J Korean Soc Spine Surg.  2017 Mar;24(1):32-38. 10.4184/jkss.2017.24.1.32.

Effectiveness of Selective Nerve Root Block for the Treatment of Single-Segment Lumbar Spinal Stenosis and Disc Herniation

Affiliations
  • 1Department of Orthopedic Surgery, School of Medicine, Wonkwang University Hospital, Iksan, Korea. osktg@wonkwang.ac.kr
  • 2Department of Orthopedic Surgery, Kosin University College of Medicine, Busan, Korea.

Abstract

STUDY DESIGN: Retrospective clinical study.
OBJECTIVES
To determine and compare the therapeutic effectiveness of selective nerve root block performed for single-segment spinal stenosis and disc herniation. SUMMARY OF LITERATURE REVIEW: The usefulness of selective nerve root block has been reported in several previous studies, but those results were aggregated across many diseases, making it difficult to estimate its effectiveness for each disease.
MATERIALS AND METHODS
From January 2008 to January 2013, among patients who had undergone selective nerve root block, those who were diagnosed with single-segment spinal stenosis or disc herniation were enrolled in this study. Among a total of 103 patients, 47 spinal stenosis patients were classified as group 1, and 56 disc herniation patients as group 2. Visual analog scale (VAS) scores and Kim's criteria were used to compare the reductions in radiating pain in each group.
RESULTS
In group 1, the VAS scores improved from 7.6 before the procedure to 2.6 and 3.3 at 1-month and 6-month follow-up visits, respectively. Kim's criteria also improved from a mean of 1.6 before the procedure to 2.9 at the 6-month follow-up. In group 2, the VAS scores improved from 7.8 before the procedure to 2.1 and 2.7 at 1-month and 6-month follow-up visits, respectively. Kim's criteria also improved from a mean of 1.8 before the procedure to 3.2 at the 6-month follow-up.
CONCLUSIONS
Radiating pain in the lower limb due to spinal stenosis or disc herniation limited to a single segment was effectively controlled by selective nerve root block.

Keyword

Spinal stenosis; Disc herniation; Selective root block

MeSH Terms

Clinical Study
Follow-Up Studies
Humans
Lower Extremity
Retrospective Studies
Spinal Stenosis*
Visual Analog Scale

Figure

  • Fig.1. Grade of nerve root compression.

  • Fig.2. Measurements were performed on a picture archiving and commu-nication system where the herniation was visualized.


