Cervical Nerve Root Block

A cervical nerve root block, sometimes called a selective nerve root block or transforaminal injection, targets the point where a nerve root exits the spine through a small bony channel. Using X-ray (fluoroscopic) or CT guidance and a small amount of contrast to confirm accurate placement, a fine needle is directed to the nerve, and local anaesthetic with steroid is delivered around it. The local anaesthetic can quickly settle the nerve pain, while the steroid aims to reduce inflammation over a longer period. Careful image guidance is essential to place the injection accurately and safely.

This injection can be used when arm pain is thought to be coming from an irritated or compressed cervical nerve root, often from a disc prolapse or bony narrowing. It serves two purposes: as a diagnostic test, a strong temporary response helps confirm which nerve is responsible; as a treatment, it can reduce pain and inflammation, sometimes enough to avoid or defer surgery while the natural recovery of a disc prolapse takes place. It is generally considered when the diagnosis needs clarifying or when nerve pain has not settled with simpler measures.

The evidence supports a useful role. Systematic reviews of cervical transforaminal and selective nerve root injections report that they can provide meaningful short- to medium-term relief of cervical radicular pain for many patients, and that they have diagnostic value in localising the responsible nerve. Because the cervical region carries specific procedural risks, the evidence also emphasises the importance of meticulous image-guided technique and, in many practices, the use of non-particulate steroid for safety. The balanced view is that this is a helpful, targeted procedure for nerve-related arm pain, best used within an overall plan rather than in isolation.

The injection is a day-case procedure performed with image guidance. Afterwards, the local anaesthetic may ease the pain quickly, while any steroid benefit builds over the following days. The response — how much pain relief, and for how long — helps guide the next steps, whether that is continued non-operative care, a repeat injection, or consideration of surgery if a structural problem persists. As with any procedure there are risks, which are discussed beforehand. Whether this injection is appropriate depends on the individual, and is decided with the treating team.

• —Borton ZM, et al. Cervical transforaminal epidural steroid injections for radicular pain: a systematic review. Bone Joint J 2022. (PMID 35491579)
• —Conger A, et al. Effectiveness of fluoroscopically guided cervical transforaminal epidural steroid injection for radicular pain: a systematic review and meta-analysis. Pain Med 2020. (PMID 31181148)
• —Lee JH, et al. Transforaminal versus interlaminar epidural steroid injection in cervical radicular pain: a systematic review and meta-analysis. Pain Physician 2022. (PMID 36608007)
• —Engel A, et al. Effectiveness and risks of fluoroscopically guided cervical transforaminal injections of steroids: a systematic review. Pain Med 2014. (PMID 24308846)
• —Mehta P, et al. Particulate versus non-particulate corticosteroids in epidural injections: a systematic review. PM R 2017. (PMID 27915069)