Therapeutic Selective Nerve Root Block Research Articles

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.

Human assumed central sensitisation (HACS) in patients with chronic low back pain radiating to the leg (CLaSSICO study)

IntroductionPatients with chronic low back pain radiating to the leg (CLBPr) are sometimes referred to a specialised pain clinic for a precise diagnosis based, for example, on a diagnostic selective...

The Efficacy of Therapeutic Selective Nerve Block in Treating Lumbar Radiculopathy and Avoiding Surgery.

BackgroundSelective nerve root block (SNRB) is a procedure that can be used as a diagnostic or a therapeutic method. SNRB can be used in multiple sites, including cervical and lumbar . Our study aims to investigate the clinical effectiveness of the use of fluoroscopically guided therapeutic selective nerve root block as a non-surgical symptom management of lumbar radiculopathy.Patients and MethodsThis is a prospective study of therapeutic nerve root block in 76 patients with low back pain and/or sciatica at Jordan University Hospital. Data was collected by independent clinical interviewers, and visual analogue score (VAS) was used to measure pain severity.ResultsA total of 76 patients, 25 (32.8%) males and 51 (67.2%) females, underwent SNRB. 69 (90.7%) patients improved immediately after the procedure. Out of the total, 22 (28.9%) patients showed a long-term relief of symptoms and did not experience any recurrence during the three months of follow-up, while 47 (61.8%) experienced a recurrence of pain. In patients experiencing recurrence of symptoms, 35 needed surgery.ConclusionTherapeutic SNRB is an important procedure in the pain management of patients with lumbar radiculopathy caused by lumbar disc prolapse and foraminal stenosis. Our study showed that avoidance of surgery was achieved in up to 54% of patients; pain relief for at least 6 months was achieved in up to 29% of patients after a single SNRB. This makes it a very good second line of management after conservative treatment and a possible method to delay, and sometimes cease, the need for surgery.

PR_096: Percutaneous Lumbar Disk Decompression Using the Dekompressor: A Pilot Study

Objective: To report on the outcomes resulting from the use of the Dekompressor, a novel percutaneous decompression technology, to treat patients with lumbar radiculopathy secondary to a herniated disk, who failed comprehensive conservative treatment. Design: Prospective. Setting: Academic spine center. Participants: 47. Interventions: Consecutive patients with lumbar radiculopathy due to a diffuse bulge causing central stenosis, focal protrusion, or disk extrusion. Symptoms, examination, and magnetic resonance imaging had to be corroborative. Each subject failed to improve after a minimum of 4 weeks of physical therapy, oral anti-inflammatories, and epidural space steroid injections. Each subject underwent percutaneous decompression with the Dekompressor immediately followed by a therapeutic selective nerve root block. Main Outcome Measures: Medication usage, Owestry Disability Index (ODI), and visual analog scale (VAS). Results: Average duration of symptoms prior to percutaneous decompression was 37 weeks. 41 of 47 patients remained in the study at 6 months. Of the 6 patients who dropped out prior to 6 months, 4 went to surgery, 1 for acupuncture, and 1 found relief with the use of pregabalin (Lyrica). For 41 patients, the average ODI score dropped from 47.2% to 23% (P<.001), representing a change of 1 full category of disability. A patient underwent percutaneous decompression to treat weakness because there was no pain. For the other 40 patients, the VAS for leg pain was 7.3 preprocedure and 1.7 at 6 months postprocedure (P<.001). 43% had a VAS score of 0, 63% had a VAS score of 1 or less, and 75% had a VAS score of 2 or less. Medication usage dropped from an average score of 3.2 to 2.2 (P<.001). Conclusions: The preliminary data from this pilot study reveal that Dekompressor may be an effective tool to treat lumbar radiculopathy. More definitive conclusions can be made after the 1-year and 2-year data are collected and analyzed.

Therapeutic selective nerve root block in the nonsurgical treatment of traumatically induced cervical spondylotic radicular pain.

To investigate the outcomes resulting from the use of fluoroscopically guided therapeutic selective nerve root block in the nonsurgical treatment of traumatically induced cervical spondylotic radicular pain. Retrospective study with independent clinical review. A total of 15 patients who met specific physical examination or electrodiagnostic criteria and failed to improve clinically after at least 4 wks of physical therapy were included. Each patient demonstrated a positive response to a fluoroscopically guided cervical selective nerve root block. Therapeutic selective nerve root blocks were administered in conjunction with physical therapy. Outcome measures included visual analog scale pain scores, employment status, medication usage, and patient satisfaction. Patients' symptom duration before diagnostic injection averaged 13.0 mos. An average of 3.7 therapeutic injections were administered. Follow-up data collection transpired at an average of 20.7 mos after discharge from treatment. An overall good or excellent outcome was observed in three patients (20.0%). Among those treated without surgery, a significant reduction (P = 0.0313) in pain score was observed at the time of follow-up. Six patients (40.0%) proceeded to surgery. These initial and preliminary findings do not support the use of therapeutic selective nerve root block in the treatment of this challenging patient population with traumatically induced spondylotic radicular pain.

