My next possible step after three EMG tests is a targeted injection near the cervical nerve root that may still be causing my left-sided pain and weakness.
I have already had a more general epidural injection before my C5-C6 disc replacement. That did not permanently solve the problem. This time, the EMG doctor described something more specific that would target the suspected nerve root directly.
The injection appears to be what is commonly called a cervical selective nerve root block, although I still need to confirm the exact procedure name from my paperwork.
The main goal is not just to inject medication somewhere in my neck. The doctor wants to see whether precisely targeting the suspected nerve changes my familiar pain.
If it does, that may provide another clue that the C5-C6 nerve-root area is still involved.
The Quick Answer
A cervical selective nerve root block is an image-guided injection placed near one specific nerve root as it exits the cervical spine.
It may contain:
- A local anesthetic to temporarily numb the nerve
- A corticosteroid to reduce inflammation
- Contrast dye to confirm where the medication is spreading
The injection can be used therapeutically to reduce pain, diagnostically to help identify which nerve root is causing symptoms, or for both purposes.
A selective nerve root block is more targeted than an injection intended to spread medicine throughout a larger portion of the epidural space.
Why My Doctor Is Recommending This Now
I had my C5-C6 disc replaced roughly 15 months ago. According to my spine surgeon, the artificial disc looks good on X-rays and my spine appears structurally sound.
Some symptoms improved after surgery. The headaches I felt near the base of my skull are better, and the pain is not always as severe as it was before the operation.
However, I still have pain affecting:
- The left side of my neck
- The area around my left shoulder blade
- Part of my upper back
- My left shoulder
- My left arm
- My ability to hold weight with that arm
The weakness is especially noticeable when I hold my baby while standing. Within roughly five minutes, the pain can become horrible.
My third EMG still showed findings that the doctor believes point toward the C5-C6 area. I explained more about those results in my article answering whether an EMG can show a pinched nerve in the neck.
The targeted injection seems to be the next attempt to connect the test findings with the pain I actually feel.
How Is This Different From a Regular Cervical Epidural?
This was my first question because I already had an epidural injection before surgery.
The terms can become confusing because both procedures may place medication near spinal nerves, and a selective nerve root block may use a transforaminal approach that reaches the epidural space.
The major practical difference is how specifically the doctor is trying to target the suspected pain source.
A broader epidural injection
A traditional interlaminar cervical epidural is generally intended to spread medication through a larger portion of the epidural space.
It may affect more than one nearby nerve root.
A selective nerve root block
A selective nerve root block is directed toward one specific nerve root as it exits through an opening beside the spine.
Stanford Medicine describes a nerve root block as an injection of anesthetic near the point where a nerve branches away from the spinal cord.
The word “selective” does not mean the medication is guaranteed to touch only one microscopic nerve fiber. It means the procedure is designed to be much more focused than a general epidural.
Why the Numbing Medicine Matters
The local anesthetic may be the most important part when the injection is being used diagnostically.
It works relatively quickly and temporarily numbs the targeted area.
If my normal pain drops significantly soon after the injection, that response may suggest the targeted nerve root contributes to my symptoms.
The doctor may ask me to rate my pain before and after the procedure. I may also be asked to perform a safe activity that normally causes the pain, such as moving the arm or holding it in a certain position.
What I need to track
I do not want to report only that I feel “better.”
I need to pay attention to:
- Whether the neck pain changes
- Whether the shoulder-blade pain changes
- Whether the pain down my arm changes
- Whether I can hold the arm up longer
- Whether the weakness feels different
- How quickly relief begins
- How much relief I experience
- When the pain returns
Those details could help separate the pain coming from the suspected nerve root from pain produced by muscles, joints, or other structures. The overlapping causes of shoulder-blade pain are outlined in separating nerve-root pain from shoulder-blade pain.
What Would Count as a Successful Diagnostic Block?
There is no single percentage I can choose for myself.
The doctor performing the procedure should explain what amount of temporary relief would be considered meaningful. The expected response may depend on the diagnosis being investigated, the medication used, and what treatment is being considered afterward.
A strong response would likely mean that my familiar pain decreases substantially during the period when the local anesthetic should be working.
However, even a positive response is not absolute proof.
Medication can sometimes spread beyond the intended location. Pain also changes naturally throughout the day. Resting before or after the injection could affect what I feel.
That is why I want to record the response carefully rather than relying on a vague memory several days later.
Could the Injection Help Longer Than a Few Hours?
Possibly.
