Efficacy of Transforaminal Steroid Block for Pain Relief Due to Recurrent Lumbar Disc Herniation in Previously Operated Case of Lumbar Discectomy

Abstract

Background: lower Back discomfort as a result of a herniated disc is quite prevalent worldwide, frequently resulting in missed work days and significant changes in affect and motivation. Recurrent lumbar disc herniation is one of the most common problem faced after a lumbar discectomy, most frequently seen among male gender, tall-heighted individuals, heavy workers, obese and smokers. Analgesic and anti-inflammatory medication is the initial course of treatment. But in the majority of instances, it progresses slowly and calls for surgical intervention or minimally invasive treatments like steroid injections. Aims and Objectives: The purpose of this study is to determine whether transforaminal steroid block can be attempted before surgery for pain relief in cases of recurrent herniated lumbar disc with failed conservative management having intractable radicular pain. Materials & Methods: Use of transforaminal selective nerve root block (SNRB) in single level recurrent lumbar disc herniation patients was studied. 40 patients with single lumbar disc herniation, operated with discectomy were studied irrespective of age and sex. All patients were injected with a combination of long acting steroid suspension with local anaesthetic (Bupivacaine-plain) near the affected nerve root via cambins triangle approach and the results were analysed. Result: Those graded mild, were pain free for up to an average of 5.5 months and those graded moderate had 3.3 months of relief. Patients suffering from extensive disc prolapse had immediate post procedural relief but not in long term. 47.5% patients have had a pain free interval upto 6 months. Conclusion: Transforaminal SNRB is an excellent alternative for pain relief in patients with recurrent lumbar disc herniation having failed conservative management with intractable lumbar radicular pain. It was also found to be a cost effective alternative and relatively less invasive, with almost no complication. Keywords: Selective nerve root block, Disc prolapse, Recurrent lumbar disc herniation.