Selective Nerve Root Blocks / Transforaminal Epidural Steroid Injection
A selective nerve root block or transforaminal epidural steroid injection is a variation of the traditional midline epidural steroid injection. The spinal nerve roots exit the spine laterally or from the side. Based on your medical history, a physical exam, and MRI findings, often a specific inflamed nerve root can be identified. Steroid can then be placed within that specific nerve root sheath to relieve pain. Local anesthetic is commonly injected along with steroid to confirm the identity of the injured nerve. If dramatic pain relief occurs soon after the procedure, you and your physician can be confident that the injected level is the source of your pain. The duration of action of the local anesthetic is usually only a few hours, but the steroid that was injected along with the local anesthetic will ultimately provide more long-lasting relief. A selective nerve root block/transforaminal epidural steroid injection is similar to a traditional epidural steroid injection in that it can accelerate the healing process and facilitate a return to work or previous activities. In order to achieve maximum effect, often repeated injections are needed.
Side effects of Selective Nerve Root Blocks/Transforaminal Epidural Steroid Injections are rare and your physician will discuss them with you. You will be asked to sign a written consent prior to the procedure. Please make sure you fully understand the risks and benefits of any procedure prior to signing the consent form.
Selective nerve root blocks, as with most other procedures, are performed in our in-office fluoroscopy suite. X-ray is used for nearly all injections. Intravenous sedation is typically not offered but a mild oral sedative may be offered, depending on your medical condition.
You will not be able to drive following this procedure, so please make arrangements for transportation. You may resume normal activities the day after the procedure, unless otherwise directed by your physician. It may take a week or more for you to feel relief. Typically a follow-up evaluation is scheduled two weeks from the date of the procedure, so that you can discuss your response to the injection with your physician.
Selective nerve root blocks/transforaminal epidural steroid injections are an increasingly common way to relieve pain due to a specific nerve root. This procedure can also assist in identifying the source of your pain. Please contact our office if you have additional questions regarding this procedure.
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Side effects of Epidural Steroid Injections
Side effects are rare, but fluid retention, insomnia, elevated blood sugar, bleeding, and infection have occurred. These side effects usually occur on patients taking strong anti-coagulants or blood thinners, or those with a high fever or an active infection. Diabetic patients will need to monitor their blood sugar before and after the procedure as steroid can cause blood sugar to rise. As long as a diabetic patient’s blood sugar is normal before the procedure and monitored after the procedure, the risk of a dangerously high blood sugar is low. During a selective nerve root block, a patient may feel pressure or sharp pain that radiates down the leg or arm. This pain is transient but can be significant. Other less common risks include increased pain, kidney failure, bowel or bladder dysfunction, paralysis, and death. Your physician should be notified if you are taking medications such as Coumadin, Plavix, Ticlid, Lovenox, Aggrenox, Insulin, or Metformin. Your physician should also be made aware of any allergies you have, especially if you are allergic to iodine or contrast. Notify your physician immediately if you have concerns about your condition after the procedure.
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