Nerve Root Block Research Articles

Satisfaction of patients with frozen shoulder following silent manipulation: a prospective observation study.

Silent manipulation is a procedure for frozen shoulders that involves manipulating the shoulder while the patient is awake by performing C5, C6, and C7 cervical nerve root block under ultrasound guidance. This retrospective study, conducted at Yokohama City University Hospital, aimed to evaluate the clinical outcomes of silent manipulation and assess whether the experience level of the practitioner influenced treatment efficacy. Between October 2020 and January 2022, 53 patients who met the inclusion criteria underwent silent manipulation for frozen shoulder. The procedure was performed by either an experienced or a less experienced practitioner, and the patients were followed-up for up to 1year post-treatment. Silent manipulation resulted in significant improvements in shoulder range of motion, as measured by forward flexion, abduction, external rotation, and hand-behind-back, as well as in patient-reported outcomes, including disabilities of the arm, shoulder, and hand and Shoulder 36 scores. These improvements were observed 1week, 3months, and 1year after silent manipulation, indicating the short-term efficacy of the procedure. Furthermore, this study revealed that the practitioners' level of experience played a significant role in the outcomes. The experienced doctor achieved better 1st external rotation and belt tying outcomes, as well as Shoulder 36 pain, muscle strength, and activities of daily living domain scores. This suggests that technical expertise in silent manipulation is crucial to achieve optimal outcomes. Silent manipulation offers an effective therapeutic approach for frozen shoulder, leading to significant improvements in range of motion and patient satisfaction. Practitioner expertise is a vital factor in treatment success, emphasizing the importance of skilled professionals in the performance of this procedure.

Efficacy and Outcomes of Selective Nerve Root Blocks in Diagnosis: A Systematic Review

Background: Selective nerve root blocks or transforaminal epidural injections are commonly utilized for both diagnosing and treating various spinal disorders, such as radiculopathy or nerve compression. However, there is currently no clear consensus on their role as a diagnostic tool. The effectiveness of these injections in accurately diagnosing the underlying cause of spinal pain remains uncertain, as studies show mixed results regarding their diagnostic reliability. While these injections can provide temporary pain relief and may help identify the specific nerve root involved, their long-term diagnostic value is still a topic of debate. A systematic review of clinical studies was conducted to evaluate the accuracy of selective nerve root injections for diagnosing spinal pain. Methodological quality was assessed using the PRISMA guidelines. Studies were categorized based on the strength of evidence into five levels: problem identification, literature searching, data review and evaluation, data synthesis and analysis or data presentation. Studies were categorized based on the strength of evidence into five levels: conclusive, strong, moderate, limited, or indeterminate. The review included an extensive literature search across multiple databases such as PubMed, Google Scholar and EMBASE. There is limited evidence regarding the effectiveness of selective nerve root injections as a diagnostic tool for spinal pain. Although the research is insufficient to provide stronger support, the existing literature suggests that selective nerve root injections can be useful in diagnosing uncertain cases of radicular pain. Moderate evidence supports their use in preoperative evaluations, particularly when imaging studies are negative or inconclusive. While the positive predictive value of these injections is low, they are valuable for their negative predictive value, meaning they are more effective in ruling out conditions than in confirming them.

Validation of a Novel Provocative Examination Maneuver for the Diagnosis of Lumbar Foraminal Stenosis Through Selective Nerve Root Block Outcomes

Validation of a Novel Provocative Examination Maneuver for the Diagnosis of Lumbar Foraminal Stenosis Through Selective Nerve Root Block Outcomes

Spinal arteriovenous fistula leading to acute paraplegia after a lumbar nerve root block: Successful embolization with complete neurological recovery-a case report.

Spinal arteriovenous fistulas (SAVFs) are the most common type of vascular malformation of the spine in adult patients. They can lead to acute or progressive myelopathy due to venous congestion of the medullary veins. While most SAVFs are acquired, their pathophysiology remains unclear. The natural history of the disease and its clinical presentation are highly influenced by the location of the fistula and various factors may trigger sudden neurological decline. We present a case of a patient who developed a complete spinal cord injury after a lumbar nerve root block, likely due to an undiagnosed SAVF. The patient underwent endovascular embolization, resulting in a complete recovery of neurological function.

