J Korean Orthop Assoc.  2009 Feb;44(1):118-122. 10.4055/jkoa.2009.44.1.118.

Effectiveness of Selective Nerve Root Block on the Need for Surgical Treatment of Lumbar Spine: A Minimum 5 Years Follow up

• Shim DM
• Kim TK
• Oh SK
• Choi YH
• Lee SJ

• KMID: 2186386
• DOI: http://doi.org/10.4055/jkoa.2009.44.1.118

Abstract

PURPOSE
To evaluate the effectiveness of a selective nerve root block (SNRB) in patients with sciatica before surgery through a more than 5 year follow up.
MATERIALS AND METHODS
Between January 2000 and December 2000, patients with sciatica, who were recommended to undergo surgery to diagnose and treat sciatica by other clinics or at our hospital, were selected to undergo SNRB before surgery. Among them, 69 patients were followed up for 5 years. The analysis was based on the patients' medical records and telephone interviews, and the treatment results in the SNRB group and operation group were analyzed using Kim's criteria and the Visual Analog Scale score.
RESULTS
Among the 69 patients, there was no improvement in symptoms in 37 patients after SNRB. Therefore, they underwent surgery. The symptoms of the remaining 32 patients were improved by SNRB. Overall, younger patients and those with a longer symptom duration required surgery.
CONCLUSION
SNRB was performed on patients with sciatica who were scheduled to undergo surgery. Some patients showed improvement in their symptoms in the long term. Therefore, SNRB should be considered as a treatment option prior to surgery.

Keyword

Sciatica; Selective nerve root block; 5 year follow up

MeSH Terms

Follow-Up Studies
Humans
Interviews as Topic
Medical Records
Sciatica

Reference

1. Atlas SJ, Keller RB, Chang Y, Deyo RA, Singer DE. Surgical and nonsurgical management of Sciatica secondary to a lumber disc herniation: fiveyear outcomes from the marine lumber spine study. Spine. 2001. 26:1179–1187.

2. Buchner M, Zeifang F, Brocai DR, Schiltenwolf M. Epidural corticosteroid injection in the conservative management of sciatica. Clin Orthop Relat Res. 2000. 375:149–156.

3. Carette S, Leclaire R, Marcoux S, et al. Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus. N Engl J Med. 1997. 336:1634–1640.

4. Dooley JF, McBroom RJ, Taguchi T, Macnab I. Nerve root infiltration in the diagnosis of radicular pain. Spine. 1988. 13:79–83.

5. Goebert HW Jr, Jallo SJ, Gardner WJ, Wasmuth CE, Bitte EM. Sciatica: treatment with epidural injection procaine and hydrocortisone. Cleve Clin Q. 1960. 27:191–197.

6. Hong YG, Sa SJ, Kim JD. Selective nerve root block for the treatment of sciatica. J Korean Orthop Assoc. 1997. 32:1056–1062.

7. Kikuchi S, Hasue M, Nishiyama K, Ito T. Anatomic and clinical studies of radicular symptom. Spine. 1984. 9:23–30.

8. Krempen JF, Smith BS, DeFreest LJ. Selective nerve root infiltration for the evaluation of sciatica. Orthop Clin North Am. 1975. 6:311–315.

9. Lee DH, Hahn SH, Yang BK, Yi SR, Chung SW, Kim MS. The short term results of selective nerve root block in herniated lumbar disc patients. J Korean Soc Spine Surg. 2004. 11:216–222.

10. Lindahl O, Rexed B. Histologic changes in spinal nerve roots of operated cases of sciatica. Acta Orthop Scand. 1951. 20:215–225.

11. Macnab I. Negative disc exploration. An analysis of the causes of nerve-root involvement in sixty-eight patients. J Bone Joint Surg Am. 1971. 53:891–902.

12. Ridley MG, Kingsley GH, Gibson T, Grahame R. Outpatient lumbar epidural carticosteroid injection in the management of sciatica. Br J Rheumatol. 1988. 27:295–299.

13. Riew KD, Yin Y, Gilula L, et al. The effect of nerve-root injections on the need for operative treatment of lumbarradicular pain. A prospective, randomized, controlled, double-blind study. J Bone Joint Surg Am. 2000. 82:1589–1593.

14. Shim DM, Kim TK, Song HH, You SS, Cho JD. The usefulness of selective spinal nerve root block. J Korean Soc Spine Surg. 2004. 11:48–54.

15. Shim DM, Park JY, Yang JH, Choi BS. Effectiveness of selective nerve root block on the need for surgical treatment of lumbar disc herniation. J Korean Orthop Assoc. 2008. 43:413–419.

16. Tajima T, Furukawa K, Kuramochi E. Selective lumbosacral radiography and block. Spine. 1980. 5:68–77.

17. White AH, Derby R, Wynne G. Epidural injections for the diagnosis and treatment of low-back pain. Spine. 1980. 5:78–86.