Selective Nerve Root Blocks for the Treatment of Sciatica: Evaluation of Injection Site and Effectiveness—A Study with Patients and Cadavers

To relate different types of radiographic contrast material distributions to anatomic compartments by using cadaveric specimens and to relate the injection site to treatment-induced discomfort and therapeutic effect. The contrast material distributions of selective nerve root blocks (SNRBs) in 36 patients (13 women, 23 men; mean age, 52 years; age range, 22-88 years) were graded by two radiologists in conference as type 1 (tubular appearance), type 2 (nerve root visible as filling defect), or type 3 (nerve root not visible). These patterns were correlated with pain reduction after 15 minutes and 2 weeks (with a visual analogue scale of 100-mm length). In addition, 30 nerve roots were injected with iodine-containing contrast material and blue dye in three cadaveric specimens. Radiographs were compared with anatomic sections. After 15 minutes and 2 weeks, 75% and 86% of the patients, respectively, reported pain relief. Mean pain relief length after 15 minutes for type 1 distribution was 60 mm; for type 2, 44 mm; and for type 3, 22 mm; and after 2 weeks, it was 34 mm for type 1, 31 mm for type 2, and 57 mm for type 3. There was no correlation between early and late response. Pain during intervention was less pronounced in type 2 injection, compared with type 1 (P = .002). On the basis of anatomic sections, type 1 injection was intraepineural; type 2, extraepineural; and type 3, paraneural. Therapeutic SNRB is effective in sciatica, but early response does not predict the effect after 2 weeks. Type 1 injections are more painful than type 2 injections.

Outcomes of Therapeutic Selective Nerve Root Blocks for Whiplash Induced Cervical Radicular Pain

This study was designed to investigate the clinical efficacy of fluoroscopically guided therapeutic cervical selective nerve root blocks (SNRBs) in patients with whiplash induced cervical radicular pain. Study design was restrospective with independent clinical review. Twenty two patients were included. Each patient met specific physical examination criteria and failed to improve clinically after at least four weeks of physical therapy and the use of oral analgesics. Each patient demonstrated a positive response to a fluoroscopically guided diagnostic cervical SNRB. Patients were excluded for radiographic evidence of a focal disc protrusion or foraminal stenosis at the symptomatic level. Therapeutic cervical SNRBs were administered in conjunction with physical therapy. Data collection and analysis were performed by an independent clinical reviewer. Outcome measures included VAS pain scores, work status, medication usage, and Oswestry disability scores. Results showed the patients' symptom duration prior to diagnostic injection averaged 6 months. An average of 2.1 therapeutic injections was administered. Follow up data collection transpired at an average of 33.3 weeks following the final therapeutic injection. Good or excellent results were observed in 14% of patients. In higher functioning individuals a significantly greater (F=.0427) improvement in pain of 48.9% was observed. In these initial findings suggest that fluoroscopically guided therapeutic SNRBs, except possibly for higher functioning individuals, are not effective in the treatment of whiplash induced cervical radicular pain.

Physical Medicine and Rehabilitation (89)

Nonsurgical treatment for radicular pain of zygoapophyseal joint cyst origin: therapeutic selective nerve root block. (Hospital of the University of Pennsylvania, Philadelphia, PA) Arch Phys Med Rehabil 2000;81;1119–1122.This report discusses the first case of zygoapophyseal joint cyst‐induced radicular pain successfully treated with therapeutic selective nerve root block. A 56‐year‐old dentist presented with pain involving the lateral thigh, lateral calf, and foot dorsum that worsened with standing and walking. Magnetic resonance imaging of the lumbar spine showed a cyst emanating from the right L4‐L5 zygoapophyseal joint, resulting in central canal and lateral recess stenosis. The patient was treated with 2 fluoroscopically guided therapeutic L5 selective nerve root blocks. The patient remained pain free at 18‐month follow‐up.

Nonsurgical treatment for radicular of pain of zygoapophyseal joint cyst origin: Therapeutic selective nerve root block

Slipman CW, Lipetz JS, Herzog RJ, Vresilovic EJ. Nonsurgical treatment for radicular pain of zygoapophyseal joint cyst origin: therapeutic selective nerve root block. Arch Phys Med Rehabil 2000;81:1119-22. We report the first case of zygoapophyseal joint cyst–induced radicular pain successfully treated with therapeutic selective nerve root block. A 56-year-old dentist presented with pain involving the lateral thigh, lateral calf, and foot dorsum that worsened with standing and walking. Magnetic resonance imaging of the lumbar spine showed a cyst emanating from the right L4-L5 zygoapophyseal joint, resulting in central canal and lateral recess stenosis. The patient was treated with two fluorscopically guided therapeutic L5 selective nerve root blocks. The patient remained pain free at 18-month follow-up. © 2000 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Nonsurgical treatment for radicular of pain of zygoapophyseal joint cyst origin: Therapeutic selective nerve root block