Outcomes after selective nerve root blockade for lumbar radicular pain from lumbar disc hernia or lumbar spinal stenosis assessed by the PROMIS-29 – a prospective observational cohort study

PurposeSelective nerve root blocks (SNRB) are used both as a therapeutic and diagnostic tool for lumbar radicular pain. Most studies evaluate the effect of SNRB simply by its relation to pain reduction. It is well known that pain is associated with other factors such as depression, anxiety, inactivity and sleeping disorders, but these patient-related outcomes are seldom evaluated. This study evaluated the influence of SNRB on pain-related outcomes including depression, anxiety, fatigue, pain interference, activity and sleep.MethodsOne hundred three patients with lumbar radicular pain were treated with a SNRB. Patient-reported outcome measures (PROMs) were assessed with the PROMIS-29 for 12 weeks (84 days) following the SNRB. Patients were stratified based on their pain reduction at the 14-day follow up as responders (≥ 30% pain reduction) and non-responders (< 30% pain reduction). Post-treatment duration was estimated with the Kaplan–Meier analysis with return to baseline as an event. A paired t-test was used to compare pre- and post-treatment responses at specific time intervals.ResultsForty-four percent (n = 45) of the patients were responders and showed significant improvement in all parameters throughout the 84-days follow-up, the exception was sleep that lost significance at day 70. The mean post-treatment duration among responders was 59 (52–67) days. Non-responders showed significant improvements in pain interference and pain intensity until day 35 and in ability for social participation until 21-day.ConclusionSNRB can improve pain intensity, pain interference, physical function, fatigue, anxiety, depression, sleep disturbance and the ability to participate in social roles.

Ultrasound-Guided Cervical Selective Nerve Root Block versus Fluoroscopy-Guided Interlaminar Epidural Injection for Cervical Radicular Pain: A Randomized, Prospective, Controlled Study.

Ultrasound (US)-guided cervical selective nerve root block (CSNRB) procedures are increasingly being performed as an alternative to conventional fluoroscopy (FL)-guided epidural injections for the treatment of cervical radicular pain. The aim of this study was to compare the effectiveness of US-guided CSNRB versus FL-guided interlaminar cervical epidural steroid injection (IL-CESI) for cervical radicular pain. A total of 60 patients with cervical radicular pain due to a single-level disc herniation were randomized into either the FL or US group. The numeric rating scale, Short Form-36, and neck disability index were evaluated before treatment at months 1, 3, and 6 after treatment. Procedure time, complications, pain medication consumption, and patient satisfaction were also recorded. Patients experienced significant improvement in pain, disability, and quality of life scores up to 6 months after the procedure (p < 0.001). Treatment success rate was achieved in 56.6% of the IL-CESI group and 50% of the CSNRB group without any significant difference between the study arms (p = 0.617). US-guided CSNRB was shown to be as effective as the FL-guided IL-CESI in the treatment of cervical radicular pain, in addition to the absence of radiation exposure and requiring less procedure time.

Clinical outcome of therapeutic spinal nerve root block and facet joint infiltration with methylprednisolone with lidocaine given in patients with lumbosacral radiculopathy: A case series

Clinical outcome of therapeutic spinal nerve root block and facet joint infiltration with methylprednisolone with lidocaine given in patients with lumbosacral radiculopathy: A case series

Therapeutic Efficacy of Ultrasound-Guided Selective Nerve Block on Chronic Cervical Radiculopathy.

