Transforaminal Nerve Root Block Research Articles

COMBINED TECHNIQUES OF CAUDAL EPIDURAL BLOCK AND TRANSFORAMINAL NERVE ROOT BLOCK IN THE TREATMENT OF DEGENERATIVE DISEASES OF THE LUMBAR SPINE: A COST-EFFECTIVENESS ANALYSIS.

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. 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. 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 < 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 < 0.0001). The cost of the materials used during the procedure was 214.72 BRL. 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.

Outcome of transforaminal nerve root block injection for lumbar radiculopathy

Outcome of transforaminal nerve root block injection for lumbar radiculopathy

Retrospective study of effectiveness in transforminal nerve root block in lumbar disc disease

Introduction: Among chronic conditions, back problems are the most frequent cause of limitations of activity in persons less than 45 years of age. Sciatic neuralgia is a nerve root oedema because of the inflammatory, immunological, and mechanical factors. The lifetime prevalence of lumbar radiculopathy has been reported to be 5.3% in men and 3.7% in women. Steroid injections play an important role in the management of sciatic radiculopathy. Steroids act by reducing the oedema around the nerve roots and decreasing pain having the advantage of reduced dosage and targeted delivery around the nerve roots forming the basis of transforaminal nerve root block injections. In this study we want to study the effectiveness of transforaminal nerve root block in 30 patients post block and 3 months later. Aims and objectives: Aims and objectives of the study are as follows: 1. To study the effectiveness in relief of symptoms in transforaminal nerve root block in lumbar disc disease. Materials and Methods: The clinical and follow-up data of 30 patients having lumbar disc disease causing sciatic neuralgia were taken from May 2019 to December 2019 in MGM medical college and hospital Kamothe Navi Mumbai were retrospectively analysed in this study. Follow-up was conducted immediately after the administration of block, as well as 3 months post the administration of the root block. Preoperative VAS scoring and was done and same were repeated post block and at 3 months to observe the functional outcome of transforaminal root block. Results: The average follow-up was 6 months. At 2 to 3 weeks’ follow-up, 28 of 30 patients reported successful pain reduction. In 25 patients, this pain reduction was obtained immediately and in a further 3 patients within 4 days. In 2 patients, the nerve root block did not show a sufficient pain reduction. In total with 6months of follow up 26 patients with pain relief after the first injection had a permanent and substantial pain reduction, 16 did not require surgery, 6 had disc herniation and the remaining 3 had foraminal stenosis for which operative procedures were planned. Conclusion: From our study we can conclude that transforaminal Root block should be the first choice in treating and diagnosing patients with disc herniation. Root block is more effective in patients with disc herniation rather than canal stenosis. We also understand from our study that transforaminal Root block is more effective in early course of disease, within 6 weeks of onset of symptoms. So we conclude that larger discs should later be planned for an open or endoscopic decompression and mild and moderate disc can also be managed conservatively after a transforaminal root block. The patient’s clinical course remains the most important determinant for treatment decision in disc herniation.

Effectiveness of selective transforaminal nerve root injection of triamcinolone with ropivacaine for lumbar radicular leg pain

Background: Selective Nerve Root Block using steroid is a proven technique for management of lumbar radiculopathy. The aim of the study was to determine the effectiveness of selective nerve root block in lumbar radiculopathy. Methods: A prospective observational study was conducted for duration of one year in patients diagnosed with lumbar radiculopathy. Patients with leg pain, positive straight leg raising test and single level disc prolapse were included in the study. The procedure was performed under fluoroscopic guidance and Visual Analogue Pain rating scale was used for assessment pre-injection, immediate post injection 1 month, 3months and 6 months post injection. Results: Total 30 patient with mean age of 37.7± 9.31 years were included in the study. In 18 patients, this pain reduction was obtained immediately and in a further 8 patients within 4 days. In 4 patients, the nerve root block did not show a sufficient pain reduction. Conclusions: Selective transforaminal Nerve Root Block in lumbar radiculopathy significantly reduces Visual Analogue Pain Score post injection.

