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8 - Selective Nerve Root Blocks

from PART I - LOCOREGIONAL PAIN CONTROL

Published online by Cambridge University Press:  04 September 2009

By
Brian D. Peterson ,
Kirkland W. Davis  and
James Choi
Edited by
Charles E. Ray, Jr.
Charles E. Ray, Jr.
Affiliation:
Denver Health Medical Center
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Summary

INTRODUCTION

Flouroscopically directed selective nerve root blocks (SNRBs) were initially described by Macnab in patients with “negative disc exploration” (1). Macnab described needle tip position, reproduction of radicular pain, confirmation of placement with injection of contrast to produce a neurogram, and anesthetization of the affected nerve with lidocaine. The technique has not changed significantly since 1971.

The utility of an SNRB is reflected in the name. It should be selective and, as such, tends to have significant diagnostic and prognostic power in evaluating patients with unclear radicular etiologies. The injection, when combined with a steroid, can be therapeutic as well. In the lumbar spine, if therapeutic benefit is the goal, a transforaminal epidural steroid injection is of more utility with more volume able to be delivered to the affected level with reflux into the epidural space.

In our clinical practice, lumbar SNRBs are performed in order to pinpoint the affected levels in patients with unclear clinical symptoms or discordant symptoms that are discordant with the magnetic resonance images (MRI). It has also been shown to have significant prognostic importance in identifying the level for surgical intervention and in identifying those patients who will benefit from surgery (2,3). Cervical selective nerve root blocks (CNRB) are performed under similar clinical circumstances. Thoracic SNRBs are rarely performed but can have important diagnostic and therapeutic utility in uncommon clinical settings.

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Chapter
Information
Pain Management in Interventional Radiology , pp. 112 - 130
Publisher: Cambridge University Press
Print publication year: 2008

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References

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