Background and Objectives: Cervical radiculopathy (CR) manifests as pain and sensorimotor disturbances in the upper extremities, often resulting from nerve root compression due to intervertebral disc herniation, degenerative changes, or trauma. While conservative treatments are initially preferred, persistent or severe cases may require surgical intervention. Ultrasound-guided selective nerve root block (SNRB) has emerged as a promising intervention for alleviating symptoms and potentially obviating the need for surgery. This study evaluates the therapeutic efficacy of ultrasound-guided SNRB in managing chronic CR, aiming to determine its potential in symptom relief and delaying or avoiding surgical procedures. Materials and Methods: A retrospective analysis was conducted on 720 outpatients treated for CR between October 2019 and March 2022. After excluding patients with traumatic CR, previous surgeries, malignancies, progressive neurological symptoms requiring immediate surgery, or inadequate conservative treatment, 92 patients who had experienced cervical radicular pain for more than three months and had failed to improve after more than six weeks of conservative treatment with VAS scores ≥ 5 were included. The patients underwent single or multiple ultrasound-guided SNRB procedures, involving the injection of dexamethasone and lidocaine under real-time ultrasound guidance. Symptom severity was assessed at the baseline, and at 4, 8, and 12 weeks post-procedure using the Visual Analog Scale (VAS). The data collected included age, sex, presence of neck and/or radicular pain, physical examination findings, recurrence of symptoms, improvement in symptoms, and whether surgical intervention was ultimately required. Statistical analyses were performed to identify the factors associated with symptom improvement or recurrence. Results: Significant symptom improvement was observed in 69 (75.0%) participants post-SNRB, with 55 (79.7%) showing improvement at 4 weeks, 11 (15.9%) at 8 weeks, and 3 (4.4%) at 12 weeks. Symptom recurrence, defined by an increase in VAS score accompanied by a pain flare lasting at least 24 h after a pain-free interval of at least one month, was noted in 48 (52.2%) patients. The presence of combined neck and radicular pain was a significant predictor of recurrence (p = 0.008). No significant associations were found between symptom relief and factors such as age, gender, initial pain severity, or MRI findings. Conclusions: Ultrasound-guided SNRB effectively manages chronic CR, providing substantial symptom relief and potentially reducing the need for surgical intervention. This technique offers a promising conservative treatment option, especially given its real-time visualization advantages and minimal radiation exposure.

Functional Outcomes of Therapeutic Selective Nerve Root Block for Single-Segment Lumbar Spinal Stenosis: A Retrospective Study.

BACKGROUND Functional evaluation after therapeutic selective nerve root block (SNRB) has been rarely reported. We explored functional outcomes of SNRB for single-segment lumbar spinal stenosis (LSS). MATERIAL AND METHODS Data for 117 patients with single-segment LSS who underwent single therapeutic SNRB were retrospectively collected between January 2019 and December 2021. Functional outcomes were assessed using Oswestry Disability Index (ODI) and Japanese Orthopaedic Association (JOA) scores preoperatively, and 3 days, and 3, 6, and 12 months after SNRB, which were compared in subgroups stratified by age, sex, BMI, sedentary time, hypertension, diabetes, affected side, pathology level, intervertebral disk. Correlation between ODI and JOA was analyzed using univariate linear regression analysis. RESULTS Clinical symptoms of LSS significantly improved within 12 months after SNRB, especially at 6 months (P<0.05). ODI scores in each subgroup gradually decreased within 6 months after SNRB, and JOA scores gradually increased. Most subgroup analyses revealed significantly increased ODI scores and decreased JOA scores at 12 months after SNRB, compared with 6-month scores (P<0.05). Notably, ODI and JOA scores at 12 months after SNRB were not significantly different than those before SNRB in patients with BMI >25 or sedentary time >8 h (P>0.05). A significant correlation existed between ODI and JOA scores (P<0.05). CONCLUSIONS Therapeutic SNRB was an effective treatment for alleviating LSS within at least 6 months. Changing sedentary habits with appropriate exercise and controlling weight with a healthy diet can improve the effectiveness of SNRB, especially in patients for whom conservative treatment is ineffective and who are unsuitable for surgical treatment.

