Noninvasive treatments like chiropractic care, non-surgical decompression, massage therapy, non-steroidal anti-inflammatory drugs/NSAIDs, targeted/specific exercises, and ice/heat therapy successfully treat most cases of sciatica. However, more aggressive treatment could be necessary for severe cases, and this is where sciatica nerve block injections come in. The Injury Medical Chiropractic team can help you understand the diagnosis and explain the benefits.

Sciatica Nerve Block

Sciatic nerve block treatments can provide profound relief for intense, non-stop symptoms. The procedure can also provide important diagnostic information to help the spine specialist locate the exact nerve fibers contributing to the symptoms.

• The nerve block stops sciatic pain signals from transmitting.
• The procedure involves injecting an anesthetic and a steroid into the nerve roots.
• The steroid reduces inflammation.
• The anesthetic prevents nerve impulses from reaching the central nervous system – CNS.
• If the procedure is successful, surgery could be avoided altogether.

What to Expect

Individuals undergoing a sciatic nerve block will be awake during the procedure. Individuals that rather be sedated are recommended to speak with their healthcare provider during the planning phase.

• When the procedure begins, a nurse sterilizes the area around the injection site and applies a local anesthetic.
• The nurse will check the injection area for numbness.
• Then the spine physician inserts a needle using direct visualization from an ultrasound, fluoroscope, or CT scan and then injects the medications.
• After the procedure, the individual is moved to a recovery area and monitored.
• Most individuals can walk almost immediately after the injection, and vigorous exercise can be resumed a few days following the procedure, depending on the injury and what the spine specialist recommends.

Possible Complications

The procedure is done under direct visualization to minimize the risk of complications. However, possible complications could present and are usually linked to the needle insertion into the spinal column. These include:

• Bleeding
• Nerve Injury
• Infection

Complications are rare, but side effects like soreness around the injection site, nausea, and a headache are common and only last a little while.

Candidates

Individuals with underlying conditions and that are taking various medications may not qualify for a sciatic nerve block or have to consult their doctor for reasons that include the following:

Long-Term Anticoagulant Use

• Individuals taking blood thinners like daily aspirin, Plavix, or coumadin, will need to stop taking these medications before the procedure.

Allergy to Contrast Dye

• Sciatic nerve blocks are done using contrast dye or ultrasound.
• Individuals with an allergy to contrast dye will need to verify with their doctor or surgeon the feasibility of only using ultrasound guidance.

Abnormal Spinal Anatomy

• Individuals with abnormal spine anatomy have an increased risk for complications and are recommended not to have the procedure.

Morbid Obesity

• Morbid obesity is a significant risk factor for developing sciatica.
• The pain and symptoms often improve with weight loss.

Infection

• Inserting a needle with an injury, wound, or active infection near or around the injection site could cause spreading.

Treatment Duration

There is a wide range of responses to sciatic nerve blocks.

• Most individuals experience pain and symptom relief between two weeks and two to four months.
• Some individuals have a long-term resolution of their symptoms.
• However, it is also possible for the nerve block to be unsuccessful.

Unsuccessful Outcomes

The sciatic nerve is the longest in the body, and there are multiple potential sites for an anesthetic blockade.

• If a sciatic nerve block does not work, the spine specialist will reanalyze the diagnosis and see if the injection site was correct.
• Identifying the exact section of the nerve to anesthetize can be difficult and may require multiple nerve block attempts.

Individuals who continue to experience debilitating sciatica symptoms after a sciatic nerve block could be recommended to undergo surgical procedures.

• Sciatic nerve ablation is a procedure that destroys nerve pathways identified to cause pain and can provide long-term relief.
• If sciatica is caused by misalignment of the vertebrae or intense external pressure on the sciatic nerve, surgery to correct the underlying cause could offer a permanent solution.

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Sciatica Syndrome

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References

5 Questions to Answer Before Considering Sciatica Surgery, Johns Hopkins Medicine, accessed September 28, 2022, www.hopkinsmedicine.org/health/conditions-and-diseases/back-pain/5-questions-to-answer-before-considering-sciatica-surgery.

Jönsson, B et al. “Diagnostic lumbar nerve root block.” Journal of spinal disorders vol. 1,3 (1988): 232-5.

Kanaan, Tareq, et al. “The Efficacy of Therapeutic Selective Nerve Block in Treating Lumbar Radiculopathy and Avoiding Surgery.” Journal of pain research vol. 13 2971-2978. 18 Nov. 2020, doi:10.2147/JPR.S276331

Rodziewicz TL, Stevens JB, Ajib FA, et al. Sciatic Nerve Block. [Updated 2022 June 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK470391/

Sciatica: Harvard Health Publishing, (2016, February 19), accessed September 28, 2022, of all the nerve www.health.harvard.edu/pain/sciatica-of-all-the-nerve.

Senthelal S, Dydyk AM, Mesfin FB. Ablative Nerve Block. [Updated 2022 April 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK499975/