Selective Cervical Nerve Root Block: Duality of Pain Diagnosis and Treatment

Creator: Krupamol Joy
Published: 2023-02-28T14:58:59

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This article elaborates on how imaging procedures guide selective cervical nerve root block that diagnoses and treats pain due to nerve compressions.

Written by

Krupamol Joy

Medically reviewed by

Dr. Kaushal Bhavsar

February 28, 2023

March 13, 2023

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Contents

What Is Selective Cervical Nerve Root Block?
How Can SCNRB Help with Pain Management?
How Is SCNRB With Imaging Carried Out?
What Are the Post-Procedure Considerations?
How Does Imaging Guidance Help With the Accuracy of SCNRB?
What Are the Benefits of Using SCNRB With Imaging Guidance?

What Is Selective Cervical Nerve Root Block?

Selective cervical nerve root block (SCNRB) identifies and treats various neck and arm pain conditions. In this procedure, during the treatment, a local anesthetic is injected, typically combined with a corticosteroid, into the region close to a particular cervical nerve root, which is a branch of the spinal cord in the neck.

The procedure aims to numb the nerve root and relieve swelling and discomfort. SCNRB is typically used to diagnose and treat conditions such as:

Radiculopathy (nerve root pain).
Cervical spinal stenosis (narrowing of the spinal canal in the neck).
A herniated disc in the neck and arm pain due to degenerative disc disease.

The procedure is minimally invasive and is usually performed in an outpatient setting under local or topical anesthesia. SCNRB can provide temporary relief from the pain and help diagnose the source of the pain. It should be noted that the procedure is not a cure for the underlying condition causing the pain, but it can be a useful tool in managing pain symptoms.

How Can SCNRB Help with Pain Management?

Selective cervical nerve root block (SCNRB) can help manage pain by reducing inflammation and numbing the affected nerve root. The injection of a local anesthetic and corticosteroid into the area near the affected nerve root helps to reduce pain by numbing the nerve and reducing inflammation.

SCNRB procedure can help with the diagnostic process by providing information about the source of the pain. For example, the nerve root may have been the cause of the pain if the patient receives significant pain relief following the surgery. This information can then inform the treatment plan and guide the choice of future interventions.

How Is SCNRB With Imaging Carried Out?

The procedure involves the injection of a local anesthetic and steroid medication into the area near a specific nerve root in the neck. The procedure is performed using imaging guidance to ensure the accurate placement of the needle and medication. The most common imaging modalities used for SCNRB are fluoroscopy and computed tomography (CT).

Fluoroscopy uses continuous X-ray imaging to guide the needle to the correct location. At the same time, CT guidance provides a 3D image of the cervical spine, which is used to plan the needle placement and to ensure that the needle is accurately placed in the correct location.

During the procedure, the patient lies face down on a table, and the neck is cleaned and numbed with a local anesthetic. The physician then uses the imaging guidance to carefully insert the needle into the targeted area and inject the medication. The patient may feel a brief stinging or burning sensation, but the procedure is generally well-tolerated. The procedure typically takes 30 minutes to an hour, and the patient is monitored for adverse reactions.

The effects of the nerve block can be immediately evaluated to determine if it provides pain relief, and the results can help the physician diagnose and determine the most appropriate course of treatment.

What Are the Post-Procedure Considerations?

Several measures should be taken to ensure a safe and smooth recovery. These include:

Rest: It is important to rest after the procedure to allow the body to recover and minimize the risk of complications.
Avoiding Certain Activities: Certain activities, such as heavy lifting, may be discouraged after the procedure to minimize the risk of complications and allow for a full recovery.
Follow-up Appointments: Regular follow-up appointments with your doctor will be necessary to monitor your progress and ensure a successful procedure.

It is important to follow the doctor's instructions carefully and to report any symptoms or concerns to the doctor promptly.

How Does Imaging Guidance Help With the Accuracy of SCNRB?

Imaging techniques help with the accuracy of the SCNRB procedure in the following ways:

Scans can help improve the accuracy of selective cervical nerve root blocks by providing visual information about the anatomy of the neck and surrounding structures. This information is crucial for accurately identifying the cervical nerve roots and their location in other structures, such as the vertebral bodies, discs, and spinal cord.
By imaging guidance, physicians can identify the exact nerve root they want to target and ensure they inject the medication into the right area.
Imaging guidance also helps to reduce the risk of complications associated with SCNRB, such as infection, bleeding, or tissue damage.

MRI (magnetic resonance imaging) is particularly useful in this regard as it provides high-resolution images of the soft tissues in the neck, including the nerve roots and surrounding structures, without exposing the patient to ionizing radiation. CT (computed tomography) scans, on the other hand, provide detailed images of the bony anatomy, including the cervical vertebrae, and can help identify any bony anomalies that may impact the needle placement during the nerve root block procedure.

What Are the Benefits of Using SCNRB With Imaging Guidance?

There are several benefits to using this procedure, including the following:

Accurate Diagnosis: SCNRB, with imaging guidance, allows the medical professional to accurately identify the source of the patient's neck pain, which can help to determine the most effective treatment plan.
Pain Relief: SCNRB, with imaging guidance, can provide immediate pain relief for patients suffering from neck pain, as it targets the specific nerve root responsible for the pain.
Reduced Need for Surgery: By providing a minimally invasive and effective way to diagnose and treat neck pain, SCNRB, with imaging guidance, can help to reduce the need for more invasive and costly surgical procedures.
Faster Recovery: Patients who undergo SCNRB with imaging guidance typically experience a faster recovery time than those who undergo more invasive procedures, as the procedure is less traumatic and less painful.
Improved Function: By reducing neck pain, SCNRB, with imaging guidance, can help to improve the patient's overall function and quality of life.