Ultrasound-guided versus fluoroscopy-guided lumbar selective nerve root block: a retrospective comparative study

The purpose of this study is to compare the accuracy and effectiveness of ultrasound-guided and fluoroscopy-guided lumbar selective nerve root block (SNRB), and to explore the feasibility of ultrasound-guided methods. This retrospective study included patients with lumbar radicular pain who underwent ultrasound-guided and fluoroscopy-guided selective nerve root block at Honghui Hospital Affiliated to Xi’an Jiaotong University from August 2020 to August 2022. Patients were divided into U-SNRB group and F-SNRB group according to ultrasound-guided or fluoroscopy-guided selective nerve root block. There were 43 patients in U-SNRB group and 20 patients in F-SNRB group. The pain visual analogue scale (VAS) scores, Japanese Orthopaedic Association (JOA) scores, related indexes and complications were recorded and compared between the two groups before, 30 min, 1 month and 6 months after block. To evaluate the feasibility, accuracy and effectiveness of ultrasound-guided selective nerve root block. There were no complications in the process of selective nerve root block in both groups. The operating time and the times of closing needle angle adjustment in U-SNRB group were better than those in F-SNRB group, and the difference was statistically significant (P < 0.05). The VAS score and JOA score of patients in the two groups were significantly improved 30 min after block, 1 month and 6 months after block, and the difference was statistically significant (P < 0.05). There was no significant difference between the two groups (P > 0.05). The accuracy of ultrasound-guided selective nerve root block and the degree of pain relief of patients were similar to those of fluoroscopy guidance, but the operation time and needle angle adjustment times were significantly less than that of fluoroscopy, and could effectively reduce radiation exposure. Therefore, it can be used as a better way to guide for choice.

Clinical Outcomes of Percutaneous Transforaminal Endoscopic Discectomy Assisted with Selective Nerve Root Block for Treating Radicular Pain with Diagnostic Uncertainty in the Elderly.

To investigate the clinical outcomes of percutaneous transforaminal endoscopic discectomy assisted with selective nerve root block for treating radicular pain with diagnostic uncertainty in the elderly. A total number of 36 elderly patients were included in the study. Clinical outcomes collected for analysis include operative time, hospital stay time, Visual Analog Scale, and Oswestry Disability Index before and after the surgery, the global outcome based on the Macnab outcome criteria. Seventeen males and nineteen females with a mean age of 73.72 ± 7.15 were included in this study. Radicular pain was the main complaint of all the patients with the least symptom duration of two months. Radiological findings showed that 80.6% of the patients with multilevel disc herniation, 16.7% received lumbar fusion surgery before, and 8.3% with degenerative scoliosis. Besides, 69.4% of the patients have at least one comorbidity. 85.4% of the patients showed a positive response to selective nerve root block, and 91.6% of the patients reported a favorable outcome at the last follow-up. The mean value of pre-operative leg pain was 7.56 ± 0.74 and dramatically decreased after surgery (2.47 ± 0.81, P < 0.001). Besides, the mean value of Oswestry Disability Index decreased from 43.03 ± 4.43 to 5.92 ± 5.24 (P < 0.001) one year after the surgery. Multilevel degeneration of the lumbar spine is common in elderly patients. Identifying the responsible segment and decompressing the nerve root through minimally invasive surgery can provide a satisfactory clinical outcome for those with radicular pain as their primary complaint. And selective nerve root block is a reliable diagnostic tool for those with an ambiguous diagnosis.

Potential S1 Nerve Root Blocks Associated with Sacroiliac Joint Injections.

