Radiating pain, numbness, tingling, or other nerve-related symptoms can occur when a spinal nerve root becomes irritated or compressed. A selective nerve root block, or SNRB, is an image-guided injection placed near one specific spinal nerve root to help determine whether that nerve is responsible for your symptoms and, in some cases, to provide temporary relief.
Because the medication is delivered close to a targeted nerve root, the procedure can be especially useful when imaging shows changes at more than one spinal level or when your physician needs more information about which nerve is causing arm or leg symptoms.
At Regenerative Spine and Pain Specialists, Dr. Zwade Marshall and Dr. Jennifer Xiong evaluate your symptoms, examination findings, imaging, previous treatment, and response to diagnostic procedures to determine whether a selective nerve root block or another treatment may be appropriate.
Request an Appointment or call (404) 618-0995 to schedule an evaluation at our Fayetteville, Marietta, or Atlanta office.
What Is a Selective Nerve Root Block?
A selective nerve root block is a targeted spinal injection performed near a specific nerve root as it exits the spine. The procedure is commonly used when a physician needs to identify whether a particular nerve root is contributing to radiating pain, numbness, tingling, or other neurologic symptoms.
A small amount of local anesthetic is placed near the selected nerve root. Corticosteroid medication may also be included when the clinical goal includes reducing inflammation around an irritated nerve.
The temporary response to local anesthetic can provide diagnostic information. If your typical symptoms improve during the expected anesthetic window, that response may support the conclusion that the targeted nerve is involved.
When corticosteroid is used, the injection may also provide temporary therapeutic relief by reducing inflammation around the nerve root. The amount and duration of relief vary from patient to patient.
An SNRB does not permanently remove pressure from a nerve or correct the structural cause of nerve compression. Instead, it can help clarify the pain source and may provide temporary symptom relief as part of a broader treatment plan.
Who May Be a Candidate for a Selective Nerve Root Block?
Your pain management provider may consider a selective nerve root block when your symptoms suggest irritation or compression of a specific spinal nerve root.
You may be evaluated for an SNRB if you have:
- Radiating pain from the neck into the shoulder, arm, or hand
- Radiating pain from the lower back into the buttock, leg, or foot
- Numbness, tingling, burning, or electric-like symptoms following a nerve-root pattern
- Imaging that shows a disc herniation, foraminal narrowing, spinal stenosis, or another change near a nerve root
- More than one abnormal spinal level on imaging and a need to identify which level is causing symptoms
- Persistent symptoms that have not improved enough with conservative treatment
- A need for additional diagnostic information before another procedure or surgical decision
A selective nerve root block is not appropriate for every cause of neck, back, arm, or leg pain. Your provider will review your symptoms, neurologic examination, imaging, medications, previous treatment, and overall health before recommending the procedure.
What Conditions Can Selective Nerve Root Blocks Help Evaluate or Treat?
Selective nerve root blocks are most useful when symptoms appear to follow the distribution of one particular spinal nerve root.
Cervical Radiculopathy
Irritation or compression of a cervical nerve root can cause neck pain that radiates into the shoulder, arm, or hand, sometimes with numbness, tingling, or weakness. A cervical selective nerve root block may help determine which nerve root is contributing to the symptoms.
Lumbar Radiculopathy and Sciatica-Like Pain
A lumbar nerve root can become irritated by a disc herniation, narrowing around the nerve, degenerative changes, or other spinal conditions. Symptoms may travel from the lower back into the buttock, leg, or foot. An SNRB can be used to evaluate a specific lumbar nerve root when the clinical picture points to radiculopathy.
Herniated Disc
A herniated or protruding disc can irritate a nearby spinal nerve. When more than one disc or level appears abnormal on imaging, a selective block may help determine which nerve is most closely associated with the patient’s symptoms.
Foraminal Stenosis
Foraminal stenosis is narrowing of the opening where a spinal nerve exits the spine. If the narrowing corresponds with radiating symptoms, a targeted nerve root block may be considered as part of the diagnostic and treatment process.
Persistent Nerve-Related Pain After Spine Surgery
Some patients continue to experience radicular or neuropathic symptoms after spine surgery. In selected cases, an SNRB may help evaluate whether a specific nerve root remains involved.
Because similar symptoms can also come from other nerves, joints, muscles, the spinal cord, or non-spinal conditions, the injection is only one part of a complete evaluation.
