[Health Column] What Is the Difference Between Nerve Blocks and Neuroplasty? A Comparison of Non-Surgical Spinal Procedures

 

Hello. I am a neurosurgeon at Shintongbangtong Clinic. Kim Min-seok no see.

 

When you visit a hospital due to back pain or numbness in your legs, you may hear suggestions such as, "Let's try a nerve block," or "You can consider neuroplasty." However, many of you have likely been confused about the difference between these two procedures and which one is right for you, even after hearing the explanation.

 

Even in the examination room Are injections and procedures different? , If a nerve block didn't work, do I need to have neuroplasty? I get the same question often.

 

Today, I will summarize the differences between nerve block and neuroplasty, the two representative non-surgical spinal procedures, and explain in an easy-to-understand way which procedure is suitable for which condition.

 

Q1. What exactly is a nerve block?

Nerve Block It is a non-surgical procedure that involves injecting local anesthetics and anti-inflammatory agents (steroids) around the nerves that transmit pain to block pain signals and reduce inflammation around the nerves.

 

Simply put, in the area where a nerve is compressed and swollen Precisely delivering drugs that reduce inflammation You can think of it as follows. It uses an injection needle, and because the procedure is performed while verifying the position of the needle tip using a C-ARM (real-time imaging device) or ultrasound, it offers high precision.

 

📌 C-ARM image-guided nerve block

 

 

There are various types of nerve blocks depending on the route of drug injection.

 

type	Access path	characteristic
Coccygeal epidural injection	Injected through the tailbone (sacral hiatus)	Wide-range drug delivery, relatively safe for elderly patients
Epidural injection between concubines	Injected into the interlamina propria between the vertebrae	Direct access to the vicinity of the lesion is possible.
intervertebral foramen epidural injection	Injected into the intervertebral foramen where the nerve emerges	Precisely targeting specific neuromuscular plexuses, reported to have the highest efficacy.
Selective Neuromuscular Block (SNRB)	Injection into the problematic single nerve root	Can combine diagnosis and treatment

 

Q2. What is the difference between neuroplasty and other procedures?

Neuroplasty Percutaneous Epidural Neuroplasty is a procedure that goes one step further than nerve block.

 

Nerve block involves administering medication with a needle 'injection' If so, neuroplasty involves inserting a special catheter (Racz catheter) with a diameter of approximately 2 mm into the epidural space through the passage near the tailbone (sacral hiatus), and [treating] the [obstructions] attached around the nerve Physically separate adhesion tissue It is a procedure that directly delivers drugs (local anesthetics, steroids, hypertonic saline, etc.) to the lesion.

 

 

Q3. Which of the two procedures is received in which case?

Even with the same back pain, the appropriate procedure varies depending on the condition. I will summarize it for you in the comparison table below.

 

standard	Nerve block	Neuroplasty
principle	Inject medication around the nerve using a needle	Adhesion separation via catheter + targeted drug delivery
equipment	syringe needle	Special catheter (Racz catheter, approx. 2 mm)
Access path	Various types such as Michu, concubine quarters, and Chugan-gong	Inserted mainly through the sacral hiatus (tailbone)
Suitable condition	Acute disc herniation, nerve root inflammation, early to mid-stage stenosis	Insufficient effect of nerve block, suspected adhesions, residual pain after surgery
Procedure time	10~20 minutes	30 minutes to 1 hour
anesthesia	local anesthesia	Local anesthesia (+ mild sedation)
Whether to be hospitalized	Return home on the same day	Discharge on the same day (1-day hospitalization depending on the case)
Treatment stages	1st non-surgical procedure	Next steps after nerve block (2nd~3rd)

 

📌 Spinal pain treatment steps leading from medication/physical therapy → nerve block → neuroplasty → surgery

 

To summarize, you can view it this way. When there is no improvement with medication or physical therapy, the first thing to try is Nerve block And, when a nerve block has been performed but the effect is short-lived or insufficient, the next step to consider is Neuroplasty no see.

 

However, not all patients must strictly follow this order. In cases where adhesions are evident on MRI or postoperative pain persists, neuroplasty may be considered from the outset.

 

Q4. Are there any side effects or precautions?

Since both procedures involve no incisions and are performed under local anesthesia, the risk of complications is relatively low compared to surgery. However, as these are medical procedures, there are points you should be aware of.

 

In the case of nerve block

You may experience temporary numbness or a heavy sensation in your legs immediately after the procedure, but this usually disappears within a few hours. As this is a procedure involving the use of steroids, if repeated treatments are necessary, it is recommended to consult with a specialist to appropriately adjust the number of sessions and intervals.

