Selective Nerve Research Articles

New ultrasound-guided L5 selective nerve root block puncture approach for the treatment of pain due to high-iliac-crest lumbar disc herniation: A case report.

Lumbar 5 (L5) selective nerve root block is a common treatment for lumbar 4/5 disc herniation. It is difficult to perform real-time ultrasound-guided targeted L5 nerve root block because of the deep structure of the L5/S1 intervertebral foramen and the occlusion of the sacrum and ilium. Therefore, the safe and efficient implementation of L5 nerve root block is very important for improving the clinical promotion and use of this procedure. A 43-year-old male, who presented with a 1-month history of lumbosacral and left lower limb pain. The characteristic manifestation of pain symptoms was continuous and distending-like pain, accompanied by numbness on the posterior side of the left lower limb. The pain could be exacerbated by prolonged standing, sedentary behavior, and turning over while being relieved by lying down to rest. The visual analog score was 7 triggered by innocuous stimuli, configuring a clinical picture of typical protrusion of the lumbar intervertebral disc. Physical examination: muscle tenderness, straight leg-raising test of the left lower limb was 60° (+), test of supinating and throwing out one's belly (+), and Achilles tendon reflex (-). The patient underwent an ultrasound-guided L5 nerve root block with a modified puncture approach technique called the "transverse process-zygapophysis separation method." The patient had a successful nerve blockade characterized by significant reduction in pain after the operation. The innovative puncture approach method may be considered a therapeutic option in patients with chronic pain.

Effectiveness of Kabat Technique versus Mirror Book Therapy on clinical and electrophysiological parameters in patients with Bell’s palsy: a comparative interventional study

BackgroundBell’s palsy significantly impacts facial function, aesthetics, and quality of life.ObjectiveTo compare the effects of the Kabat Technique (KT) and Mirror Book Therapy (MBT) on clinical and electrophysiological parameters in patients with Bell’s palsy.MethodsThis randomized controlled trial included 31 patients divided into two groups: KT (n = 16) and MBT (n = 15). Both groups received their respective interventions (6 days/week for 3 weeks) in addition to conventional physiotherapy. Sunnybrook Facial Grading Score and Nerve Conduction Test (amplitude and latency of frontalis, nasalis, and mentalis muscles) were assessed pre- and post-intervention.ResultsStatistical analysis (SPSS v20) revealed significant intragroup improvements in all outcome measures (p < 0.05). Intergroup comparison showed MBT had superior improvements in amplitude of frontalis and reduced latency of nasalis. Both groups demonstrated significant improvement in the Sunnybrook grade shift.ConclusionThis study suggests that KT and MBT, combined with conventional physiotherapy, positively impact clinical and electrophysiological parameters in Bell's Palsy patients. MBT showed superior results in select Nerve Conduction Test parameters.

Interventional Pain Management in Degenerative Spine Disorders: A Case Report

Low back pain (LBP) is a common health issue affecting a significant portion of the population, particularly adults aged 35-55 years. Nearly 70-80% of individuals in developed countries experience LBP at some point in their lives. We reported a 54-year-old female presenting with LBP persisting for one year. Her pain predominantly occurs during walking, is limited to 100 meters, and is characterized by gripping sensations in the thigh and calf, exacerbated by positional changes but relieved with rest. Imaging revealed anterior listhesis of the L4 vertebral body relative to L5 (&lt;25%) and multiple bulging discs at various lumbar levels, most notably severe at L4-5 with moderate central and severe bilateral neural foraminal stenosis. The patient underwent Selective Nerve Root Block (SNRB) and facet joint blocks with local anesthetic and steroid medication, resulting in a reduction of pain complaints and decreased leg numbness post-intervention. Understanding and addressing specific spinal pathologies in this case was expected to guide effective treatment strategies to alleviate symptoms and improve patient function.

Is the Silfverskiöld Test a valid tool for evaluating calf muscles spastic overactivity in patients with stroke? A retrospective observational study.