The local anesthetic is expected to be temporary. If the injection also contains a corticosteroid, the steroid may reduce inflammation around the nerve root and provide relief that lasts longer.
Steroid relief usually does not need to begin immediately. It may take time for the anti-inflammatory effect to develop.
Possible outcomes include:
- No noticeable change
- Relief only while the anesthetic is active
- Short-term improvement lasting several days
- Relief lasting weeks or longer
- Improvement in only one part of the pain pattern
- Temporary worsening from procedure-related soreness
I do not know which result I will have. My earlier epidural experience cannot predict exactly how I will respond to a more targeted injection.
Will a Cervical Nerve Root Block Fix My Weakness?
This is one of my biggest concerns.
The main purpose of the injection is generally to identify or reduce pain related to an irritated nerve root. It does not directly repair damaged nerve fibers. That distinction between symptom relief and recovery is discussed in pain versus actual nerve healing.
If inflammation is interfering with the nerve, reducing that inflammation could potentially improve how the area feels and functions. Pain relief may also allow me to use the arm more naturally.
However, an injection cannot guarantee that lost strength will return.
The weakness could reflect:
- Pain preventing normal effort
- Muscle loss from reduced use
- Ongoing nerve irritation
- Lasting nerve injury
- A combination of these problems
My EMG may help distinguish some of these possibilities, but the actual report needs to be compared with my strength examination and imaging.
I recently wrote about continuing pain and arm weakness 15 months after C5-C6 disc replacement. Pain relief would be valuable, but restoring or protecting strength is just as important to me.
Why Would the Injection Help If Ibuprofen Already Helps?
Ibuprofen gives me better overall pain relief than the different nerve-pain medications I have tried.
That may suggest inflammation or nearby musculoskeletal pain is part of my symptoms. I discussed that in more detail when explaining why ibuprofen may help my nerve-related pain.
A targeted injection is different because the medication is placed near one suspected nerve root instead of circulating throughout my entire body.
If the targeted injection gives much stronger relief in the exact path of my pain, it could be more informative than the broad relief I receive from ib ibuprofen.
If ibuprofen helps but the nerve root block does not, that might make my doctors consider whether inflammation elsewhere is a larger part of the problem.
What Happens During a Cervical Selective Nerve Root Block?
I have not undergone this specific procedure yet, so this section describes the usual process rather than my personal experience.
Positioning
The patient may lie on the back, side, or stomach depending on the doctor’s technique and the equipment being used.
Cleaning and numbing the skin
The injection area is cleaned carefully. A small amount of local anesthetic may be used to numb the skin and tissues along the needle path.
Using image guidance
The doctor uses fluoroscopy, CT guidance, or another imaging method to guide the needle toward the intended cervical nerve root.
This is not supposed to be a blind injection based only on feeling the outside of the neck.
Injecting contrast dye
A small amount of contrast dye may be injected while images are taken. This helps the doctor confirm the needle position and watch where the liquid travels.
Delivering medication
Once the doctor is satisfied with the placement, a small amount of local anesthetic, steroid, or both may be injected.
Monitoring afterward
The medical team may observe the patient for a short time and check for changes in pain, strength, sensation, or other symptoms.
The exact process can differ between offices. My doctor’s instructions will matter more than a general online description.
Will the Injection Hurt?
I cannot give my personal answer yet because I have not had this exact injection.
I expect some discomfort from the numbing injection, pressure from the procedure needle, and possibly a brief reproduction of the pain when medication reaches the irritated nerve.
That does not mean everyone experiences severe pain. The sensation depends on the injection location, individual sensitivity, current nerve irritation, and how the procedure is performed.
After having three EMG tests, I know that my imagination can make a nerve procedure sound worse than the actual experience. My EMGs involved strong electrical shocks and many small needle pokes, but each sensation was brief and the latest test took around 15 minutes.
I shared the complete experience in what my three EMG tests really felt like.
I will write a separate first-person account after I receive the targeted injection. I do not want to pretend I know exactly what it feels like before it happens.
Are Cervical Nerve Root Injections Safe?
These injections are performed regularly, but placing a needle near the cervical spine is not risk-free.
The neck contains the spinal cord, nerve roots, and important blood vessels in a relatively small area.
Possible risks can include:
- Temporary increased pain
- Bleeding
- Infection
- Allergic reaction
- A reaction to contrast dye
- Temporary numbness or weakness
- Headache from a spinal fluid leak
- Steroid-related side effects
- Nerve injury
- Blood-vessel injury
- Rare but serious neurological complications
The FDA has warned that corticosteroid injections into the epidural space can rarely cause serious neurological events. Corticosteroids are commonly used this way, but the FDA has also noted that this epidural use has not been specifically approved by the agency.