Conclusion

Selective cervical nerve root block (SCNRB) with imaging guidance can provide significant benefits for patients suffering from neck pain, including accurate diagnosis, pain relief, reduced need for surgery, faster recovery, and improved function. This procedure, hence, has a profound role in improving the patient’s quality of life.

Frequently Asked Questions

1. What Are the Possible Adverse Effects Associated With Cervical Selective Nerve Root Block?

There are certain side effects precipitated by cervical selective nerve root block. Soreness at the injection point is often reported with cervical selective nerve root blocks. This procedure carries the risk of trauma to the blood vessels in the neck region, bleeding from the injection point, hypersensitivity (allergy) reactions, and infections. A sudden dip in blood pressure is also reported occasionally in association with cervical selective nerve root block.

2. How Do ESI (Epidural Steroid Injection) And Selective Nerve Root Block Differ From Each Other?

Though both procedures of their techniques are quite different from each other. In ESI, the medication is introduced superior to the dural layer covering the spinal cord, while in selective nerve root block, it is close to the nerve root. ESI affects an extended area, while selective nerve root tackles the pain associated with that particular spinal nerve.

3. What Is the Other Synonym for Selective Nerve Root Block?

The selective nerve root is also known by the name transforaminal epidural injection. It is employed to tackle pain by checking the conveyance of impulses for pain right at the root of the nerve. Here a combination of numbing agent and anti-inflammatory medicine is used, which provides added benefit in calming down the inflammatory changes in the nerve.

4. Is Cervical Nerve Block a Safer Method?

A cervical nerve block is considered to be a safer technique. However, the healthcare provider must be well-versed in doing a cervical nerve block. Inadequate experience and knowledge regarding the procedure can give rise to complications. Hence, getting the procedure done under an expert medical professional with sufficient practical training and exposure.

5. What Are the Complications Concerning Cervical Nerve Block?

Cervical nerve block does carry certain risks and complications. There are chances for puncturing and traumatizing the vertebral artery (blood vessel) while doing a cervical nerve block. Insult to the spinal cord is another risk that can have grave impacts on health. Irregularities in the menstrual cycle are also reported following cervical nerve block.

6. What Is the Estimated Average Duration of Action for Cervical Nerve Root Block?

The duration of action of nerve root block varies from individual to individual. There is no clear-cut duration. Studies have concluded that the effects and influence of cervical nerve root block wanes off in a few months. However, certain individuals reported the effects only for two or three weeks. Hence the duration of action is estimated to be within the range of a few weeks to a few months.

7. What Are the Two Different Categories of Central Nerve Block?

There are two specific categories of central nerve block - spinal block and epidural block. In the spinal block, the injection medicine is exposed directly into the cerebrospinal fluid (fluid enclosed within the spinal cord and brain) by means of injection. While in the epidural type of central nerve block, the injection is made to release the medicine superior to the dural layer (the layer that shields the spinal cord and brain).

8. Does Selective Nerve Root Block Hurts?

The person would not be feeling severe pain during injection. However, once the injection solution is introduced into the body, the person may experience a kind of pressure and tightness at the injection site rather than pain. Proper techniques and expertise of the doctor help in keeping the patient comfortable throughout the procedure.

9. How Long Does It Take a Person to Recover From the Effects of a Nerve Root Injection?

Nerve root injections do not demand prolonged rest and recovery periods. Most often, the person can return to their routine activity in a few hours following the injection. However, instructions are often given to withdraw from stressful activities within the first 24 hours. The person does not need to be bedridden all the time, but care should be taken not to inflict trauma on the site of needle penetration.

10. Why Is a Selective Nerve Root Block Advised?

Selective nerve root blocks are advised as an effective pain-rateg to tackle resistant and persisting pain in the neck or back. It is proven to be effective in alleviating the pain that is brought about by a single nerve. It also eases inflammation and pressure on the nerve, which provides great relief to the patient. The selective nature of the nerve block particularly blocks the signals from the severed and involved nerve, sparing the other nerves. In addition to its therapeutic application, it is also employed for diagnostic purposes.

11. What Is the Estimated Success Rate for a Nerve Root Block?

Nerve root block is estimated to have a 55 to 65 percent success rate in tackling nerve pain and associated discomfort. More than half of the patients given with specific nerve root block experienced considerable pain relief, while a smaller proportion reported no remarkable pain reduction even with nerve root block. Some patients who could not experience immediate relief later developed symptomatic relief after a few days.

12. How Effective Is a Cervical Nerve Block?

The cervical nerve block is a potent pain-relieving strategy. It has remarkable efficacy and potency in dealing with pain that stems from a nerve root. In addition to pain relieving, it also works well for calming down the inflammatory changes in the nerve that triggered the pain and discomfort. It is also employed for detecting the cause of certain pain, where other diagnostic tests fail to figure out the origin and cause.

13. What Are the Possible Concerns of Root Block?

Nerve root blocks pose certain challenges and complications. Since the medicine is shot at the close vicinity of the nerve root, at times, it may puncture or traumatize the nerve, giving rise to nerve injuries. The person experiences soreness and weakness at the injection point, often lasting for a few days. Sometimes, hematoma (bruising) may also become evident at the site.

14. Is It Possible to Clear Off Cervical Pain Permanently?

The answer to this question is based on the underlying condition that evokes cervical pain in an individual. Certain pathological conditions in the neck can be cured completely, while others need prolonged and chronic treatment. So only after identifying the hidden etiology behind the cervical pain the treatment strategy is designed. In addition to pain management, cervical pathologies are also dealt with by physical therapy. Surgical approaches must be initiated in more severe cases to achieve permanent relief.

Sources

Dr. Kaushal Bhavsar

Pulmonology (Asthma Doctors)

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