Spastic equinus (plantar flexed) foot is a common postural pattern in patients who suffer from post-stroke spasticity. To date, some clinicians use the Silfverskiöld Test in their practice to differentiate between gastrocnemius and soleus muscle overactivity in patients with spastic equinus (plantar flexed) foot. This use of the Silfverskiöld Test goes beyond its original aim, which was to distinguish isolated gastrocnemius contracture in patients with equinus deformity. The aim of this study was to investigate the Silfverskiöld Test validity for evaluating spastic equinus (plantar flexed) foot (i.e., differentiation between gastrocnemius and soleus muscle overactivity) by checking its outcome against those of selective diagnostic nerve block of tibial motor nerve branches to the soleus, gastrocnemius and tibialis posterior muscles. The design of the study was retrospective observational. The study was set in a university hospital. Sixty-seven adult stroke patients with spastic equinus (plantar flexed) foot. Each patient underwent selective diagnostic nerve block of tibial motor nerve branches to the soleus, gastrocnemius and tibialis posterior muscles. All patients were evaluated before diagnostic nerve block by means of the Silfverskiöld Test which was considered positive when ankle joint passive dorsiflexion was greater with the knee flexed than extended. Furthermore, they were assessed before and after nerve block by means of the modified Ashworth Scale and the Tardieu Scale. Our sample included 41 males and 26 females (mean age 57.6 years) suffering from spastic equinus (plantar flexed) foot due to chronic stroke (mean time from onset 2.4 years). Forty-eight patients out of 67 presented with positive Silfverskiöld Test. The χ2 test showed no association between the Silfverskiöld Test and spastic overactivity of the gastrocnemius (P=0.253), soleus (P=0.605) and tibialis posterior (P=0.462) muscles as evaluated by serial selective diagnostic block of the tibial nerve motor branches. Our findings do not support the Silfverskiöld Test as a valid tool for evaluating spastic equinus (plantar flexed) foot to differentiate between gastrocnemius, soleus and tibialis posterior spastic muscle overactivity in adult patients with stroke. The choice for an appropriate management of spastic equinus (plantar flexed) foot in adults with stroke should not be mainly defined on the base of Silfverskiöld Test.

A Comparative Study Between Selective Nerve Root Blocks Versus Caudal Epidural Steroid Injection in the Management of Lumbar Radiculopathy.

Lumbar radiculopathy is one of the most common disorders encountered by a spine surgeon. The condition involves back pain, which may radiate to the lower limbs, and neurological symptoms, which involve a specific nerve root. Caudal epidural steroid injections (CESIs) and selective nerve root blocks (SNRBs) are two of the most common interventions, which are used to control the pain and neurological symptoms associatedwith chronic lumbar radiculopathy. This study compares the two nonsurgical treatment procedures and aims to assist medical professionals dealing with this condition, in makingan informed decision regarding which procedure would be better suited for their patients. Our study showed that CESIs better alleviated pain and had a greater improvement in functional impairment at short-term (one month) follow-up. However, both procedures had similar efficacy at three-month follow-up.

Added value of 18Fluorine-fluorodeoxyglucose (18F-FDG) PET/MRI for evaluation of failed back surgery syndrome: comparison with non-contrast MRI.

Given increasing research suggesting the utility of positron emission tomography/magnetic resonance imaging (PET/MRI) in identifying the pain generator of low back pain, our study aims to assess its effectiveness in evaluating the source of pain in patients with failed back surgery syndrome (FBSS) by comparing the performance of fluorine-18-labeled fluorodeoxyglucose (18F-FDG) PET/MRI with conventional MRI. We retrospectively analyzed data from patients with FBSS who underwent 18F-FDG PET and MRI of the lumbar vertebrae and lower extremities for undetermined sources of pain. We assessed 1) The diagnostic reliability and efficacy of MRI and 18F-FDG PET/MRI according to correct differential diagnosis, affected level, and affected side of the pain source compared to the findings of selective root or peripheral nerve block or revision lumbar spine surgery; and 2) The association between standardized uptake value (SUV) and standardized uptake value ratio (SUVR) threshold and accuracy of the suspected pathology on 18F-FDG PET/MRI. Among 30 included patients, the diagnostic accuracy of pain source recognition was higher for 18F-FDG PET/MRI than for MRI alone (1.0 vs. 0.4 in spinal disease and 0.8 vs. 0 in lower extremity disease, both p < 0.05). SUVR values of 1.4-1.5 showed the highest accuracy (0.93), higher than the accuracy obtained using the SUV threshold (0.87). 18F-FDG PET/MRI added value to MRI alone in detecting of hypermetabolic activity associated with pain from spinal and non-spinal sources.