Sacroiliac (SI) joint dysfunction is a common cause of lower back pain. The diagnosis of SI joint pain remains challenging. Sacroiliac joint injection remains the gold standard of diagnosis of SI joint pain as well as providing therapeutic effect. One complication related to SI joint injection is temporary numbness and weakness of the leg. To evaluate the anatomy of the SI joint and the flow of the contrast in the sacroiliac joint and to understand how local anesthetic can affect the nerve roots and cause temporary weakness and numbness of the leg. Study Design. Retrospective case series. Setting. Academic medical center. Patients who underwent SI joint injection with three-dimensional cone beam computed tomography with fluoroscopy (3D-CBCT) imaging were identified through retrospective review of two providers' case log from the electronic medical record. The cone beam CT images were reviewed to study the contrast spread and flow in the SI joint. 27/32 patients with the mean age of 56 years (range 39-87 years), 20 females, and 7 males were included in this study. After reviewing cone beam CT images, 4/27 (14.8%) patients showed contrast spread in the SI joint and spread into the S1 posterior neuroforamen. The remainder 23/27 (85.2%) patients had contrast localized in the SI joint. Limitations. Small population size, retrospective review of medical records. Our results indicate that the injection of lower concentration of local anesthetic with less volume may be necessary to decrease the risk of S1 nerve root block and epidural block. Furthermore, to improve the specificity of a diagnostic SI injection, an appropriate evaluation should be considered to rule out any S1 nerve pathology as a significant pain generator.

Study of Efficacy of Selective Nerve Root Block in Patients of Lumbar Radiculopathy with Disc Prolapse

Study of Efficacy of Selective Nerve Root Block in Patients of Lumbar Radiculopathy with Disc Prolapse

TÉCNICAS COMBINADAS DE BLOQUEIO PERIDURAL SACRAL E BLOQUEIO FORAMINAL NO TRATAMENTO DE DOENÇAS DEGENERATIVAS DA COLUNA LOMBAR: UMA ANÁLISE DE CUSTO-EFETIVIDADE

ABSTRACT Objective: This study aims to assess cost-effectiveness of caudal epidural block with transforaminal nerve root block in the treatment of degenerative diseases of the lumbar spine. Methods: A total of 47 patients with lumbar sciatica symptoms were included. Low back pain and leg pain were assessed using the visual analogue scale (VAS), both in the pre-procedure and one week after. The cost-effectiveness and value required to improve each point on the VAS were estimated using addition, division, and rule of three calculations. Results: For low back pain, scores ranging from 2 to 10 were found before the procedure, with a mean of 7.5 ± 2.14 (95%CI: 6.8–8.1). A week after, these scores ranged from 0 to 10, with a mean of 3.1±2.8 (95%CI: 2.3–4.0; p &lt; 0.0001). Regarding leg pain, scores ranging from 1 to 10 were noted before the procedure, with a mean of 6.8 ± 2.5 (95%CI: 6.1–7.4). A week after, these scores ranged from 0 to 9, with mean of 2.4 ± 2.5 (95%CI: 1.8–3.1; p &lt; 0.0001). The cost of the materials used during the procedure was 214.72 BRL. Conclusion: Caudal epidural with transforaminal nerve root block were a cost-effective treatment modality for patients with degenerative diseases of the lumbar spine. Level of evidence III, Retrospective cohort study.

Hidden risk of gadolinium-based contrast agents during interventional pain medicine procedures: a retrospective chart review

IntroductionEpidural steroid injections and epidural blood patches commonly involve the injection of a small amount of radiocontrast media under fluoroscopy to properly identify the target tissue or anatomic space and...

A New, Effective, Safe, and Accurate Method of Cervical Selective Nerve Root Block