Diagnostic vs. Therapeutic Selective Nerve Root Blocks
A selective nerve root block can serve a diagnostic role, a therapeutic role, or both depending on the clinical plan.
Diagnostic Selective Nerve Root Block
For diagnostic purposes, a small amount of local anesthetic is placed near a specific nerve root. Your physician then evaluates whether your usual radiating symptoms change during the expected anesthetic period.
This can be particularly useful when MRI or other imaging shows abnormalities at multiple levels and it is not clear which level is responsible for your symptoms.
Therapeutic Selective Nerve Root Block
When corticosteroid medication is included, the goal is to reduce inflammation around the irritated nerve root and potentially provide temporary relief.
The amount of relief, how quickly it occurs, how long it lasts, and whether function improves can all help guide future treatment decisions.
A selective nerve root block and a transforaminal epidural steroid injection may use a similar needle approach near a spinal nerve root. The terminology and clinical purpose can differ depending on whether the main goal is diagnostic selectivity, therapeutic epidural medication delivery, or both.
Cervical vs. Lumbar Selective Nerve Root Blocks
The spinal level treated depends on where your symptoms originate and which nerve root your physician suspects is involved.
Cervical Selective Nerve Root Block
A cervical SNRB targets a nerve root in the neck. It may be considered when symptoms radiate into the shoulder, arm, or hand and examination or imaging suggests cervical nerve-root irritation.
Lumbar Selective Nerve Root Block
A lumbar SNRB targets a nerve root in the lower back. It may be considered when symptoms radiate through the buttock, leg, or foot and the pattern suggests lumbar radiculopathy.
The exact level and side are selected based on your symptoms, neurologic examination, imaging findings, and the diagnostic question your physician is trying to answer.
Because cervical procedures are performed near important nerves and blood vessels, careful image guidance and technique are particularly important. Your physician will discuss the risks and alternatives that apply to the specific spinal level being treated.
How Does a Selective Nerve Root Block Work?
Before the procedure begins, you will be positioned so your physician can safely access the appropriate area of the spine. The skin is cleaned, and local anesthetic is used to numb the injection site.
Your physician uses fluoroscopy, a form of real-time X-ray guidance, to advance a thin needle toward the selected spinal nerve root. Contrast material may be used when appropriate to help confirm positioning and visualize the medication pathway.
A small amount of medication is then injected near the nerve root. Local anesthetic provides the temporary diagnostic block. Corticosteroid may also be included when the treatment plan calls for an anti-inflammatory effect.
If the procedure is being used diagnostically, your care team may ask you to compare your symptoms before and after the injection and note whether movements or activities that normally provoke radiating pain feel different during the expected anesthetic window.
After the injection, the needle is removed and you are monitored before discharge.
What to Expect Before, During, and After a Selective Nerve Root Block
Before the Procedure
Your care team will provide preparation instructions based on your medical history and the specific spinal level being treated.
Before your appointment, tell your provider if you:
- Take blood-thinning or antiplatelet medications
- Have diabetes
- Have an active infection, fever, or illness
- Have allergies to medications, contrast material, or other substances
- Are pregnant or may be pregnant
- Have experienced a previous reaction to an injection or corticosteroid medication
- Have had recent changes in your health
Do not stop prescription medications, including blood thinners, unless the prescribing or treating clinician specifically instructs you to do so.
Follow any instructions provided by the office regarding eating, drinking, medications, and transportation. If you are preparing for an upcoming visit, our patient forms are available online.
During the Procedure
You may feel a brief pinch or burning sensation when local anesthetic is administered. During needle positioning or injection, some patients notice pressure, temporary discomfort, or a brief reproduction of their radiating symptoms.
Fluoroscopic imaging allows the physician to view the relevant anatomy while guiding the needle near the targeted nerve root.
After the Procedure
Temporary soreness, numbness, or weakness can occur after the injection. Because a local anesthetic may temporarily affect the targeted nerve, follow the care team’s instructions about walking, driving, and activity until its effects have resolved.
If corticosteroid is used, any anti-inflammatory effect may take several days or longer to become noticeable.
If the procedure is being used diagnostically, you may be asked to track changes in your usual radiating pain and function. Contact the office if you develop symptoms that concern you.
Risks, Side Effects, and Safety Considerations
Selective nerve root blocks are performed near spinal nerves and other important structures, so the potential risks and benefits should be reviewed carefully.