Therapeutic role of Trans - foraminal nerve root block in management of lumbar radiculopathy

Treatment of Acute Lumbar Radicular pain has many controversies. While pure mechanical compression was considered previously as a source of sciatica, there is increasing evidence that chemical irritation of the nerve root plays an essential and perhaps even more important role. Trans foraminal selective nerve root block is an approved method for management of radicular pain. The aim of our study was to conduct a prospective study, 1. To assess the adequacy of relief provided by trans-foraminal Nerve Root Block for Lumbar Radicular pain. 2. To determine the effectiveness of selective (trans-foraminal) nerve root injection in diagnosis and treatment of patients with Lumbar radiculopathy. 28 patients with radicular pain involving single nerve root were selected. Trans-foraminal selective nerveroot block was done as per standard technique. Results were analyzed using VAS Score & RMDQ Score. Analyzing results showed that 89.3% patients had improvement. RMDQ score were reduced by 61% by end of 6 months. 18 patients (85.7%) who are on more than 6 months of follow up are able to do their daily activities without difficulty. We conclude by our study that, the trans-foraminal nerve root block combined with careful history, physical examination and quality radiolographic studies, is an important tool in the diagnosis and treatment of patients with predominant Lumbar radicular symptoms.

Analysis of radiological parameters associated with decreased fractional anisotropy values on diffusion tensor imaging in patients with lumbar spinal stenosis

Previous studies have indicated that decreased fractional anisotropy (FA) values on diffusion tensor imaging (DTI) are well correlated with the symptoms of nerve root compression. The aim of our study is to determine primary radiological parameters associated with decreased FA values in patients with lumbar spinal stenosis involving single L5 nerve root. Patients confirmed with single L5 nerve root compression by transforaminal nerve root blocks were included in this study. FA values of L5 nerve roots on both symptomatic and asymptomatic side were obtained. Conventional radiological parameters, such as disc height, degenerative scoliosis, dural sac cross-sectional area (DSCSA), foraminal height (FH), hypertrophic facet joint degeneration (HFJD), sagittal rotation (SR), sedimentation sign, sagittal translation and traction spur were measured. Correlation and regression analyses were performed between the radiological parameters and FA values of the symptomatic L5 nerve roots. A predictive regression equation was established. Twenty-one patients were included in this study. FA values were significantly lower at the symptomatic side comparing to the asymptomatic side (0.263 ± 0.069 vs. 0.334 ± 0.080, P = 0.038). DSCSA, FH, HFJD, and SR were significantly correlated with the decreased FA values, with r = 0.518, 0.443, 0.472 and - 0.910, respectively (P < 0.05). DSCSA and SR were found to be the primary radiological parameters related to the decreased FA values, and the regression equation is FA = - 0.012 × SR + 0.002 × DSCSA. DSCSA and SR were primary contributors to decreased FA values in LSS patients involving single L5 nerve root, indicating that central canal decompression and segmental stability should be the first considerations in preoperative planning of these patients. These slides can be retrieved under Electronic Supplementary Material.

Particulate versus Nonparticulate Corticosteroids for Transforaminal Nerve Root Blocks: Comparison of Outcomes in 494 Patients with Lumbar Radiculopathy

Particulate versus Nonparticulate Corticosteroids for Transforaminal Nerve Root Blocks: Comparison of Outcomes in 494 Patients with Lumbar Radiculopathy

RESULTS OF TREATMENT OF ACUTE LUMBAR DISC HERNIATION WITH TRANSFORAMINAL NERVE ROOT BLOCK

ABSTRACT Objective: To determine the efficacy of anesthetic transforaminal nerve root block in patients with sciatica secondary to lumbar disc herniation through a prospective observational study. Methods: The study included 176 patients from a private clinic undergoing transforaminal injection performed by a single spinal surgeon. The patients were assessed after two weeks, three months and six months regarding to the improvement of the pain radiating to the lower limbs. In case of persistent symptoms, patients could choose to perform a new nerve root block and maintenance of physical therapy or be submitted to conventional microdiscectomy. Results: By the end of six-month follow-up of the 176 patients, 116 had a favorable outcome (95 after one block and 21 after two blocks), and only 43 required surgery. Conclusion: The results of our study suggest a positive effect of transforaminal block for the treatment of sciatica in patients with lumbar disc herniation.

