Case Study: Selective nerve root block transforaminal right S1

The patient had a radiating pain along the back of the right thigh and leg into the sole of the foot for which they were seeing me as an outpatient. We got an MRI, which showed disc herniation and compression of the right S1 nerve root. We discussed treatment options. The patient tried Medrol-Dosepak, which did not help.

We discussed getting a selective nerve root block done. We discussed risks and benefits including infection, bleeding, injury to nerve, temporary or permanent numbness or stiffness, externalization of drug into the vessel and complications therefore including weakness, tingling, and numbness into the right leg among others. The patient understood and signed an informed consent.

The patient was taken to the procedure room and the patient was put prone on the operating table. Sedation was given. The back was prepped and draped aseptically in the usual fashion. C-arm was brought in. Visualization of the entry was done under fluoro and local anesthesia with lidocaine was done. Spinal needle was inserted along the path.

Finding the needle’s satisfactory position in the foramen, omnipaque 1 cc was injected. The nervogram was produced, which was saved. This was followed by injection of 1 cc of lidocaine mixed with 40 mg of Kenalog. The needle was removed and Band-Aid was applied. The patient was moved to recovery in a stable condition.

Patient followed up one, four and six weeks after nerve root block transforaminal right S1. Patient reported improvements with their pain in the back and the right leg.

Disclaimer – Patient’s name, age, sex, dates, events have been changed or modified to protect patient privacy.

I am fellowship trained in joint replacement surgery, metabolic bone disorders, sports medicine and trauma. I specialize in total hip and knee replacements, and I have personally written most of the content on this page.

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