Temporary effects may include:
- Soreness or bruising at the injection site
- A temporary increase in pain
- Temporary numbness or weakness
- Dizziness or lightheadedness
- Flushing or temporary blood sugar changes when corticosteroid is used
Less common complications can include:
- Bleeding
- Infection
- Allergic or medication-related reactions
- Dural puncture and spinal headache
- Nerve irritation or injury
- Unintended injection into a blood vessel
- Other neurologic or vascular complications
Serious complications are uncommon but can be significant, particularly with injections performed near the cervical spine. The risks depend on the spinal level, your anatomy, medications, medical conditions, and the medications used during the procedure.
Your physician will review the potential benefits, limitations, alternatives, and risks that apply to your individual situation before recommending the injection.
How Soon Can a Selective Nerve Root Block Start Working?
The timing of any response depends on the medications used and the purpose of the injection.
If local anesthetic is included, you may notice a temporary change in radiating pain relatively soon after the procedure. When the block is being used diagnostically, this early response is especially important because it helps your physician evaluate whether the selected nerve root is likely contributing to your symptoms.
If corticosteroid medication is used, any anti-inflammatory effect generally takes longer to develop. Some patients notice improvement within several days, while others may take longer.
It is also possible to experience temporary soreness or no meaningful improvement. An SNRB does not provide useful diagnostic information or therapeutic relief for every patient.
How Long Can Relief From a Selective Nerve Root Block Last?
The duration of relief after a selective nerve root block varies considerably.
The local anesthetic component is temporary and is primarily useful for diagnostic information. When corticosteroid is included, some patients experience symptom improvement lasting days, weeks, or longer, while others have little or no sustained relief.
The response may depend on factors such as:
- Whether the targeted nerve root is actually the source of symptoms
- The degree and cause of nerve irritation or compression
- The medications used
- How long symptoms have been present
- Your underlying spinal condition
- Your response to previous treatment
The injection does not permanently remove a disc herniation, enlarge a narrowed foramen, or reverse degenerative spinal changes.
Can Selective Nerve Root Blocks Be Repeated?
Repeat selective nerve root blocks are not automatically appropriate for every patient.
Your provider may consider another injection based on factors such as the diagnostic information obtained, the amount and duration of relief, improvement in function, the medications used, your overall health, and the broader treatment plan.
If a block does not provide the expected diagnostic response or therapeutic benefit, your provider may recommend reassessing the suspected pain source rather than simply repeating the same procedure.
Depending on your diagnosis and response, another option could include an epidural steroid injection, rehabilitation, additional diagnostic evaluation, spinal cord stimulation for selected chronic neuropathic pain, or surgical evaluation when clinically appropriate.
Insurance plans may also have specific requirements regarding repeat injections and related procedures.
What Happens If a Selective Nerve Root Block Does Not Work?
A selective nerve root block that does not meaningfully change your symptoms can still provide useful information.
If the response does not support the targeted nerve root as the primary source of pain, your provider may review your examination findings, imaging, and treatment history and consider whether another spinal level or another structure may be responsible.
Depending on your condition, the next step could include:
- Physical therapy or rehabilitation
- Changes to medications
- Additional imaging or diagnostic testing
- An injection targeting a different spinal level when clinically appropriate
- An epidural steroid injection when broader epidural treatment is appropriate
- Evaluation for other causes of arm or leg pain
- Spinal cord stimulation for selected persistent neuropathic pain conditions
- Surgical evaluation when significant nerve compression, progressive neurologic symptoms, or another surgically treatable condition is present
The goal is to use the response to the block together with the rest of your evaluation to guide the next treatment decision.
Why Choose Regenerative Spine and Pain Specialists?
Regenerative Spine and Pain Specialists provides comprehensive interventional pain management for patients with spine-related and chronic pain conditions.
Our physicians, Dr. Zwade Marshall and Dr. Jennifer Xiong, are Harvard-trained, double-board certified anesthesiologists and interventional pain management specialists.
Dr. Marshall is the founder and chief medical officer of Regenerative Spine and Pain Specialists and completed his anesthesiology residency and interventional pain management training at Harvard-affiliated Brigham and Women’s Hospital.
Dr. Xiong completed her anesthesiology residency and fellowship training in interventional pain management at Harvard Medical School’s Brigham and Women’s Hospital. Her approach emphasizes compassionate, patient-centered care focused on function and quality of life.
