’s usually mild and temporary, causing pain or tingling that resolves within a few days (maximum 7-8 days). Permanent nerve damage is extremely rare, with a rate of about 1 in 50,000.

Spinal Cord Damage

Spinal injections don’t target the spinal cord directly, so the risk of spinal cord damage is very low. However, spinal cord injury can occur indirectly due to chemical irritation, bleeding (blood clot), or reduced blood flow. The rate of spinal cord injury is estimated at around 1 in 150,000.

Worsening Pain or Paralysis

In extremely rare cases, spinal injections can lead to a worsening of pain or even paralysis. This may be due to complications after an infection, such as arachnoiditis. The rate of these complications is very low, estimated between 1 in 50,000 to 1 in 150,000.

Summary Of Risks

More Common (<10%):

• Mild bruising or bleeding at the injection site.
• Temporary changes in sensation or weakness in the affected leg or arm.
• Vasovagal reaction causing dizziness or fainting (resolves within 15-30 minutes).
• No effective pain relief.
• Steroid flare – increased pain for a few days post-injection.

Rare (<1%):

• Severe allergic reaction (anaphylaxis).
• Headache.
• Nerve injury.
• Infection.
• Facial flushing.
• Skin discoloration or fat atrophy at the injection site.
• Elevated blood sugar levels in diabetics for 1-2 weeks.
• Irregular menstrual cycle for 1-2 months.

Extremely Rare (<0.1%):

• Permanent worsening of pain.
• Paralysis.
• Cauda equina syndrome.
• Blindness.
• Hiccups.

Your doctor will take all necessary precautions to minimise these risks and will discuss them with you.

How to contact us

If you have any questions regarding the information contained in this leaflet, please call 02074823875 or email injections@complete-physio.co.uk and we will arrange for one of our clinical specialists to speak with you.

Frequently Asked Questions (FAQs)

1. What is a nerve root, and why is it important?

• Answer: A nerve root is the part of a nerve that extends from the spinal cord to different areas of the body. If the nerve root becomes irritated or damaged due to injury or degeneration of the spine, it can cause pain in the back, neck, arms, or legs. Nerve root injections can help alleviate this pain.

2. What is a nerve root injection, and how does it work?

• Answer: A nerve root injection involves injecting a mixture of local anaesthetic and corticosteroid near the affected nerve root to reduce inflammation and pain. This can help both diagnose and treat pain caused by irritated or inflamed spinal nerves.

3. Why might I need a nerve root injection?

• Answer: You may need a nerve root injection if you experience pain, changes in sensation, or weakness in your arms, legs, neck, or lower back due to conditions like sciatica, herniated discs, or spinal stenosis. It’s often used when other treatments have not provided sufficient relief.

4. What is included in the nerve root injection?

• Answer: The injection typically includes a local anaesthetic for immediate pain relief and a corticosteroid to reduce inflammation for longer-term relief. The effectiveness varies depending on the severity and type of your condition.

5. What are corticosteroids, and how are they different from anabolic steroids?

• Answer: Corticosteroids are anti-inflammatory medications used to reduce pain and swelling around a nerve. They are not the same as anabolic steroids, which are used illegally to build muscle mass. Corticosteroids help manage musculoskeletal conditions safely.

6. What should I expect during the procedure?

• Answer: Your appointment is 30-45 minutes. The actual procedure takes less than 5 minutes, but this does depend on the number and type of injection being performed. You’ll be positioned comfortably while the area to be treated is cleaned with antiseptic. Using ultrasound guidance, a needle is carefully inserted near the nerve root, and the medication is injected. You’ll need to wait in our waiting area for 20-30 minutes after the procedure.

7. Is the nerve root injection painful?

• Answer: You might feel some discomfort during the injection, but it usually subsides quickly. Some soreness around the injection site is common for a few days after the procedure. Your doctor will provide advice on managing any discomfort.

8. What are the potential risks and side effects of a nerve root injection?

• Answer: Common side effects include mild bruising, temporary changes in sensation, and a temporary increase in pain (steroid flare). Rare but serious risks include infection, nerve damage, and allergic reactions. However, these complications are very uncommon.

9. How should I prepare for the nerve root injection?

• Answer: Before your injection, you’ll need to complete a medical screening and consent form. Make sure to inform the clinic if you have any medical conditions, such as unstable blood pressure, diabetes, or if you’re on blood thinners. You’ll also need an up-to-date MRI scan of your back.

10. Do I need an MRI before I have a nerve root injection?

• Answer: Yes, ideally you need to have had an MRI scan within the last 6 months. If your symptoms have changed or worsened since you last had one, we may ask you to have another up to date MRI. We can organise this for you if it is required prior to the injection appointment.

11. Do I need to have an X-Ray before I have a nerve root injection?

• Answer: No, an X-Ray is nor required, however you will need to have an up to date MRI – ideally within the last 6 months.

12. Will I need another injection in the future?

Answer: If the injection provides significant relief and other treatments aren’t effective, you may benefit from another injection if symptoms return. However, injections are typically limited to three per year in the same area to prevent overuse.

13. What are the benefits of a nerve root injection?

• Answer: Benefits include significant temporary or long-term pain relief, improved activity levels, and better quality of life. Nerve root injections can also clarify your diagnosis and reduce the need for surgery by breaking the pain cycle and aiding rehabilitation.

14. Are there any conditions that would prevent me from having a nerve root injection?

• Answer: Yes, certain conditions may prevent us from being able to carry out an ultrasound guided injection to the spine. For example, infections, tumours, bleeding disorders, uncontrolled diabetes, heart problems, pregnancy, or known allergies to the medications used can contraindicate the procedure. Your doctor will assess your suitability before proceeding.