As far as treatments went, this one scared me shitless. The doctor prescribed a CT guided nerve root injection. Essentially they stick a needle in your spine using a CT machine to make sure it doesn’t accidentally go into the nerve or anywhere else nasty, then inject a combo of anaesthetic and steroids to calm everything the fuck down.
Rational brain understands this is a normal procedure, and people get a lot of benefit out of it. It’s not a silver bullet but it’s a tool to help things heal, in conjunction with physiotherapy and not being a big fucking idiot for the next little while. But anxious brain started humming along, filling itself with a background radiation of bad thoughts. The x-ray place gave me next to no information about the procedure straight up, so all I really had was secondhand info.
The one thing they were adamant about was making sure I had someone drop me off and pick me up. You can’t drive after the procedure, because the anaesthetic can put your leg(s) to sleep. So big thanks to Ad for taking time off work to rescue me here.
They told me they wouldn’t do the procedure unless they had someone drop me off, But when I arrived they gave zero shits and waved me through to the sitting area.
The nurse who called my name was a little weird. But to be fair, I was a little weird at that point too, pretty freaked out. She guided me down a stark white corridor dotted with doors to unknowable places, before plopping me in a chair and handing me a bunch of consent forms with all the information I wish I’d had earlier. Then she disappeared down the corridor through one of the doors. I didn’t see where she went.
Your Doctor has requested that you undergo a Nerve Root Sleeve (NRSI) and/or Epidural Injection (El). A Queensland X-Ray radiologist will perform this procedure.
NRSI is the introduction of local anaesthetic and/or steroid into the sheath around the nerve. This is usually requested because the nerve is thought to be inflamed
I took a moment to scan the forms before signing them. As I was reading, another patient was discharged. An older lady. The technician pointed down the corridor to the exit and sent her on her way. But as she shuffled her way toward freedom the technician burst back through the door, calling out and waving a disposable coffee cup.
The lady turned around in confusion, then put her hands over her mouth as a look of horror crossed her face.
This can’t be coffee, I surmised as the nurse led the woman into a bathroom for some privacy. The cup contained, presumably, a full set of false teeth left behind accidentally. It’s quite common, I’m sure.
I signed the documents and stood around awkwardly until my nurse returned.
This examination is best performed under CT guidance and may take up to 30 minutes to perform. You will be lying on your stomach for the duration of the procedure. A scan is taken to localise the area to be injected. The skin on your back/ back of your neck will be cleaned with an antiseptic solution and local anaesthetic will be injected into the area. This may sting slightly for a short time.
She led me through one of the mystery doors. My prize: a bed covered in pillows, hanging out of a machine that looked like a giant robot doughnut. I was pretty impressed the first time I did a CT scan, I didn’t realise how they worked until I looked it up. It’s essentially an x-ray machine that spins around, building up a 3D image of whatever irradiated subject happens to be in its path. Similar principle to an MRI I guess but different tech.
She asked me to lay on the bed in a Superman pose, which confused the hell out of me and took a minute to work out what she meant. But then I carefully deposited myself face down on the bed and rearranged some pillows for comfort. Later I’d wish I’d rearranged them more. But that was the least of my problems.
With consent the nurse lifted my shirt and pulled down my shorts, then put some kind of measuring tool on my back. Then the fun started. The bed crawled slowly into the machine, going back and forth a bit to adjust itself, then a robot told me not to move and to stop breathing now.
Gasp.
It wasn’t until that point that I realised how shallow I’d have been breathing already. The thought of someone digging around in my spinal cord while I was taking big gasps and moving around wasn’t super appealing, and the pillows were constricting my ability to breathe as well. So when I was asked to hold my breath, the fire in my lungs added to all the other anxieties racing through my head and once I was finally allowed to take a breath I was almost hyperventilating. I had to really focus on breathing shallow, but enough to be comfortable.
A needle is then directed into the area under imaging guidance. The position of the needle-tip is checked with imaging and x-ray dye (contrast) may be injected. The local anaesthetic and/or steroid are then injected. There may be an increase in the leg pain when the injection commences. This pain usually eases as the anaesthetic spreads around the nerve root.
After that was all lined up, the doctor came in and introduced himself to me. I was laying face down on a bed, and couldn’t exactly move so he crouched down next to me like I was a toddler to ask me if I’d ever had this procedure before.
“Nevarrr” I said, immediately realising how weird a response that was. My brain was racing and I was afraid to move even though nothing had happened yet. I wasn’t the best conversationalist.
But the doctor was good. He explained what was about to happen, much the same as the consent form, before getting to work.
Actually he was very good. I barely felt the anaesthetic, which from past experience can be pretty unpleasant. I mentioned that to him and he said he did it really slowly, so thanks for that. But the next section was the one I was especially not looking forward to.
I saw the nurse rifling around on the table for the needle. I saw how long the packaging was, but at that point I didn’t see how long the needle itself was. A small blessing, because when they removed it afterwards it looked like something you might use on a hippo or some other large animal you didn’t particularly like. Definitely not what I’d want going into my own body.