Our approach to selective nerve root blocks includes:
- Individualized evaluation before recommending a procedure
- Review of your neurologic symptoms and imaging
- Fluoroscopic image guidance
- Targeting of a specific spinal nerve root when clinically appropriate
- Careful review of your response to guide future treatment decisions
- Access to other interventional options when an SNRB is not the right treatment
- Care focused on function and quality of life rather than promising a specific outcome
Selective Nerve Root Block Care in Fayetteville, Marietta, and Atlanta
Regenerative Spine and Pain Specialists offers selective nerve root block evaluation and treatment through our offices in Fayetteville, Marietta, and Atlanta.
Fayetteville
Our Fayetteville pain management clinic is located at:
874 West Lanier Ave., Suite 250
Fayetteville, GA 30214
Marietta
Our Marietta pain management clinic is located at:
3939 Roswell Road, Suite 240
Marietta, GA 30062
Atlanta
Our Atlanta pain management clinic is located in Buckhead at:
371 E Paces Ferry Rd NE, Suite 802
Atlanta, GA 30305
Evaluation, follow-up, and procedure scheduling may vary by location. Our team will let you know where your appointment or procedure will take place based on your treatment plan.
For questions about scheduling, call (404) 618-0995 or contact Regenerative Spine and Pain Specialists.
Frequently Asked Questions About Selective Nerve Root Blocks
A selective nerve root block is an image-guided injection placed near one specific spinal nerve root. It may be used diagnostically to determine whether that nerve is contributing to radiating symptoms and may also include anti-inflammatory medication for temporary therapeutic relief.
An SNRB may be considered for radiating arm or leg pain, numbness, tingling, burning, or electric-like symptoms that follow the pattern of a particular spinal nerve root.
It can be either or both. Local anesthetic can provide diagnostic information about whether a specific nerve root is responsible for symptoms. Corticosteroid medication may also be included to reduce inflammation and provide temporary relief.
The procedures can overlap, especially when a transforaminal approach is used. A selective nerve root block emphasizes targeting one specific nerve root for diagnostic selectivity, while an epidural steroid injection is generally described as delivering anti-inflammatory medication into the epidural space for therapeutic treatment. The terminology can vary by clinical context.
Local anesthetic is used to numb the skin, but you may still notice a brief pinch, pressure, temporary discomfort, or a brief reproduction of your radiating symptoms during needle positioning or injection.
If local anesthetic is used, you may notice a temporary change in your usual symptoms relatively soon after the procedure. If corticosteroid is included, any anti-inflammatory effect may take several days or longer to become noticeable.
The anesthetic effect is temporary. When corticosteroid is included, relief may last days, weeks, or longer for some patients, while others experience little or no sustained benefit. Results vary considerably.
Repeat injections may be considered depending on the diagnostic information obtained, the amount and duration of relief, improvement in function, the medications used, your health, and insurance requirements. They are not automatically scheduled as a predetermined series.
Potential effects include temporary soreness, increased pain, numbness, weakness, dizziness, bleeding, infection, medication reactions, dural puncture, nerve injury, unintended injection into a blood vessel, and other neurologic or vascular complications. Your physician will discuss risks specific to the spinal level being treated.
Temporary soreness, numbness, or weakness can occur. Follow the activity, walking, driving, medication, and recovery instructions provided by your care team. If the procedure is diagnostic, you may also be asked to track changes in your radiating pain and function.
Your provider may reassess whether the targeted nerve root is the primary source of your symptoms and consider another spinal level, a different injection, additional diagnostic testing, rehabilitation, or surgical evaluation when appropriate.
Regenerative Spine and Pain Specialists offers selective nerve root block evaluation and treatment at our Fayetteville, Marietta, and Atlanta, Georgia locations. Our scheduling team will confirm the appropriate location for your evaluation and procedure.
Schedule an Appointment for a Selective Nerve Root Block Evaluation
Radiating neck, arm, back, or leg symptoms can interfere with sleep, work, walking, exercise, and everyday activities. When your symptoms may be coming from a particular spinal nerve root, a selective nerve root block can provide diagnostic information and may also offer temporary symptom relief.
Dr. Zwade Marshall and Dr. Jennifer Xiong can evaluate your symptoms, neurologic examination, previous treatment, and imaging when appropriate to help determine whether an SNRB or another treatment better fits your condition.
Request an Appointment online or call (404) 618-0995 to schedule with Regenerative Spine and Pain Specialists.
Patients can also review our financial options or contact our office with questions before scheduling.