J Korean Soc Spine Surg.  2001 Dec;8(4):527-533.

The Selective Spinal Nerve Root Block as Predictors of Outcome of Operative Treatment in the Lumbar Spine

• Shim DM
• Song HH
• Kim TK
• Ha DH
• Chae SU
• Kim HJ
• Kim JH

Abstract

PURPOSE: The selective spinal nerve root block is one of the preoperative diagnostic tool to identify and confirm the lesion site of primary cause of pain. The purpose of this study was to ascertain the correlation between diagnostic selective spinal nerve root blocks and outcome following surgical treatment of selected levels of both lumbar herniated intervertebral disc (HIVD) and spinal stenosis. MATERIAL AND METHOD: In a total 341 selective nerve root blocks in 169 patients who were diagnosed as lumbar HIVD and spinal stenosis from Jan. 1993 to Jun. 1997 with performed in a retrospective study, two groups of patients were chosen for this study. The result of pain change of selective nerve root block were judged by Denis' pain scale, the end-result selective spinal nerve root and operative treatment used by Kim's criteria. RESULT : 1. The end-results of selective spinal nerve root block, excellent and good results were 64 cases (67.3%) in lumbar HIVD group and 50 cases (67.5%) in spinal stenosis group. The end-results of selective spine surgery, at last follow up, excellent and good results were 82 cases (86.2%) in lumbar HIVD group and 56 cases (75.7%) in spinal stenosis group. RESULT: 2. The predictive value of selective spinal nerve root block was 68.4% in lumbar HIVD group and 74.3% in spinal stenosis group. In addition, statistical analysis with regression analysis, to show any significant correlation between the selective spinal nerve root block results and the outcome of operative treatment, especially in spinal stenosis group.
CONCLUSION
The selective spinal nerve root block is one of the valuable procedure that helpful and predictors of outcome selective operative treatment of lumbar spinal stenosis.

Keyword

Selective spinal nerve root block; Diagnostic tool

MeSH Terms

Follow-Up Studies
Humans
Intervertebral Disc
Retrospective Studies
Spinal Nerve Roots*
Spinal Nerves*
Spinal Stenosis
Spine*

Reference

1). Arnhoff FN, Triplett HB, Pokorney B. Follow - up study of patient treated with nerve blocks for low-back pain. Anesth Analg. 46:170–178. 1977.

2). Berman AT, Garbarino JL, Fisher SM. The effect of epidural injection of local anethesia and corticosteroid of patient with lumbosacral pain. Clin Orthop. 188:144–151. 1984.

3). Brena SF. Nerve block and chronic pain states-an update. Postgrad Med. 78:62. 1985.

4). Brown FW. Management of diskogenic pain using epidural and intrathecal steriods. Clin orthop. 129:72–78. 1977.

5). Cappio M. I1 Tratamento Indrocortisonico per via Epidu -rale Saerale Delle Lombosciatalgie. Reumatismo. 9:60. 1957.

6). Crock H. Normal and pathological anatomy of the lumbar spinal nerve root cannals. J Bone Joint Surg. 63B:487–490. 1981.

7). Delanny TJ, Rowlinson JC, Carron H, Butler A. Epidural steroid effects on nerve and meninges. Anesth Analg. 58:610–614. 1980.

8). Denis F, Armstrong GED, Serls K, Matta L. Acute thoracolumbar burst fractures in the absence of neurologic deficit: A comparison between operative and nonoperative treatment. Clin Orthop. 189:142–149. 1984.

9). Derby R, Kine G, Saal JA. Response to Steroid and Duration of Radicular Pain as Predictors of Surgical Outcome. Spine. 17:176–183. 1992.

10). Dooley J, McBroom R, Tauguchi T. Nerve infiltration in the diagnosis of radicular pain. Spine. 13:79–83. 1988.

11). Esses SL, Moro JK. The value facet joint blocks in patient selection for lumbar fusion. Spine. 18:185–190. 1993.

12). Goebert HW, Jallo SJ Gardner WJ, Wasmuth CE, Bitte EM. Sciatica Treatment with epidural injection pro -caine and hydrocortisone. Studies Cleve Clin. 27:191–197. 1960.

13). Greene LN. Dexathamethasone in the management of symptoms due to herniated lumbar disc, J Neurol Neurosurg Psychiatri. 38:1211. 1971.

14). Haueisen D, Smith B, Myers S. The diagnostic accu -racy of spinal injection studies: Their role in the evaluation of recurrent sciatica. Clin Orthop. 198:179–182. 1985.

15). Herron LD. Selective Nerve Root Block in Patient Selection for Lumbar surgery surgical result, J Spinal Disorder,2-. 2:75–79. 1989.

16). Howe J, Frymoyer JW. The effect of questionnaire design on the determination of end results in lumbar spinal surgery. Spine. 10:804–805. 1985.

17). Kelmanorisu H. Epidural injection therapy of sciatic pain, Am J Surg. 64:183. 1944.

18). Kikuchi S, Hasue M, NIshyama K. Anatomic and clinical studies of radicular symptom. Spine. 9:23–30. 1984.

19). Lindahl D, Rexed B. Histologic changes in spinal nerve roots of operated cases of sciatica. Acta Orthop Scand. 20:215. 1951.

20). Macnab I. Negative disc exploration. J bone Joint surg. 53-A:891–902. 1971.

21). Offierski CM, Macnab I. Hip-spine syndrome. Spine. 8:316–321. 1983.

22). Sanderson PL, Wood PL. Surgery for lumbar spinal stenosis in old people. J Bone Joint Surg. 75-B:393–397. 1993.

23). Shim DM, Kim SS, Han HJ, Lee BC, Sin JH. Selective spinal nerve root block on lumbar disease. J Kor Spine Surg. 1:293–299. 1994.

24). Tajima T, Furukawa K, Kuramochi E. Sel ective lumbosacral radiography and block. Spine. 5:68–77. 1980.

25). Van AP. Pain patterns and diagnostic blocks. The Lumbar Spine. Philadelphia: WB Saunders Co;p. 107–132. 1990.

26). Warfield C, Creews D. Epidural steroid injection as a predictor of surgical outcome. Surg Gynecol Obstet. 164:457–458. 1987.

27). White AH, Derby R, Wynne G. Epidural injection for the diagnosis and treatment of low-back pain. Spine. 578-86:1980.