1) To detail indications for lumbar and sacral Selective Nerve Root Blocks. 2) To report the technique, discussing relevant anatomy and adaptations to optimise procedure. 3) To explore risks involved in this procedure and to review evidence for its benefit.

A Selective Nerve Root Block (SNRB) involves injection of local anaesthetic and/or long-acting steroid into the perineural sheath of a specific lumbar or sacral nerve root as it exits the neural foramen, and for this reason is also referred to by the alternative term of transforaminal epidural injection. Historically nerve blocks have been conducted by anaesthetists without imaging guidance. However, usage of fluoroscopy or computed tomography (CT) guidance allows increased accuracy of needle placement, reflecting in improved efficacy of procedure and fewer complications and allowing...

1. INDICATIONS SNRB is performed in the context of lumbosacral radicular pain (defined as pain radiating to one or more lumbar or sacral dermatomes caused by nerve root compression and/or inflammation). The indications can be grouped as follows: a) Diagnostic intent: In patients with no imaging evidence of disease but where the symptoms relate to a nerve root level, or those with multiple abnormal imaging findings such that confirming the origin of symptoms is difficult from imaging alone.[1] In our institution, levobupivacaine is used for...

Lumbosacral Selective Nerve Root Block is a common outpatient procedure which provides a useful management option in patients with lumbosacral radicular pain. This educational exhibit has reviewed the details of which radiology trainees should be aware and provides a concise guide to performing this procedure safely. Key points: Localise targeted neural foramina with the help of AP, lateral and oblique views on fluoroscopy. Check position of needle with fluoroscopy before delivering contrast. Confirm correct position and extravascular location with contrast prior to delivering medication.

http://my.statdx.com. Wagner, A. A. L., Editor, C. & Raghavendra, M. Paraspinal Injections - Facet Joint and Nerve Root Blocks. 8–10 (2012). Datta, S. et al. Diagnostic Utility of Selective Nerve Root Blocks in the Diagnosis of Lumbosacral Radicular Pain: Systematic Review and Update of Current Evidence. Pain Physician 16, 97–124 (2013). Riew, K. D. et al. The effect of nerve-root injections on the need for operative treatment of lumbar radicular pain. A prospective, randomized, controlled, double-blind study. Journal of Bone & Joint Surgery - American...