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LUMBAR NERVE ROOT
BLOCK
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NERVE BLOCK Your
doctor has referred you to the radiology department for a nerve
block. This is
performed by inserting a needle under fluoroscopy down to the region
of the spine through which the nerve exits (the neural
foramen).
Anti-inflammatory steroid (currently methylprednisolone) and
local anesthetic (Xylocaine) is injected. During the injection there
will be pain in the hip and leg, sometimes severe, (typically in the location
of the pain for which the procedure is being performed). Following the injection it
is common to note temporary leg numbness and varying degrees of leg
weakness. The
anesthetic is the same material your dentist uses, and the
anesthesia will persist 1 to 3 hours (as does oral numbness from
dental procedures).
Because of the risk of falling we want you to walk only with
assistance until the numbness and weakness clears. Furthermore, you should not
attempt to drive your car until the leg returns to normal. Some patients note crampy
discomfort in the leg following the procedure lasting 1 to 3 hours
(rarely as long as 5 hours); this is an effect of the steroid
preparation injected.
You may take your usual pain reliever for this if you
wish. This is
not a spinal or epidural injection; there is no risk
of spinal headache or spinal anesthesia. We
have not encountered any complications of this procedure over the
past 14 years. If there
is any persistent numbness, weakness, or pain beyond 5 hours, you
should consult your referring physician as a
precaution. Likewise,
you should consult your doctor if there is any question of infection
(fever, chills or local redness, swelling, pain) over the 2 to 3
weeks following the procedure; we have not had any infections to
date. There
may be immediate relief of symptoms due to the local anesthesia, but
this will be temporary (you should inform your doctor if such relief
occurs because it is helpful for diagnosis). Longer lasting or permanent
relief which may result from the steroid injected can take from 3
days to 2 weeks. The
procedure takes approximately 15 minutes, and we will observe you
for 10 additional minutes to determine whether you will be able to
walk to your car or will need a wheelchair (to avoid falling during
the period of leg numbness and weakness). Someone who can drive you home and help you from the car to your dwelling must accompany you. If
you are diabetic, you may have an increase in blood sugar for
several days following this procedure; please discuss this with the
physician treating your diabetes. Please notify us if you are
allergic to Betadine (an iodine solution used to cleanse the skin),
Xylocaine (Lidocaine) or steroid. We do not inject steroid in
patients with active infections (viral, bacterial, tuberculous,
etc.); please call if there is any question in this regard or if you
have any other questions:
(617) 754-5287.
DISCOGRAM Your
doctor has referred you to the Radiology Department for a
discogram. A discogram
is a radiographic and provocative diagnostic test for a patient who
has pain emanating from a degenerative or internally disrupted
lumbar disc. It is not
meant to give a determination as to whether a disc is bulging or
herniated. Patients
with lots of ongoing low-back pain may have a degenerative or
internally disrupted disc.
Discography is meant to give the physician a better idea as
to whether or not the source of pain is coming from this type of
pathology within the lumbar disc. Discography
is performed by placing a needle into the disc itself with injection
of dye. A CT Scan is
performed to confirm radiographically whether or not there is a
disruption within the disc itself. In addition to the injection
of dye and in addition to a positive radiographic test, the patient
must, without him knowing it, give a concordant pain response. If there is both objective
evidence or disc disruption and subjective evidence of concordant
pain response, the discogram then is positive. With
a positive discogram, a procedure such as an anterior interbody
fusion or a posterior interbody fusion can be performed to remove
the disc. The disc
space is then filled with bone graft for
stability. If
the discogram is negative; that is, either the objective radiograph
is negative or there is no concordant pain response, then it is well
known that the region of the lumbar spine, which was tested, is not
implicated in the patient’s pain pattern.
WHAT IS A MYELOGRAM?
The spinal cord and nerves which branch off to various areas of the body (arms, legs, trunk) are enclosed within the spinal column, a bony covering made up of many segments called vertebrae. The spinal cord and nerves are contained in a long sac within the spinal column and are bathed in a watery fluid like salt water called cerebrospinal fluid. When there is pressure upon the spinal cord or nerves, their ability to provide normal movement and feeling is affected. The pressure may come from bone slippage (spondylolisthesis), disc rupture, bony overgrowth due to arthritis, or tumors. A myelogram is performed to determine the cause of
pressure on the spinal cord or nerves and, if possible, at which
vertebral level. A
myelogram consists of introducing a contrast material (dye) into the
spinal canal, which can be seen on
x-rays. Preparation:
Liquids should
be taken liberally (in large quantities) before and after the
procedure. During the
Procedure: You will be asked to wear a hospital gown. The procedure is performed while lying on your stomach. A small area of skin on the lower back will be washed with betadine soap, a dark orange liquid that will kill bacteria on the skin surface. The area will be covered with sterile drapes. The area is then numbed by injecting local anesthetic. A thin spinal needle is then passed through a relatively wide space between the bones of the spinal column and slowly advanced. The contrast material (dye) is then carefully injected. Upon completion of the injection, the spinal needle is removed. The contrast dye is moved by gravity to the area to be studied by tilting the table and asking you to turn. The radiologist positions you, then obtains x-rays of the area to be studied. Several x-rays are made in this manner until the area is well studied. The total procedure takes about 30 minutes. You will stay in the hospital for four (4) hours following the procedure.
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