Reference

1. Tadokoro K, Miyamoto H, Sumi M, et al. The prognosis of conservative treatments for lumbar spinal stenosis: analysis of patients over 70 years of age. Spine (Phila Pa 1976). 2005; 30:2458–63.
2. Ng L, Chaudhary N, Sell P. The efficacy of corticosteroids in periradicular infiltration for chronic radicular pain: a randomized, double-blind, controlled trial. Spine (Phila Pa 1976). 2005; 30:857–62.
3. Saal JA, Saal JS. Nonoperative treatment of herniated lumbar intervertebral disc with radiculopathy. An outcome study. Spine(Phila Pa 1976). 1989; 14:431–7.
4. Guigui P, Devyver B, Rillardon L, et al. Intraoperative and early postoperative complications of lumbar and lumbosacral fusion: prospective analysis of 872 patients. Rev Chir Orthop Reparatrice Appar Mot. 2004; 90:5–15.
5. Macnab I. Negative disc exploration. An analysis of the causes of nerve-root involvement in sixty-eight patients. J Bone Joint Surg Am. 1971; 53:891–903.
6. Shim DM, Kim TK, Song HH, et al. The usefulness of selective spinal nerve root block. J Korean Soc Spine Surg. 2004; 11:48–54.
Article
7. Shim DM, Park JY, Yang JH, et al. Effectiveness of selective nerve root block on the need for surgical treatment of lumbar disc herniation. J Korean Orthop Assoc. 2008; 43:413–9.
Article
8. Shim DM, Kim TK, Chae SU, et al. Long term results of the selective spinal nerve root block for the herniated lumbar intervertebral disc. J Korean Soc Spine Surg. 2003; 10:30–5.
Article
9. Narozny M, Zanetti M, Boos N. Therapeutic efficacy of selective nerve root blocks in the treatment of lumbar radicular leg pain. Swiss Med Wkly. 2001; 131:75–80.
10. Tajima T, Furukawa K, Kuramochi E. Selective lumbosa-cral radiculography and block. Spine (Phila Pa 1976). 1980; 5:68–77.
Article
11. Hong YK, Sa SJ, Kim JD. Selective spinal nerve root block for the treatment of sciatica. J Korean Orthop Assoc. 1997; 32:1056–62.
Article
12. Lee DH, Yang SH, Yang BR, et al. The short term results of selective nerve root block in herniated lumbar disc patients. J Korean Soc Spine Surg. 2004; 11:216–22.
Article
13. Vad VB, Bhat AL, Lutz GE, et al. Transforaminal epidural steroid injections in lumbosacral radiculopathy: a prospective randomized study. Spine (Phila Pa 1976). 2002; 27:11–6.
14. Botwin KP, Gruber RD, Bouchlas CG, et al. Fluoroscopi-cally guided lumbar transformational epidural steroid injections in degenerative lumbar stenosis: an outcome study. Am J Phys Med Rehabil. 2002; 81:898–905.
15. Lutz GE, Vad VB, Wisneski RJ. Fluoroscopic transforaminal lumbar epidural steroids: an outcome study. Arch Phys Med Rehabil. 1998; 79:1362–6.
Article
16. Schö nströ m N, Willé n J. Imaging lumbar spinal stenosis. Radiol Clin North Am. 2001; 39:31–53.
17. Willé n J, Danielson B, Gaulitz A, et al. Dynamic effects on the lumbar spinal canal: axially loaded CT-myelography and MRI in patients with sciatica and/or neurogenic claudication. Spine (Phila Pa 1976). 1997; 22:2968–76.
18. Ciric I, Mikhael MA, Tarkington JA, et al. The lateral recess syndrome. A variant of spinal stenosis. J Neurosurg. 1980; 53:433–43.
19. Wildermuth S, Zanetti M, Duewell S, et al. Lumbar spine: quantitative and qualitative assessment of positional (upright flexion and extension) MR imaging and myelography. Radiology. 1998; 207:391–8.
Article
20. Choi SJ, Song JS, Kim C. The use of magnetic resonance imaging to predict the clinical outcome of nonsurgical treatment for lumbar intervertebral disc herniation. Korean J Radiol. 2007; 8:156–63.
21. Kikuchi S, Hasue M, Nishyama K. Anatomic and clinical studies of radicular symptom. Spine (Phila Pa 1976). 1984; 9:23–30.
22. Amundsen T, Weber H, Nordal HJ, et al. Lumbar spinal stenosis: conservative or surgical management. A prospective 10-years study. Spine (Phila Pa 1976). 2000; 25:1424–36.
23. Atlas SJ, Keller RB, Robson D, et al. Surgical and nonsurgical management of lumbar spinal stenosis: four-year outcomes from the Maine lumbar spine study. Spine (Phila Pa 1976). 2000; 25:556–62.
24. Derby R, Kine G, Saal JA. Response to steroid and duration of raducular pain as predictors of surgical out come. Spine (Phila Pa 1976). 1992; 17:176–83.
25. Beynon R, Hawkins J, Laing R, et al. The diagnostic utility and cost-effectiveness of selective nerve root blocks in patients considered for lumbar decompression surgery: a systematic review and economic model. Health Technol Assess. 2013; 17:1–88.
Article
26. Krempen JF, Smith BS, DeFreest LJ. Selective nerve root infiltration for the evaluation of sciatica. Orthop Clin North Am. 1975; 6:311–5.
Article
27. White AH, Derby R, Wynne G. Epidural injections for the diagnosis and treatment of low-back pain. Spine. 1980; 5:78–86.
Article
28. Ridley MG, Kingsley , Gibson T, et al. Outpatient lumbar epidural carticosteroid injection in the management of sciatica. Br J Rheumatol. 1988; 27:295–9.
29. Carette S, Leclaire R, Marcoux S, et al. Epidural corticoste-roid injections for sciatica due to herniated nucleus pulpo-sus. N Engl J Med. 1977; 336:1634–40.
Article
30. Shim DM, Kim TK, Oh SK, et al. Effectiveness of Selective Nerve Root Block on the Need for Surgical Treatment of Lumbar Spine - A Minimum 5 Years Follow up. J Korean Orthop Assoc. 2009; 44:118–22.
31. Kobayashi S, Baba H, Uchida K, et al. Blood circulation of cauda equina and nerve root [Japanese]. Clin Calcium. 2005; 15:63–72.
32. Porter RW. Spinal stenosis and neurogenic claudication. Spine (Phila Pa 1976). 1996; 21:2046–52.
Article
Full Text Links
  • JKSS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr