Treatment: Dorsal Root Ganglion Block / Transforaminal Epidural

Why you might need?

You have an inflamed nerve root in your back usually caused by irritation from a bulging ‘intervertebral’ disc, or perhaps a facet joint. This causes pain running down from your back and into your arm or leg depending on whether the disc is in your neck or low back. Sometimes it is possible that a single nerve may be damaged in some way without any disc inflammation.

Treatment Preparation

Your consultant will provide you with all the relevant information before your procedure along with any preparation you may need to do in the days leading up to your surgery. It is important to tell your consultant about any medicines you may be taking, including any over the counter pain medicines such as paracetamol or aspirin.

You may need radiological (imaging) tests before your procedure, including ultrasound, x-ray or an MRI scan.

Do not eat (this includes chewing gum) or drink for 6 hours before you are due to have surgery otherwise your surgery may be delayed or rescheduled.

Please ensure you have a competent adult available to take you home after you leave OneWelbeck Orthopaedics.

Treatment Risks

Common complications

A DRGB/TFE is a very commonly performed procedure but as with all medical procedures there are some risks. Complications that are minor and occur quite frequently include:

• Bruising of the skin and under the surface.
• A fall in the blood pressure. This can easily be corrected by putting up a drip and giving fluid to the patient, or giving specific drugs.
• Feelings of nausea or sickness. These can be treated with anti-sickness drugs.
• Mild to moderate discomfort. This can normally be treated by giving small doses of painkillers into the drip.
• A feeling of heaviness and difficulty in moving the legs, this very occasionally happens, but wears off over a few hours. In a tiny minority of cases you may need to be kept in hospital overnight.

Rare complications

• If the DRGB/TFE is performed in the low lumbar spine, then difficulty passing urine may occur. Rarely, the nerves that control the bladder may stop working for a few hours. Again this normally goes away after a few hours. When this happens a small number of people will need to have a tube passed into the bladder to drain off the urine. The bladder does recover in a short time and there is no permanent damage.
• Severe headache. If the needle causes a leak of the fluid around the spinal cord a severe headache can result. The chances of this happening are about 1 in 5,000. The headache would mean that you stay in hospital for treatment for perhaps several days. There are usually no long lasting problems from this.
• It is possible that all or part of the injection may accidentally go into a vein. If this happens you may feel dizzy, light-headed, sick or faint.
• Difficulty breathing. Sometimes the epidural block solution can enter the fluid around the spinal cord and affect the nerves that supply breathing. This is rare and injecting dye first, to ensure correct needle position usually prevents this from happening. Stopping the epidural and sitting the patient up is normally all that is needed to sort this problem out. During this time extra oxygen may be given to you by a mask.
• A blood clot can form in the spinal canal, due to a puncture of a vein. Extremely uncommon. However this may need to be surgically removed.
• Infection. It is extremely uncommon but sometimes an abscess may form in the spinal canal, which may need an operation to remove it.
• Pain. Sometimes patients complain of worsening of their pain, or a new pain. It is difficult to explain this as there is rarely anything new to find on examination.
• You may suffer an allergic reaction to any of the medications.
• Nerve damage and weakness.
• The injected steroid or cortisone may cause disturbance of other body hormones.

What will happen during my procedure?

An anaesthetist will discuss with you the type of sedation used and the process they will follow. This procedure will not require a full general anaesthetic (GA). However, a local anaesthetic (LA) technique enhanced with intravenous pain relief and sedation will be employed where appropriate. You will be given the opportunity to ask any questions and raise any concerns you may have with the anaesthetist.

Once in the theatre suite you will be connected to some monitoring equipment to measure your heart rate, blood pressure and the oxygen content of your blood. A needle or ‘drip’ will be placed in a vein, usually in the back of the hand. Then you will be asked to lie down on the operating table. Being in a comfortable position is very important when this procedure is done.

When this is achieved your skin will be cleaned with antiseptic solution, some local anaesthetic will be introduced into the skin. When the skin has gone numb a needle will be introduced through the skin very slowly and carefully. Once the needle is in the correct place, a single dose of medication will be injected and then the needle will be removed.

When the injections are completed, you will then be positioned in a way to make you as comfortable as possible.

Treatment Recovery

After your procedure, you will be carefully supervised by your dedicated nurse at OneWelbeck Orthopaedics. Once you have seen your Consultant you will be able to go home the same day. It is important to rest to allow the best chance of healing.

Make sure you follow any advice given to you by your consultant including any advice on pain relief and any exercises you may be given.