 

Although complications such as infection, hemorrhage, and nerve damage have been reported rarely, the risk is very low when performed by a skilled specialist under C-ARM image guidance.

 

In the case of neuroplasty

Since this procedure involves inserting a catheter, it is technically more precise than a nerve block. Pain in the lower back or legs may temporarily increase after the procedure; this is a reaction that occurs during the process of separating adhesions and usually subsides within 2 to 3 days.

 

 

Q5. What is good to check before the procedure?

Whether it is a nerve block or neuroplasty, rather than "what procedure you receive" "Whether this procedure is suitable for the cause of my pain" It is more important to verify it accurately.

 

This is because even with the same leg numbness, the appropriate procedure varies depending on whether the cause is a herniated disc, spinal stenosis, nerve adhesion, or a muscle problem such as the piriformis muscle.

 

 

The procedure should not be a standalone treatment; its effectiveness is maintained only when linked with subsequent rehabilitation. It is advisable to follow a process where, after alleviating acute pain through the procedure, stiff muscles are loosened using manual therapy, and core strength is restored through exercise therapy.

 

❓ Frequently Asked Questions

Q1. Are the steroids used in nerve blocks harmful to the body?
Unlike oral steroids that affect the entire body, the steroids used in nerve blocks are injected in small amounts only into the local area surrounding the nerve, so the risk of systemic side effects is very low. However, excessive repetition in a short period is not advisable, so it is recommended to consult with your attending specialist regarding the frequency and intervals.

 

Q2. If nerve block is ineffective, do I need surgery immediately?
This is not always the case. If the effect of a nerve block is short-lived or insufficient, neuroplasty may be considered as a preliminary step before surgery. This is because adhesions around the nerve may have prevented the medication from reaching it properly. However, if weakness in the foot or accompanying bowel and bladder dysfunction occur, surgical intervention may be prioritized, so you must consult with a specialist.

 

Q3. I heard that the procedure is painful. Is that true?
Since the procedure is performed under local anesthesia, it is rare to experience severe pain during the treatment. In the case of a nerve block, there may be a momentary tingling sensation when the needle reaches the nerve, while in the case of neuroplasty, there may be a dull ache as the catheter passes over the site of adhesion. In most cases, the pain is tolerable, and the procedure itself is completed within 10 to 30 minutes.

 

Q4. Is it mandatory to get an MRI to receive the procedure?
In many cases, nerve blocks can be performed using only X-rays and ultrasounds. However, if neuroplasty is being considered or if a decision regarding surgery needs to be made, a precise examination via MRI may be necessary. Even if the hospital does not have an MRI machine, you may be advised to have it performed at a nearby radiology department.

 

Q5. How long do the effects of the procedure last?
Although there are individual differences, nerve blocks generally provide effects lasting from weeks to months, and a study by Seoul National University Bundang Hospital reported that the effects were maintained in approximately 55% of patients even after one year. Since neuroplasty includes adhesion lysis, its effects tend to last longer than those of nerve blocks; a study by Kim et al. (2020) confirmed significant pain reduction and functional improvement after a 12-month follow-up. However, to maintain the effects for a long time, it is important to consistently perform rehabilitation exercises after the procedure.

 

Organize 🧭

Although nerve block and neuroplasty look similar in name, Procedures with different principles and targets of application no see.

 

Nerve block involves injecting medication with a needle to reduce inflammation around the nerve. 1st non-surgical procedure And, neuroplasty physically separates adhesions with a catheter and delivers drugs to a target. Next step of the procedure no see.

 

It is not a matter of which procedure is better or worse. Suitable for the cause and stage of my pain I recommend that you decide on a direction.

 

I always treat patients based on the standard of whether I could make the same judgment on my own family.

 

📚 Reference Materials

· Professor Cheon-Ki Jeong's team at Seoul National University Hospital (2021). "Prospective comparative study of surgical and non-surgical treatments for herniated discs." 128 subjects, 2-year follow-up.
· Kim SH et al. (2020). “Clinical Outcomes of Percutaneous Epidural Neuroplasty”. Pain Medicine. 12-month follow-up study of 100 subjects.
· Oh Y et al. (2019). “Percutaneous Epidural Neuroplasty for Failed Back Surgery Syndrome”. Journal of Clinical Medicine. Multicenter study involving 207 subjects.
· Manchikanti L et al. (2019). "Percutaneous Adhesiolysis for Lumbar Central Spinal Stenosis". Pain Physician. Systematic Review Level II Evidence.
· Seoul National University Bundang Hospital (2020). Long-term efficacy follow-up study of nerve block (55% efficacy maintained after 1 year).
· Health Insurance Review & Assessment Service (2022). Statistics on patients with herniated discs — 2,757,526 people.