Ultrasound-guided forearm selective nerve block: A bright future on the horizon

Objective: In light of the advancement of modern medicine, anesthesiologists and surgeons are increasingly prioritizing patient comfort in diagnostic and therapeutic procedures. A growing body of research revolves around the utilization of ultrasound-guided forearm selective nerve blocks for surgeries involving the distal upper limb. This review aims to provide an overview of regional anesthesia techniques in forearm, hand, and wrist surgeries, laying a theoretical foundation for the prospects of ultrasound-guided forearm selective nerve blocks in optimizing comfort during diagnostic and therapeutic procedures. Methods: A retrospective review of literature sourced from the PubMed database was conducted to comprehensively evaluate and elucidate the advantages and drawbacks of ultrasound-guided forearm selective nerve blocks, brachial plexus blocks, Bier blocks, and wrist blocks. Additionally, a summary was provided regarding the selection of local anesthetics for ultrasound-guided forearm selective nerve blocks. Results: Overall, ultrasound-guided forearm selective nerve block techniques exhibit several advantages over Bier’s block, brachial plexus block, and wrist block for the majority of forearm, wrist, and hand surgeries. These advantages include reduced anesthesia-related time, prolonged duration of analgesia, and minimal impairment of upper extremity motor function. Consequently, these techniques enhance surgical safety and facilitate postoperative recovery. Furthermore, the addition of dexmedetomidine or dexamethasone to ultrasound-guided selective nerve blocks of the forearm could extend the duration of analgesia. Conclusion: Ultrasound-guided forearm selective nerve block is a straightforward and conducive anesthesia method for distal upper limb surgeries, aligning with the principles of fast surgical recovery and enhanced patient comfort during diagnostic and therapeutic procedures. Given its manifold benefits, widespread promotion and adoption of this technique in clinical practice are warranted.

Evaluation of the efficacy of ultrasound-guided selective cervical nerve root pulsed radiofrequency treatment in patients with chronic cervical radicular pain.

Management of cervical radicular pain is complex and may be resistant to conservative treatment. The primary aim of this study was to evaluate the efficacy of ultrasound-guided selective cervical nerve root pulsed radiofrequency (US-SCNR PRF) treatment in patients with radicular neck pain due to cervical disc herniation who did not respond to conservative treatment. The secondary aim was to determine the efficacy of the treatment in terms of functionality, neuropathic pain, and treatment-related adverse events. This study included 62 patients with chronic cervical radicular pain who underwent US-SCNR PRF treatment. Pain intensity was assessed using the Numerical Rating Scale before treatment and at 1, 3, and 6months after treatment. The Neck Disability Index and Douleur Neuropathique 4 Questions were used to assess functionality and neuropathic pain before and 6months after treatment. Significant pain relief was defined as ≥ 50% reduction in the pain score compared with the pre-treatment score. Cervical radicular pain was significantly reduced at 1, 3, and 6months after pulsed radiofrequency compared to pre-treatment (P < 0.001). Successful pain relief was achieved in 59.6% of the patients at 6month. However, there was no significant difference between the mean pain scores in the 1st month, 3rd month and 6th month. In addition, the functionality and neuropathic pain scores were significantly reduced at 6month. These results suggest that US-SCNR PRF treatment is effective for cervical radicular pain, functionality, and neuropathic pain for at least six months in the majority of patients with refractory cervical radicular pain, and is considered a safer and preferable treatment modality due to real-time visualization of the cervical nerve roots and adjacent neurovascular structures and no radiation exposure.

Full-Incision Double-Eyelid Blepharoplasty with Selective Sensory Nerve Preservation.

Full-incision double-eyelid blepharoplasty can result in upper eyelid skin numbness postoperatively. However, few studies have examined sensory loss after eyelid surgery. We propose a novel surgical approach with selective sensory nerve preservation to prevent postoperative upper eyelid numbness. We enrolled 90 patients who underwent full-incision double-eyelid blepharoplasty with selective sensory nerve preservation from March 2021 to February 2022. Major longitudinal nerves that spread vertically to the palpebral margin under the orbicularis oculi muscle in the medial portion of the upper eyelid were dissected and carefully preserved. Eyelid sensation was measured using a Cochet-Bonnet filament-type esthesiometer at four predetermined anatomical locations in the upper eyelid. The mean esthesiometry reading was calculated at the preoperative and 2-week and final postoperative visits. The follow-up duration was 2-4 months (mean, 3 months). The mean esthesiometry readings at the inferonasal location were 5.22 cm (n=170, SD=0.28) preoperatively, 5.21 cm (n=170, SD=0.31) at 2 weeks postoperatively, and 5.22 cm (n=170, SD=0.29) at the final postoperative visits. Sensation was not significantly different between the second visit and the baseline (P=0.014) or between the final visit and the baseline (P=0.158). None of the patients reported a reduction in their subjective eyelid sensation. Full-incision double-eyelid blepharoplasty with selective sensory nerve preservation can prevent postoperative upper eyelid numbness while producing reliable and dynamic palpebral creases. The vital nerve branches of the upper eyelid can be preserved, thereby retaining skin sensation near the margin of the eyelid. We propose a novel full-incision double-eyelid blepharoplasty technique that incorporates selective sensory nerve preservation to prevent postoperative upper eyelid numbness. Full-incision double-eyelid blepharoplasty with selective sensory nerve preservation can prevent postoperative upper eyelid numbness while producing reliable and dynamic palpebral creases. The vital nerve branches of the upper eyelid can be preserved, thereby retaining skin sensation near the margin of the eyelid. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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

