Ability of diagnostic injection to predict surgical outcomes in patients with chronic low back pain and lumbar radiculopathy

Abstract

BackgroundArising from different anatomical structures of the spine, chronic low back pain is one of the leading causes of disability, and its management is still controversial. Thus, appropriate and effective management of chronic low back pain requires a precise diagnostic tool in order to target pain generators. Therefore, the role of diagnostic injection in predicting the outcome of surgical treatment of chronic low back pain and lower limb radicular pain need to be evaluated in order to guide the surgeon, especially in case of unclear pathoanatomical features. Thus, the aim of this study was to assess the predictive value of lumbar spine diagnostic injections in surgical outcome in patients with chronic low back pain and lumbar radiculopathy.Patients and methodsThis study included 30 patients complaining of chronic low back pain and/or lumbar radiculopathy who underwent lumbar spine surgery following positive diagnostic injections. The pre- and postoperative assessments consisted of a general neurological examination, evaluation of the Oswestry disability index, and a visual analog scale.ResultsThis prospective non-controlled study was conducted on 30 patients complaining of chronic low back pain and/or lumbar radiculopathy. The mean age was 42.60 ± 8.27 years with a range of 24.0–62.0 years. The visual analog scale decreased significantly from preoperative mean value of 8.26 ± 0.79 to postoperative mean value of 1.97 ± 0.92; with almost two-thirds of the patients experienced more than 75% pain reduction. The Oswestry disability index decreased significantly from preoperative mean value of 34.13 ± 4.88 to 11.47 ± 3.36 after surgery in the whole sample. The post-selective nerve root block visual analog scale was significantly correlated to the postoperative visual analog scale, while the postoperative Oswestry disability index was not significantly associated with the post-selective nerve root block visual analog scale.ConclusionThe use of lumbar selective nerve root block and lumbar provocative discography for patients with chronic low back pain and radiculopathy and equivocal radiological findings can improve surgical outcomes regarding pain intensity and spine functional outcomes. Diagnostic selective nerve root block can predict the postoperative pain relief.