What is a Root Sleeve Injection

At each level in the spine, a nerve emerges which goes out to supply nerve impulses to various body regions, including skin, muscle and organs. The area of the nerve as it emerges is called the nerve root. Each nerve root is surrounded by a little tunnel of connective tissue called the nerve root sleeve. Inside the nerve root sleeve is continuous with the epidural space of the spine, so an injection, which places medicines inside this tunnel, is effectively a type of epidural injection. A root sleeve injection places a small amount of local anaesthetic and cortisone-type medication into the nerve root sleeve.

How is the RSI performed

You lie on your front on the operating theatre table while x-rays are taken to establish where the needle should go. After a sterile preparation, local anaesthetic is used to numb the skin and superficial tissues, and then the injecting needle is passed under guidance from the x-ray. When the needle looks to be in the right position, placement in the nerve root sleeve is confirmed by putting some dye in to see it spread along the tunnel. If this doesn’t look right, the needle is repositioned until the dye spreads in the right pattern.

Once the needle is confirmed to be in the right position, some diluted local anaesthetic and a highly concentrated cortisone solution are injected, a total volume of around 3ml.

The procedure is performed under light sedation. The sedation means you won’t remember the injection but it’s a long way short of a full general anaesthetic. You won’t be able to drive for 24 hours after having sedation, and you will need to fast for 4 hours before your procedure.

After the procedure

You will be observed in the recovery room for 30-60 minutes and be free to leave the hospital soon after that. There can be some temporary numbness in your leg after the RSI which can make walking a little challenging so longer observation may be required if this happens. If you have pain at the site of the injection you should use a cold pack and some simple analgesia in the recommended doses for a couple of days.

In the case of numbness, which has not gone away after 24 hours, or any loss of control over bladder or bowel, you should contact NIPM 4923 8900 in office hours 9-4pm, or attend an Emergency Department and ask that they contact us if it is after hours.