Ultrasound-Guided Selective Glossopharyngeal and Maxillary Nerve Blocks for Analgesia After Tonsillectomy: A Pilot Study.

Purpose Postoperative pain management methods for tonsillectomy commonly include the use of opioids, non-steroidal anti-inflammatory drugs, and acetaminophen. However, some patients report pain despite the use of these medications. In recent years, ultrasound-guided selective glossopharyngeal nerve block (UGSGNB) and ultrasound-guided maxillary nerve block (UGMNB) have been reported to be effective for analgesia post-tonsillectomy. We retrospectively analyzed the effects of UGSGNB and UGMNB in the perioperative management of patients who underwent tonsillectomy under general anesthesia. Methods This retrospective study evaluated adults (18-61 years old) who had received general anesthesia for tonsillectomy. The control group comprised 25 patients who received general anesthesia using the standard protocol, and the nerve block group comprised 10 patients who also received additional UGGNB and UGMNB. Results While these nerve blocks may have contributed to improving the postoperative food intake, they did not reduce the frequency of postoperative analgesia used. Improved dietary intake after UGSGNB and UGMNB could be advantageous for postoperative recovery. Conclusion Further research with a larger number of cases and prospective intervention studies are necessary to determine the effects of combining UGSGNB and UGMNB for post-tonsillectomy analgesia.

P180 CONTRIBUTION OF AFFERENT RENAL NERVES TO HYPERTENSION AND HYPERTENSIVE HEART FAILURE

Background and Objective: Renal nerves contain efferent and afferent fibers. This study aimed to investigate the contribution of afferent renal nerves to the development of hypertension and hypertensive heart failure in several rat models of hypertension. Methods: Selective afferent renal nerve denervation (ARDN) or sham operation was performed in the following models: (1) SHRSP at 9 weeks; (2) 4% high-salt diet (HS)-fed SHRSP at 8 weeks (HS from 8 weeks); and (3) 8% HS-fed Dahl salt-sensitive rats at 9 weeks (HS from 6 weeks). Dahl rats fed 0.3% low-salt diet were controls for (3). Blood pressure (BP) was measured by telemetry in (1) and (2), and by tail-cuff method in (3). Results: (1) Mean BP was elevated from 9 weeks to 11 weeks in sham-SHRSP (155.2±2.0 vs 144.0±1.9 mmHg, n=10, p&lt;0.05). Mean BP in ARDN-SHRSP (157.8±2.7 mmHg, n=10) did not differ from sham-SHRSP at 11 weeks. (2) Mean BP increased from 8 weeks to 11 weeks in HS-sham-SHRSP (191.5±8.1 vs 126.5±4.0 mmHg, n=6, p&lt;0.05). Mean BP in HS-ARDN-SHRSP (186.0±7.1 mmHg, n=6) did not differ from HS-sham-SHRSP at 11 weeks. (3) Systolic BP increased (243.6±7.0 vs 140.0±2.7 mmHg, n=9 each, p&lt;0.05) and echocardiographic left ventricular (LV) fractional shortening decreased (25.9±1.7 vs 48.8±0.4%, p&lt;0.05) in HS-sham-Dahl rats compared to low-salt controls at 16 weeks (“HFrEF” phase). LV weight, lung weight, and LV fibrosis were significantly increased in HS-sham-Dahl rats compared to controls. ARDN attenuated these changes except for BP. At 12 weeks (pre-HFrEF phase), plasma norepinephrine levels increased in HS-sham-Dahl rats compared to controls and were attenuated by ARDN (controls 188.7±16.5, HS-sham 563.8±82.7, HS-ARDN 327.4±50.2 pg/ml; n=15, 12, 14; p&lt;0.05). Conclusions: Signals from afferent renal nerves contribute to sympathoexcitation and the development of HFrEF without affecting BP in Dahl salt-sensitive hypertensive rats, but not to the development of hypertension in SHRSP and HS-fed SHRSP.