Interventional Pain Management for Failed Back Surgery Syndrome

Patients who suffer from the condition known as failed back surgery syndrome (FBSS) present to the offices of physicians, surgeons, and pain specialists alike in overwhelming numbers. This condition has been defined as persistent back and/or leg pain despite having completed spinal surgery. As lumbar surgery continues to grow in prevalence, so will the number patients suffering from FBSS. It is important for physicians treating this population to expand their knowledge of FBSS etiologies and appropriate diagnostic imaging modalities, combined with confirmatory diagnostic injections, and proper technique for interventional pain procedures. In doing so, the physician may adequately be prepared to manage these complex cases in the future, ideally with the support of stronger evidence. Management begins with a systematic evaluation of common FBSS etiologies such as new-onset stenosis, recurrent herniated nucleus pulposus (HNP), epidural fibrosis, pseudarthrosis, and others. History and physical may be supplemented by imaging including X-ray, magnetic resonance imaging, or computed tomography myelography. Certain diagnoses may be confirmed with diagnostic procedures such as intra-articular injections, medial branch blocks, or transforaminal nerve root blocks. Once an etiology is determined, a multidisciplinary approach to treatment is most effective. This includes exercise or physical therapy, psychological counseling, medication, and interventional procedures. The most invasive treatment option, short of revision surgery, is spinal cord stimulation. This intervention has a number of studies demonstrating its efficacy and cost-effectiveness in this population. Finally, revision surgery may be used when indicated such as with progressive neurological impairment or with issues regarding previous surgical instrumentation.

CT use in pain management

Although the application of CT-guided fluoroscopy techniques for interventional radiology have become more popular, a majority of practitioners in health care remain unfamiliar with their possibilities. Accurate imaging accompanied by guided techniques increase the precision of analgetic procedures, improving results and reducing complications. Main focuses of CT fluoroscopy use in pain management are axial spinal procedures, including zygapophyseal (ZAJ) (facet) joint injection, medial branch rhizolysis, sacroiliac joint injection, transforaminal nerve root block and peri-radicular infiltration, dorsal interlaminar epidural injection, costotransverse and costovertebral joint injections, and blocks of the sympathetic nerve ganglia, splanchnic, and celiac plexus nerve blocks.

Effects of Combination of a Transforaminal Nerve Root Block and an Epidural Steroid Injection for Chronic Radiating Pain

Methods: Thirty patients who suffered from chronic radiating pain that resistant conservative treatments including epidural steroid injection (ESI) were enrolled. Following a transforaminal nerve root block under fluoroscopic visualization, an ESI was administered at the level of the intervertebral space showing an obstacle to cephalad epidural spread of the dye injected during a transforaminal nerve root block. Twenty to forty mg of triamcinolone with 0.5% lidocaine was injected in divided doses. The patients received these nerve blocks at intervals of 1-2 weeks until the patients were satisfied with the results. If the pain reappeared, repeated blocks were administered at intervals of 2 months. Treatment results were evaluated twice using a pain relief scale and categorized as excellent, good, fair, or poor. Results: Pain improvements of more than 50% of the initial pain intensity, graded excellent or good, were observed in 66.7% at 1 week after the 1st blocks and 73.3% at 3 months after the final blocks. Conclusions: These findings suggest that a combination of a transforaminal nerve root block and ESI is an effective procedure for radiating pain not responding to ESI. However, comparative prospective studies to determine the effects of this combination therapy versus classical transforaminal injections may be mandatory.