Selective Nerve Root Block in Patient Selection for Lumbar Surgery

Abstract

The cause of lumbar radicular symptoms often remains elusive after standard clinical and radiographic evaluation. Selective nerve root block is a useful test to indicate whether the pain is neural in origin and/or whether nerve root is pain producing in these patients with equivocal clinical and imaging studies. Over 8 years, the author performed selective nerve root blocks in 215 patients. Of this group, 78 patients underwent surgery. Following surgery, 71 patients were available for a minimum 12-month follow-up. The preoperative diagnoses included previously unoperated-upon lumbar disc herniation, previously unoperated-upon spinal canal stenosis, and prior lumbar surgery. The average follow-up was 34 months (range, 12-96 months). Overall, there were 38 good (53%), 16 fair (23%), and 17 poor (24%) surgical results. The results for those patients who had had prior surgery were disappointing (52% poor). These data reaffirm that surgical intervention should only be recommended for previously operated-upon patients with unequivocal findings.