Objective: Cervical selective nerve root block (SNRB) is an effective procedure that has long been performed for patients with radiating pain or paresthesia. However, there are several delicate structures around the cervical nerve root, damage to which could lead to irreversible neurovascular injury. Therefore, cervical SNRB requires a high skill level and extensive experience to execute it safely. To overcome these disadvantages, we used biplane computed tomography (CT)-guided fluoroscopy and a needle guidance program to achieve symptom improvement in a safer and shorter procedure. This study aimed to investigate the new method and report on its excellent clinical effects.Methods: A total of 57 patients who experienced radiating pain due to cervical spinal stenosis resulting from a herniated disc were enrolled. From September 2020 to September 2021 subjects underwent a biplane CT-guided fluoroscopic nerve block at an outpatient clinic. All procedures were performed by biplane CT-guided fluoroscopy. We analyzed treatment effects with a numerical rating scale (NRS) at 2 and 4 weeks after the procedure. Logistic regression was performed to reveal the significance of changes in NRS after the injection.Results: Pain improved in 56 of 57 patients (98%) after 2 and 4 weeks of follow-up compared to pre-injection pain. At the 2-week follow-up, the mean reduction based on NRS scores was 3.226 (2.782-3.674, 0; 95% confidence interval [CI], p &lt; 0.001) indicating a 48% decrease in pain scores compared with the initial NRS. The mean reduction in NRS 4 weeks after the procedure was 3.544 (3.090-3.998, 0; 95% CI, p &lt; 0.001) indicating a 52% reduction compared with the initial NRS. The average duration of the procedure was 4 minutes. Conclusion: We demonstrate a clinically effective, safe, and accurate method using a biplane CT-guided fluoroscopy and needle guide program. This new method can be an easy and relatively uncomplicated alternative to treatment for patients with cervical radiculopathy and provides safe and accurate targeting, making it easy for inexperienced surgeons.

Anatomical Analysis of the S1 Neural Foramen Using Three-Dimensional Computed Tomography Imaging: Insights for Effective S1 Nerve Root Block

The first sacral nerve root block (S1 NRB) is used to diagnose and treat lumbosacral and radicular pain. This study aims to clarify the anatomy of the S1 neural foramen using three-dimensional (3D) computed tomography (CT) images and to establish the optimal fluoroscopic angle, localize the S1 neural foramen on fluoroscopy, and determine the safe puncture depth for S1 NRB. In this single-center cohort study, 200 patients with lumbar degenerative disease who underwent preoperative CT were enrolled. Four distinct studies were conducted using the CT data. Study 1 examined the correlation of the sacral slope angle and the supine and prone positions. Study 2 analyzed the tunnel view angle (TVA) using 3D reconstruction. Study 3 ascertained the location of the S1 neural foramen in fluoroscopy images. Study 4 investigated the safe depth for performing S1 NRB. The regression analysis in Study 1 revealed a correlation of the sacral slope angle and the supine and prone positions. Study 2 determined an optimal fluoroscopic TVA of approximately 30° for the S1 NRB. Study 3 found that the S1 neural foramen was located caudal to the L5 pedicle 1.7±0.2 times the distance between the L4 and L5 pedicles. Study 4 revealed that the depths of the S1 neural foramen and root were 27.0±2.1mm and 16.5±2.0mm, respectively. Our study suggests an optimal fluoroscopic angle, a simple method to locate the S1 neural foramen on fluoroscopy, and an ideal puncture depth for a safe and effective S1 NRB.

Risk factors for recurrence of frozen shoulder after shoulder manipulation under ultrasound-guided cervical nerve root block

This study aimed to investigate risk factors for recurrence of frozen shoulder after shoulder manipulation under ultrasound-guided cervical nerve root block (MUC). We retrospectively reviewed 135 frozen shoulders in 121 patients who underwent MUC. We defined frozen shoulder as a limited shoulder range of motion (ROM) (passive forward flexion <120°, external rotation <30°, or internal rotation lower than L3). Patients fulfilling any one criteria were considered to have frozen shoulder. If patients continued to have severe pain and limited ROM at 3 months after MUC, we defined as recurrence of frozen shoulder and they were offered a further MUC or arthroscopic capsular release (ACR). We compared the ROM, Constant Shoulder (CS) score, and University of California, Los Angeles score before and 3 months after MUC between patients with the successful of MUC group (Success group) with those recurrence of frozen shoulder who required a further MUC or ACR group (Recurrence group). Multiple logistic regression analysis was used to identify risk factors for recurrence of frozen shoulder after MUC. Patients who underwent MUC were retrospectively enrolled and divided into: the successful of MUC group (Success group, n=112) and required a further MUC or ACR group (Recurrence group, n=9). The Recurrence group had significantly lower external rotation and CS score before MUC than those in the Success group (P<.05). The Recurrence group showed significantly inferior all ROM and functional scores 3 months after MUC (P<.05). The levels of blood glucose and hemoglobin A1c both before and 3 months after MUC in the Recurrence group showed inferior compared with those of Success group. The difference, although not statistically significant, trended towards significance (before MUC/3 months after MUC; the glucose levels P=.06/.06, the hemoglobin A1c levels P=.07/.09, respectively). The visual analog scale pain score (at rest, during activity, at night) both before and 3 months after MUC in the Recurrence group showed significantly higher scores compared with those of Success group (P<.05). Multiple logistic regression analysis revealed that lower CS score before MUC was independent risk factor for recurrence of frozen shoulder after MUC. The overall incidence of recurrence of frozen shoulder after MUC was 7.4%. The lower CS score before MUC was an independent risk factor for recurrence of frozen shoulder after MUC. Moreover, patients in the Recurrence group tended to have poorly controlled diabetes and higher visual analog scale pain score both before and 3 months after MUC.

