Transforaminal / Facet (Root Sleeve) Injection


What is a Root Sleeve Injection?

  • Spinal nerves exit the spine at each disc level - this exit point is known as the root of the nerve. The root sleeve is the connective tissue that encases each spinal nerve root.
  • A root sleeve injection involves the injection of local anaesthetic and steroid onto the spinal nerve root suspected of causing pain.
  • This is an important diagnostic tool and also used to treat radicular (spinal nerve) pain symptoms.
  • The image on the right shows a herniated disc (orange arrows) causing irritation to the nerve root (glowing red).
  • This procedure is always performed under X-ray and in the day surgery setting. 

 

Prior to the Procedure

  • All blood thinning products (except aspirin) must be stopped prior to your procedure. You will be advised by letter when to stop taking these medications at the time that your admission date is arranged.
  • You are able to take your other regular medications with a sip of water on the morning of your procedure.
  • If you are an insulin dependent diabetic you will always be at the beginning of the list. Please bring your insulin with you and it will be given to you following your procedure.
  • Hamilton Day Surgery Centre staff will advise you of your fasting and admission times.
  • You must not have anything to eat, drink, smoke or chew prior to your procedure.
  • You will need to organise someone to drive you home after the procedure as you will not be able to drive for 24 hours after your procedure.

 

What Will Happen?

  1. You will be admitted to the day surgery by a nurse and you will be asked to change into a gown.
  2. The Anaesthetist will speak with you and place a cannula (plastic needle) into a vein in your hand.
  3. In the procedure room, you will be assisted to position on the procedure table on your abdomen with a pillow under your hips and abdomen.
  4. The Anaesthetist will give you some sedation into your vein.
  5. An X-ray machine will be used to determine where the Doctor will place the needle for your procedure. 
    • The procedure will take approximately 10 minutes to complete.
  6. Steroid and local anaesthetic will be injected once correct placement has been established with use of X-ray contrast (Omnipaque).
  7. After the procedure, you will be placed on a trolley and taken to recovery, where you will remain for approximately one hour.
  8. After having something to eat and drink, you will be discharged with a carer.

 

Post Procedure

  • Gentle activity and rest is recommended in the first 24 hours following the procedure. You may then return to normal activity.
  • The local anaesthetic will wear off 12 – 18 hours following your procedure.
  • The steroid will take 48 hours to start working.
    • During this time there may be a window of increased discomfort or pain.
  • A nurse from HPC will telephone you 24 to 48 hours following your procedure to check on your progress and organise a follow up appointment. 
  • The steroid will remain effective for 1 – 6 months, depending on amount of irritation or inflammation present.


If you require further explanation of the procedure, please contact Hunter Pain Clinic nursing staff on (02) 4985 1800.

 

* Image by BruceBlaus: Blausen.com staff. "Blausen gallery 2014". Wikiversity Journal of Medicine. DOI:10.15347/wjm/2014.010. ISSN 20018762. (Own work) [CC BY 3.0 (http://creativecommons.org/licenses/by/3.0)], via Wikimedia Commons