Facet, nerve root, and epidural block

Percutaneous spinal blocks are diagnostic or therapeutic procedures designed to help the neurologist or orthopaedist in their evaluation of confounding low back and/or lower extremity pain. During the initial workup, nonspinal percutaneous blocks, such as hip or sacroiliac joint injection, may be necessary to exclude one of these sites as the origin of the patient's symptoms. Generally, these blocks are safe, quick and easily performed under fluoroscopic guidance. Once the appropriate needle position has been obtained and the short-and/or long-acting anaesthetics instilled into the appropriate site, the patient's response to the block should be documented and transmitted to their referring physician. In the case that the block is successful, the block may be repeated at intervals for pain control, particularly in patients who chose not to have surgery or who are poor surgical candidates. Ultimately, however, as the patient's arthritis and/or disc degeneration progresses, the blocks will become less and less effective and a more permanent solution will be required. This chapter explains the indications, injection options, and methods of performing these various spinal blocks.