This does not mean the procedure should never be performed. It means I need to understand why it is being recommended, who will perform it, what imaging guidance will be used, and how the doctor reduces the known risks.
Why Image Guidance and Contrast Dye Matter
A targeted cervical injection requires precision.
Fluoroscopy or CT guidance allows the doctor to see the needle’s location relative to the bones and the intended nerve-root opening.
Contrast dye helps show where injected liquid is traveling before the full medication is delivered.
This can help the doctor avoid placing medication in an unintended location. It does not remove every possible risk, but it adds important information that cannot be obtained by looking at the outside of the neck.
I plan to ask which type of imaging will be used and whether contrast dye is part of the procedure.
Questions I Need Answered Before Scheduling It
What is the exact name of the injection?
I want to confirm whether it is a selective cervical nerve root block, cervical transforaminal epidural steroid injection, or another procedure.
Which level and side will be treated?
My symptoms and EMG findings involve the left side and apparently point toward C5-C6, but the written order should identify the exact target.
Is this mainly a diagnostic block or a treatment?
The answer affects how I should measure and report the response.
Which medications will be injected?
I want to know whether the injection contains local anesthetic, corticosteroid, or both.
What imaging guidance will be used?
I want the doctor to explain how the needle placement and medication spread will be confirmed.
What result would count as a positive block?
I need clear instructions for rating the pain and testing the symptoms afterward.
Could I experience temporary arm weakness?
If the local anesthetic affects motor fibers, I need to know whether my arm could temporarily feel weaker and whether I will need someone else to drive.
Does my artificial disc change the procedure?
The doctor should know that I have a C5-C6 artificial disc and review the relevant postoperative imaging.
What happens if the injection helps?
I want to understand whether the next step would be another injection, physical therapy, different imaging, surgery, or some type of nerve ablation.
What happens if it does not help?
A negative response should lead to another diagnostic question rather than simply ending the investigation.
Why I Am Cautious About the Mention of Nerve Ablation
The EMG doctor mentioned possible nerve ablation if the targeted injection helps.
That immediately made me wonder whether I would lose feeling somewhere or whether ablating a nerve could worsen my existing arm weakness.
Before moving toward any ablation, I need to know the exact nerve or nerve branch being discussed.
Radiofrequency ablation commonly targets small sensory nerves carrying pain from spinal joints. That is different from intentionally damaging a mixed cervical nerve root that supplies sensation and controls arm muscles.
The Stanford Medicine Spine Center describes radiofrequency ablation as using electrical current to heat nerve tissue, but that basic explanation does not tell me which nerve my doctor would treat.
I am not assuming the doctor plans to burn the main C5 or C6 nerve root. The term may have been used more generally during our conversation.
The exact procedure name matters too much for me to guess.
How I Plan to Track My Response
If I receive the injection, I plan to write down my pain before leaving for the appointment.
I want separate ratings for:
- Neck pain
- Shoulder-blade pain
- Upper-back pain
- Shoulder pain
- Pain traveling down the arm
- Numbness or tingling
- Arm weakness
- Ability to perform a familiar movement
I will then record changes during the first several hours, later that day, and over the following days.
I also want to note whether the pain returns in the same pattern when the numbing medicine wears off.
A written record should be more reliable than trying to remember everything during a follow-up appointment.
What I Hope This Injection Finally Clarifies
At this point, I am not expecting one injection to solve 15 months of pain and weakness.
What I want is a clearer answer.
My surgeon says the artificial disc looks good. My shoulder evaluation did not reveal a problem that explains everything. My MRI has not provided an obvious answer. Yet my third EMG still appears to point toward C5-C6.
A targeted cervical nerve root block may help connect those pieces.
If the injection temporarily shuts down the familiar pain spreading through my neck, shoulder blade, shoulder, and arm, that would be useful information.
If it does nothing, that also matters. It may mean the main source is somewhere else or that the pain is coming from several structures instead of one nerve root.
Either way, I want the procedure to move the investigation forward rather than becoming one more treatment that is performed without a clear plan for what comes next.
Written by Daxon Weaver, who shares his real experiences with cervical disc replacement, lumbar fusion, chronic nerve pain, EMG testing, and spine surgery recovery on Spine Recover. This article describes one patient’s experience and is not a substitute for individualized medical care.