But it did. The doctor had several goes guiding the needle in, then sending me into the CT machine to check the positioning. As it got closer I started to feel something not unlike pain. I mentioned it and he told me the anaesthetic may not reach quite so far in. Thankfully it wasn’t pain as much as a weird pain-adjacent sensation, I continued doing the best job I could laying completely still and not moving.
It took maybe six 6 or 7 trips into the CT before he was satisfied. He injected a contrast dye and sent me back in one last time, apparently to highlight the nerves and make sure the needle wasn’t going to smash into them. Then the scary part began.
Risks associated with the procedure may include:
- Pain and/or bruising at the needle puncture site.
- Bleeding in the deeper tissues.
- Infection involving redness, swelling, or increased pain over the injection site. Fever or chills need to be directly reported to QXR Radiology and your referring doctor.
- Headache can occur in less than 1% of uncomplicated Epidural Injections.
- Occasionally, the sac containing the spinal nerve roots may be punctured during the needle placement. If the sac is punctured there is a potential for fluid to slowly leak out over time giving you a headache. The radiologist performing the procedure will alert you if this has occurred. This is not a serious situation. You will be asked to lie flat for 4 hours and to drink plenty of fluid. This helps prevent any headache. The risk of headache after sac puncture is about 5%.
- Direct injection into the nerve root produces intense pain and may damage the nerve resulting in loss of sensation and weakness of the muscle supplied by the affected nerve.
- Very rare complications (<1:100 000) include direct damage to the spinal cord or injury to a blood vessel causing weakness in limbs or other spinal symptoms such as problems with bladder and bowel function.
- Risks associated with injectable drugs used including allergic reaction or toxicity. Very severe reaction is rare and a life threatening reaction is extremely rare (< 1: 100,000).
- Adverse effects from injected steroids
- On occasion the cortisone (steroid) used in this injection can initially cause a reaction known as a “steroid flare”, which may cause more pain in the area of injection.
- Backache or sciatica due to the muscle being aggravated by the insertion of the needle or injection. This is usually mild and temporary.
- Injury to the spinal cord.
- Any procedure has the potential to be associated with unpredictable risks including death.
The doctor reminded me that there may be a flare of pain as the steroid went in. I’ve been dealing with this for weeks now, so I was pretty relaxed about that. In the end I felt a bit of tightness, some pain adjacency, and then it was done. He ripped the needle out and that was that.
After it was complete it felt weird. I felt weird. I continued laying face down not wanting to move; less of a Superman, more of a scare goat. Based on feeling, I wasn’t 100% sure everything had been removed so I didn’t want to jeopardise my precious spine until the nurse confirmed I could sit up.
I had a bit of trouble getting up, that’s one of the things that has been hurting this whole time. I wasn’t sure how much the injection would be masking, I wasn’t sure if putting pressure on my spine was a good idea at this point. But the professionals assured me it was ok, so I pushed myself into a sitting position with a small but diminished amount of pain, then stood up.
Then I sat straight back down again. I was light-headed and felt like I was going to tumble over. The nurse said the colour had drained out of my face, and asked the technician to bring a glass of water.
I thanked her and said, “hopefully this one’s not full of teeth.”
It was a weird experience. I realised the background sciatic pain I’d been dealing with was completely gone. I hadn’t noticed how bad it was until it wasn’t there anymore, so that was a success. There was still a bit of back pain, but that that’s not what the treatment was for so I wasn’t too fussed. But I could still feel a tugging in my back as I walked, so that bit of tightness was still there even though the anaesthetic had calmed the nerves.
The whole procedure from walking in the door to walking out again was only 45 minutes, and once again they gave zero shits about my driver. I should have just taken an Uber.
On the way out I messaged B:
The anaesthetic started to wear off a bit past midnight. But the steroid definitely didn’t: when I tried to sleep I felt my heart rate going crazy. I checked my watch and it had slowly ticked up all afternoon since the injection, to somewhere between 100 and 110 beats per minute just laying in bed. A resting heart rate of 90. Hectic.
It’s a bit weird but apparently insomnia can be a side effect too. Laying in bed at 2am writing blog posts, I definitely felt like I’d been smashing coffee all day. Whenever I closed my eyes there was another thought or impulse or distraction to keep me from sleeping and it was very frustrating, especially since I was planning to be woken in a few hours by the construction site and my upstairs neighbour’s asshole dog.
But the heart rate started heading back down a little, and the sciatica was under control mostly. I wouldn’t have even called it pain, just another distraction.
But I’m feeling optimistic about things. The next few days will be taking it very easy, and I’ve already spoken to the physio about what recovery looks like. I don’t have a program yet, but I think on the weekend I’m going to go do some bench press. It’s allowed. I wouldn’t if it weren’t. And I’m very motivated not to let this happen again.
