Abstract
Lower back pain with radiculopathy is one of the common complaints that patient presents to an orthopaedician. Study was done to assess effect of extraforaminal Selective Nerve Root Block (SNRB) in management of lumbar radiculopathy in 50 patients between December 2019 and June 2020 at Bapuji Medical College and Chigateri General Hospital, Davanagere, Karnataka, India. Extraforaminal SNRB was performed and Visual Analogue Scale (VAS) scores recorded pre procedure, immediate post procedure, one month and 6 months post procedure. Significant decrease (p<0.001) in VAS scores immediate post procedure by 5 or more points in 25%; by 3-4 points in 44% and 1-2 points in 6% of the patients obtained. One month post procedure showed statistically significant results (p<0.005) owing to change in VAS score by 1-2 points in 84% (42) patients and no change or increase in the VAS scores only in 10%(5) patients. VAS scores at 6th month showed statistically significant results (p<0.005) with reduction of VAS scores in 46.34% (19), retention of VAS score 0 in 31.70% (13) and no change or increase in VAS scores in only 21.95% (9) patients. Our study concludes that extraforaminal SNRB acts as excellent diagnostic tool and therapeutic modality for immediate and long term pain management in lumbar radiculopathy. Increase in the pain scores at 6th month (p=0.2) shows that recurrence of symptoms is a possibility. Further randomized control studies with larger study population, association of patient factors affecting extraforaminal SNRB would give better insight and knowledge of the factual data.
Highlights
Lower back pain with radiculopathy is one of the common complaints that patient presents to an orthopaedician
Patients between age group of 20 and 70 years, who presented with complaints of lower back ache and radiating pain to lower limb, diagnosed clinically to have lumbar radiculopathy without neurological and motor weakness and its pathology confirmed to be intervertebral disc prolapse affecting single lumbar nerve root post magnetic resonance imaging (MRI) and patients willing and consenting for the procedure were selected
Majority of the patients who presented with lower back ache were females (68%) which is similar to the results found in several researches directed towards studying the prevalence of lower back ache and radiculopathy to lower limbs in males and females and agrees with the results of mean age groups found to be affected [21, 22]
Summary
Lower back pain with radiculopathy is one of the common complaints that patient presents to an orthopaedician. It is a common and benign disease that affects almost all persons with a lifetime prevalence of up to 84% [1] and defined as pain from lower back radiating to lower limb along the course of a particular lumbar nerve [2,3,4]. The condition can be managed with conservative treatment unless there is indication for surgical management. Immediate surgery is indicated in patients with lumbar radiculopathy associated with foot drop or bladder incontinence [9]. Causes of lumbar radiculopathy includes intervertebral disc prolapse, degenerative osteophytes, facet joint hypertrophy ligamentum flavum hypertrophy that can cause foraminal stenosis and irritation of the exiting nerve roots [10]
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