Slipman CW, Lipetz JS, Herzog RJ, Vresilovic EJ. Nonsurgical treatment for radicular pain of zygoapophyseal joint cyst origin: therapeutic selective nerve root block. Arch Phys Med Rehabil 2000;81:1119-22. We report the first case of zygoapophyseal joint cyst–induced radicular pain successfully treated with therapeutic selective nerve root block. A 56-year-old dentist presented with pain involving the lateral thigh, lateral calf, and foot dorsum that worsened with standing and walking. Magnetic resonance imaging of the lumbar spine showed a cyst emanating from the right L4-L5 zygoapophyseal joint, resulting in central canal and lateral recess stenosis. The patient was treated with two fluorscopically guided therapeutic L5 selective nerve root blocks. The patient remained pain free at 18-month follow-up. © 2000 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Nonsurgical treatment for radicular of pain of zygoapophyseal joint cyst origin: Therapeutic selective nerve root block

Nonsurgical treatment for radicular of pain of zygoapophyseal joint cyst origin: Therapeutic selective nerve root block

Nonsurgical treatment of zygapophyseal joint cyst–induced radicular pain

Slipman CW, Lipetz JS, Wakeshima Y, Jackson HB. Nonsurgical treatment of zygapophyseal joint cyst–induced radicular pain. Arch Phys Med Rehabil 2000;81:973-7. Objective: To evaluate the role of fluoroscopically guided injection procedures in the nonsurgical treatment of zygapophyseal joint cyst–induced radicular pain. Design: Retrospective study with independent clinical review. Participants: Fourteen patients (average age, 60.2yrs), with an average symptom duration of 18.8 months, were included. Methods: Medical records were reviewed; patients with a radiographically observed zygapophyseal joint cyst that may have represented a compressive lesion corresponding to the patient's symptoms of radicular pain were eligible for inclusion. The level of nerve root involvement was confirmed by physical examination or electrodiagnostic findings. Patients whose root level involvement remained undetermined were required to demonstrate a positive response to a fluoroscopically guided diagnostic selective nerve root block (SNRB). Nonsurgical treatments included therapeutic SNRB, intraarticular zygapophyseal joint corticosteroid injection, and cyst puncture. Data collection and analysis were performed by an independent clinical reviewer. Outcome Measures: Pain score, work status, medication usage, and patient satisfaction with treatment. Results: The majority of the observed cysts (71.4%) were at the L4-L5 level. Follow-up data collection was done at an average of 1.4 years after termination of treatment. An excellent outcome was observed in 4 patients (28.6%). Fifty percent of patients underwent surgery. Conclusions: Preliminary findings suggest a role for fluoroscopically guided injection techniques in the nonsurgical treatment of zygapophyseal joint cyst–induced radicular pain, with up to one-third of patients experiencing lasting symptomatic relief. © 2000 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Therapeutic selective nerve root block in the nonsurgical treatment of atraumatic cervical spondylotic radicular pain: A retrospective analysis with independent clinical review

Slipman CW, Lipetz JS, Jackson HB, Rogers DP, Vresilovic EJ. Therapeutic selective nerve root block in the nonsurgical treatment of atraumatic cervical Spondylotic radicular pain: a retrospective analysis with independent clinical review. Arch Phys Med Rehabil 2000;81:741–746.Objective: To investigate the outcomes resulting from the use of fluoroscopically guided therapeutic selective nerve root block (SNRB) in the nonsurgical treatment of atraumatic cervical Spondylotic radicular pain.Study Design: Retrospective study with independent clinical review.Participants: Twenty subjects (10 men, 10 women) with mean age 56.6 years.Methods: Each patient met specific physical examination, radiographic, and electrodiagnostic criteria to confirm a level of cervical involvement. Those patients whose root level remained indeterminate were required to demonstrate a positive response to a fluoroscopically guided diagnostic SNRB prior to the initiation of treatment. Therapeutic injections were administered in conjunction with physical therapy. Data collection and analysis were performed by an independent clinical reviewer.Main Outcome Measures: Pain score, work status, medication usage, and patient satisfaction.Results: Twenty patients with an average symptom duration of 5.8 months were included. An average of 2.2 therapeutic injections was administered. Follow-up data collection transpired at an average of 21.2 months following discharge from treatment. A significant reduction (p = .001) in pain score was observed at the time of follow-up. Medication usage was also significantly improved (p = .005) at the time of follow-up. An overall good or excellent result was observed in 60%. Thirty percent of patients required surgery. Younger patients were more likely (p = .0047) to report the highest patient satisfaction rating following treatment.Conclusions: This study suggests that fluoroscopically guided therapeutic SNRB is a clinically effective intervention in the treatment of atraumatic cervical Spondylotic radicular pain.

Therapeutic selective nerve root block in the nonsurgical treatment of atraumatic cervical spondylotic radicular pain: A retrospective analysis with independent clinical review

Therapeutic selective nerve root block in the nonsurgical treatment of atraumatic cervical spondylotic radicular pain: A retrospective analysis with independent clinical review