WITHDRAWN: Personalized clinical decision-making by evaluating the effects of a selective nerve block on cycling and gait: A clinical case study

WITHDRAWN: Personalized clinical decision-making by evaluating the effects of a selective nerve block on cycling and gait: A clinical case study

Towards spatially selective efferent neuromodulation: anatomical and functional organization of cardiac fibres in the porcine cervical vagus nerve.

Spatially selective vagus nerve stimulation (sVNS) offers a promising approach for addressing heart disease with enhanced precision. Despite its therapeutic potential, VNS is limited by off-target effects and the need for time-consuming titration. Our research aimed to determine the spatial organization of cardiac afferent and efferent fibres within the vagus nerve of pigs to achieve targeted neuromodulation. Using trial-and-error sVNS in vivo and ex vivo micro-computed tomography fascicle tracing, we found significant spatial separation between cardiac afferent and cardiac efferent fibres at the mid-cervical level and they were localized on average on opposite sides of the nerve cross-section. This was consistent between both in vivo and ex vivo methods. Specifically, cardiac afferent fibres were located near pulmonary fibres, consistent with findings of cardiopulmonary convergent circuits and, notably, cardiac efferent fascicles were exclusive. These cardiac efferent regions were located in close proximity to the recurrent laryngeal regions. This is consistent with the roughly equitable spread across the nerve of the afferent and efferent fibres. Our study demonstrated that targeted neuromodulation via sVNS could achieve scalable heart rate decreases without eliciting cardiac afferent-related reflexes; this is desirable for reducing sympathetic overactivation associated with heart disease. These findings indicate that understanding the spatial organization of cardiac-related fibres within the vagus nerve can lead to more precise and effective VNS therapy, minimizing off-target effects and potentially mitigating the need for titration. KEY POINTS: Spatially selective vagus nerve stimulation (sVNS) presents a promising approach for addressing chronic heart disease with enhanced precision. Our study reveals significant spatial separation between cardiac afferent and efferent fibres in the vagus nerve, particularly at the mid-cervical level. Utilizing trial-and-error sVNS in vivo and micro-computed tomography fascicle tracing, we demonstrate the potential for targeted neuromodulation, achieving therapeutic effects such as scalable heart rate decrease without stimulating cardiac afferent-related reflexes. This spatial understanding opens avenues for more effective VNS therapy, minimizing off-target effects and potentially eliminating the need for titration, thereby expediting therapeutic outcomes in myocardial infarction and related conditions.

Feasibility of Selective Dorsal Scapular Nerve and Long Thoracic Nerve Blocks in Scapulothoracic Arthrodesis Surgery.

Feasibility of Selective Dorsal Scapular Nerve and Long Thoracic Nerve Blocks in Scapulothoracic Arthrodesis Surgery.

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.

Fillet flap transfer as alternative to conventional lower limb amputation

The fitting of a prosthesis after lower limb amputation is associated with several challenges. Skeletal stump-prosthesis interfaces and selective nerve transfer can partially overcome these but are also associated with new impairments that emphasize the necessity of innovative approaches. The concept of so-called spare part surgery with the use of fillet flaps could play an important role in this respect. An overview of the classical prosthesis-associated discomforts, advantages and disadvantages of treatment strategies and presentation of alternative surgical concepts. A selective literature search was carried out considering the experiences of the authors and perspectives with respect to the advantages and disadvantages of the surgical treatment options. Furthermore, aclinical case is presented. The transfer of the sole of the foot as afillet flap to the weight-bearing region of the amputation stump offers anumber of benefits, such as creating afully weight-bearing stump, prevention of neuralgia, preserved sensation and conservation of the body image. As long as the calcaneal region is not impaired, this technique can be performed in amputations below as well as above the knee. The question of whether parts of the bone should be included in the transfer must be individually evaluated for each patient. This approach enables optimization of the residual limb stump for the subsequent fitting of a prosthesis for the patient.

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.

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.