Results from an expedited spinal nerve root block clinic at a UK tertiary neurosurgical centre

Study designRetrospective Observational Study. IntroductionLumbar radicular pain has a prevalence of 3–5%. Level 1 evidence has demonstrated equivalence between surgical and injection treatment. We assess the outcomes from a transforaminal epidural steroid injection clinic in a tertiary neuroscience referral centre. MethodsWe performed an analysis of data from consecutive patients entered into a new internal referral database between August 2018 to May 2021. Radicular pain was classified as one of “first presentation” or “recurrence”. Outcomes were obtained from follow up clinic letters and recorded in a binary manner of “positive result” or “negative result”. Spinal pathology was documented from radiology reports and MRI images. ResultsWe analysed 208 patients referred to the clinic. Excluding those who improved to a point of not requiring treatment, and those who underwent surgical intervention, 119 patients undergoing injection were included, of which 14 were lost to follow-up. 68 % of patients had a positive result from injection. Subgroup analysis demonstrated good outcomes for both hyperacute (<6 weeks) and chronic (>12 months). Contained disk pathologies had better outcomes than uncontained. There was no difference in outcomes across grades of compression, but previous same level surgery was associated with poorer response rates. ConclusionsThere is a high rate of natural resolution of symptoms in patients with LSRP. In those where pain persists, TFESI is a valuable first line treatment modality. This study suggests the efficacy of TFESI is potentially independent of grade of stenosis and chronicity of symptoms. Contained disc pathologies respond better than uncontained.

Revisional Endoscopic Foraminal Decompression via Modified Interlaminar Approach at L5-S1 after Failed Posterior Instrumented Lumbar Fusion in Elderly Patients.

Elderly people usually have poorer surgical tolerance and a higher incidence of complications when undergoing revision surgery after posterior instrumented lumbar fusion (PILF). Full-endoscopic transforaminal surgery is a safe and effective option, but sometimes, it is difficult to revise L5-S1 foraminal stenosis (FS) after PILF. Therefore, we developed full-endoscopic lumbar decompression (FELD) at the arthrodesis level via a modified interlaminar approach under local anesthesia. This study aimed to describe the technical note and clinical efficacy of the technique. Eleven patients with unilateral lower limb radiculopathy after PILF underwent selective nerve root block and then underwent FELD. Magnetic resonance imaging (MRI) and computer tomography (CT) were performed on the second postoperative day. Their clinical outcomes were evaluated with a Visual analog scale (VAS) of low back pain and sciatica pain, Oswestry disability index (ODI), and the MacNab score. Complete decompression was achieved in every case with FELD without serious complications. Postoperative VAS of sciatica pain and ODI at each time point and VAS of low back pain and ODI after three months postoperatively were significantly improved compared with those preoperative (p < 0.05). According to the MacNab criteria, seven patients (63.6%) had excellent results at the two-year follow-up, and four patients (36.4%) had good results. No patients required further revision surgery. FELD, via a modified interlaminar approach, is effective for treating unilateral L5-S1 FS after PILF in elderly people.