Dorsal Root Ganglion Block

Cervical/Thoracic/Lumbar
If back or neck pain, upper or lower extremity pains or numbness, disc herniations or degenerative disc disease are your concern, and you have already obtained epidural steroid injections and are waiting for the healing process, you may be a candidate for a nerve block. Occasionally, one's pain will be so debilitating that I will complete the nerve block first, and then proceed with epidural steroid injections. The most common cause of back pain is due to problems of the disc between the bones of the lower back, and nerve root impingement, both of which are detectable with MRI (Magnetic Resonance Imaging). Disc problems can include either a herniated or a degenerated disc. Both can cause pain in either the neck or back, or any extremity may be isolated as well.

 

How does it work?
When the spinal nerves are being irritated, they produce pain symptoms that can travel from the back to the arms, head, trunk or legs. These pain pathways can be treated conservatively by injections around the nerves utilizing an epidural steroid injection (ESI). If after (or prior to) your epidural steroid injections you are suffering (it takes time for the nerves to heal), a treatment option is the DRG, or the Dorsal Root Ganglion block. The object of this procedure is to block the pain signal itself, done so by burning a tiny lesion on the surface of the offending nerve. This is done utilizing radiofrequency or dehydrated alcohol, at the physician's discretion. The procedure is completed in my office. You will be positioned on your stomach, and a small needle is placed into the offending area of your spine, where numbing medication is applied. You must remain awake throughout the procedure, as testing is done to identify the nerves that are causing your pain specifically. During this brief test you will feel a 'thumping' or 'ticking' sensation. Once identified, a tiny spot on the outer lining of the nerve is burned with radiofrequency or alcohol. This procedure blocks the pain signal that travels from the irritated nerve to your brain. It does NOT heal or correct your diagnosis. The entire procedure is completed under x-ray guidance, documenting the exact location of the block.

 

How long until I feel better?
The response to treatment varies from individual to individual. However, most patients usually obtain immediate relief of discomfort. Occasionally, the pain will return (but decreased) after a few hours, and this is not uncommon as the initial local anesthetic I used is wearing off at this time. Rest assured, use ice, and give yourself a few days to achieve true results. This is a safe, conservative procedure, and therefore it occasionally must be repeated. Because the lesion made on your nerve is so tiny, you may need another DRG to locate the appropriate portion of the nerve(s) responsible for your pain.

 

What are the risks?
Nerve blocks are a minimally invasive procedure; risks include infection and bleeding, increased pain, allergic reaction, hypotension, headache and nerve irritation at the site.

 

What is the recovery?
After your procedure we will keep you in our office recovery area, where your vital signs are monitored by licensed staff for the above listed adverse conditions. When nerve blocks are performed on your low back (lumbar spine) there is a good chance that the numbing medication will affect one of your legs, making it feel numb. This is anticipated, and we will not discharge you until the numbness wears off and you are able to ambulate safely. This varies from individual to individual, but on average the numbness wears off within thirty minutes to two hours. Most of our patients are able to leave the office and return to work or home, driving themselves and having no ill effects.

 

Post Procedure Instructions

After your procedure today, you should follow the instructions below.
Please read carefully. Your nurse will be available to answer any of your questions. The injection that you received contained local anesthesia and possibly some steroid medication. The steroid is to reduce any inflammation and pain; this is not the steroid that is used to build muscle. You may have some pain at the sight of the injection and in the area of your normal pain. This may last several hours to several days. You will not feel the full effect of your treatments for 3 months. During this time, your body will be attempting to return to a neutral position and the nerves will be healing as much as they possibly can.

 FOR ANY EMERGENCY CALL 911 OR GO STRAIGHT TO THE NEAREST EMERGENCY ROOM FOR EVALUATION 


After Your Procedure:

  • Increase your intake of fluids today. If you can tolerate caffeine, include some caffeinated beverages.
  • Perform the prescribed exercises every morning before you get out of bed and every night before you go to bed.
  • Do not soak in water today. You may shower today, but do not take a bath and do not go to the pool or hot tub today. Begin your water exercises tomorrow.
  • Remove your bandage later today.
  • No hot packs to the injection area today. If the site of your injection bothers, you place ice on the site for 15 minutes every hour as needed.
  • Do not hesitate to contact your doctor for unusually severe back or neck pain, fever, chills, stiff neck, headache, inability to urinate, redness or drainage from the injection site, or new onset of leg/arm burning, muscle spasms, numbness, or weakness.

IF YOU EXPECT A CALL BACK FROM YOUR PHYSICIAN AND YOU HAVE CALLER ID BLOCK, YOU MUST REMOVE THE BLOCK OR YOU WILL NOT RECEIVE A CALL BACK FROM THE PHYSICIAN. If you are unable to reach your doctor, go to the emergency room for evaluation and they will notify your doctor.

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External links for additional info
ASA - ASAHO.org
ASIA-spinalinjury.org
American Medical Association
Memorial Hospital West
Memorial Hospital Pembroke
Sheridan HealthCare
American Osteopathic Association
American Society of Interventional Pain Physicians

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