Spinal nerve root injection

Why do I need a nerve root injection?

A nerve root injection is done to help your consultant diagnose the cause for your leg or bottom pain, or as an attempt to treat it.

Do I need someone with me on the day of the injection?

A family member is allowed to be with you on the day and can come down to the theatre entrance. However, they cannot be with you in theatre during the injection.

If you are old enough to drive, you must not drive after the procedure so it is advisable to have someone to bring you and take you home that day.

Do I need to stop any medications before the injection?

If you are taking any medication to thin your blood such as Warfarin or Clopidogrel, please inform your consultant as you will need to stop taking these before the injection. If you are on Aspirin, you can continue to take this. Otherwise please take all your medication as normal.

Will I have an anaesthetic?

The procedure is done under local anaesthetic as a day case because this is the safest way to do the injection. You can eat and drink as normal before your procedure. You will come into hospital on the day of the injection.

For younger children, if you have discussed sedation with your consultant, then only drink clear fluids on the morning of your injection and do not eat any breakfast.

What do I need to bring with me?

Bring a dressing gown and comfortable shoes to walk to theatre in. You will be provided with a hospital gown and will keep your underwear on.

What happens when I get to the hospital?

You will normally be admitted to the theatre admissions unit (TAU). You will have some initial checks done by a nurse and will see your consultant. You will be taken to the operating theatre when it is time for your injection.

How is the nerve root injection done?

You will be helped onto a table lying on your tummy. Once you are comfortable in this position, the surgeon will prepare the equipment necessary to do the injection.

The surgeon will prepare the skin of your back with a cleaning solution.

Local anaesthetic will be placed in the skin and a needle will be guided down close to the nerve using the X-ray machine. It is important for you to inform the surgeon if you experience any leg pain during the needle insertion as this may indicate that the needle is close to the nerve and may need repositioning.

Once the surgeon is happy the needle is correctly placed, a dye will be injected to make sure the needle is in the correct position. This may reproduce the symptoms in your leg or bottom. When the surgeon is happy with the needle position, steroid and local anaesthetic will be injected and again may reproduce your leg or bottom pain. This is the end of the procedure.

A member of staff will sit and talk to you all the way through.

What if I might be pregnant?

For women of child bearing age, it is important you tell us if there is any chance you may be pregnant as we are using X-rays to guide the needle.

What happens afterwards?

You will be helped down and be taken back to TAU in a wheelchair. After a short time on the ward you will be allowed to go home and an appointment will be made to see your surgeon between 2 and 8 weeks after the injection.

The steroid is not absorbed into your blood and will not produce the side effects of long-term steroids taken by mouth.

How effective is it?

The injection improves the leg or bottom symptoms in 80 percent of cases and can start to work any time from immediately to 2 weeks after the procedure. It works for between a few hours and permanently with most patients getting between 6 weeks and 6 months of significant pain relief. 1 in 5 injections will give good pain relief for more than a year.

Worsening of the pain occurs for 1 out of 20 patients and usually only lasts a few days.

When can I go back to school?

In most cases you will be fine to return to school or work, and drive, the next day.

What are the risks of this procedure?

All invasive procedures have some risks and your consultant will discuss all these with you before the injection:

• infection happens in around 1 out of 2000 cases
• bleeding is rare, but bleeding around the nerve can compress the nerves and an urgent MRI scan may be needed with urgent open surgery if a collection of blood needs to be removed
• pain and weakness in around 1 out of 5000 cases
• tearing the lining of the nerve requiring a period of bed rest and possible further injection happens in around 1 out of 3000 cases
• a rise in blood sugar levels for a few days in those who have diabetes
• allergic reaction to the medication or contrast is rare
• vascular injury (damaging a blood vessel) is very rare

Please ask your consultant any questions you may have before agreeing to the injection.