Selective nerve root block for management of symptomatic lumbosacral disc bulge causing radicular pain: A case series (original) (raw)
Related papers
Role of root block in lumbar spine radiculopathy
National Journal of Clinical Orthopaedics
Introduction: Chronic lumbosacral pain is a common and challenging clinical entity problem in pain management centre. Since its first description by Mixter Barr in 1934, lumbar disc herniation is one of the few abnormality in the lumbar spine, were a clear relationship between the morphological alteration and pain seems to exist 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 role perhaps even most important role. Materials and Methods: Chronic spinal back pain due to prolapsed intervertebral disc and lumber canal stenosis was previously treated with lumbar epidural steroid injections which gives its effect via drugs into the epidural space, not at particular level and its effect was also short lasting. Selective nerve root block and radiofrequency ablation therapy block the pain pathway by blocking the ascending pain pathway at dorsal root ganglion at particular level. Results: In this study, 100 patients were included. 82 patients were treated with selective nerve root block and 18 patients treated with pulse radiofrequency, were followed for average 6 months. Maximum number of patients are found in age group of 31 to 40 (41%). Mean age of our study is 41.7 years. In this study, total 51 % were male and 49 % were female so, male to female ratio is almost 1:1. Maximum number of patients having disc herniation at level of L4-L5(43%) and L5-S1(47%). Discussion: In our study, majority of patients were between age group of 31-40 years. In patients older than 50 years a disc has developed some degree of inherent stability through fibrous changes that occurs with loss of water content. In our study, the disc herniation was found to be slight more common in males. A herniated disc occurs most often in the lower lumber region of the spine especially at the L4-L5 and L5-S1 levels (90% in this study). This is because the lower lumber discs bear much more of the body weight and comparatively more bending force which leads to more degeneration and ruptures. Conclusion: The selective nerve root block combined with careful history, physical examination and quality radiographic studies, is an important tool in the diagnosis and treatment of patients with predominant lumber radicular symptoms and it is a less invasive procedure. It gives an acceptable results in form of pain relief if given in early course of disease.
International Journal of Spine Surgery, 2021
Background: Lumbar disc herniation with radiculopathy has a favorable natural history, and a selective nerve root block (SNRB) is an accepted treatment modality. This study aims to ascertain the temporal pattern of pain and disability following the administration of an SNRB in the management of lumbar disc herniation with radiculopathy because there is limited evidence regarding this issue in the published literature. Methods: This prospective study included 50 patients who underwent an SNRB and were followed for 3 months. Numerical Rating Scale (NRS) for back and leg pain and Oswestry Disability Index (ODI) and Depression Anxiety Stress Scales-21 (DASS-21) scores were collected. At the final follow-up at 3 months, the number of patients who underwent surgery was ascertained. Results: Forty-two of 50 (84%) patients avoided the surgery with a reduction in mean preinjection NRS for back and leg pain from 7.5 (SD 1.33) and 7.7 (SD 1.35) to 3.1 (SD 1.69) and 2.3 (SD 1.14) (P < 0.001), respectively, within the 30 minutes after injection. The pain relief was sustained until the last follow-up. The ODI score also decreased from a mean preinjection level of 59.4 (SD 14.69) to 26.3 (SD 9.43) (P < 0.001) at 3 months. The mean preinjection depression score was higher in patients who had recurrence of pain and eventually underwent surgery. Conclusion: Early administration of an SNRB in the course of lumbar radiculopathy is recommended as it provides instantaneous and sustained relief of back and leg pain and disability in a majority of patients. Clinical Relevance: SNRB should be administered early in the course of management of lumbar radiculopathy and should not be delayed until after other non-surgical modalities have failed.
Retrospective study of effectiveness in transforminal nerve root block in lumbar disc disease
2021
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...
A study on effectiveness of selective nerve root blocks in lumbar radiculopathies
International Journal of Orthopaedics Sciences, 2019
Background: Low back pain is one of the most common reason for visit to a doctor & young age morbidity, disability, work absenteeism constitutes almost 40% of all occupational risk factors. Lumbar radiculopathy with or without neurological deficits are managed with variety of conservative or operative measures, and generally recovers well. Selective nerve root blocks (SNRBs) having diagnostic or therapeutic use, are popular and advantageous to avoid uncertain potential surgical complications. Aim of this study is to establish therapeutic efficacy and evaluate complications following selective nerve root blocks. Materials and Methods: The present study was a randomized, prospective study carried out from August 2016 to March 2018, on 50 cases satisfying the inclusion criteria following complete assessment, received selective nerve root blocks. Patients were assessed for pain relief and disability reduction. Result: Evaluated with VAS and ODI score. In study, immediate improvement of VAS score was 33.04%, 45.3% at 1week, 59.8% at 4weeks and 66.9% after 3months. Reduction in ODI score was 37.7% till 1week, 54.8% till 4weeks and 66.8% till 3months follow up periods. Conclusion: SNRB is an important, effective, less expensive and less invasive treatment modality to provide lasting therapeutic benefit, allowing the patient to participate in life style modifications, physiotherapies and early resumption of routine activities.
Pain physician, 2013
Lumbosacral selective nerve root blocks and/ or transforaminal epidural injections are used for diagnosis and treatment of different disorders causing low back and lower extremity pain. A clear consensus on the use of selective nerve root injections as a diagnostic tool does not currently exist. Additionally, the validity of this procedure as a diagnostic tool is not clear. To evaluate and update the accuracy of selective nerve root injections in diagnosing lumbar spinal disorders. A systematic review of selective nerve root blocks for the diagnosis of low back and lower extremity pain. Methodological quality assessment of included studies was performed using the Quality Appraisal of Reliability Studies (QAREL) checklist. Only diagnostic accuracy studies meeting at least 50% of the designated inclusion criteria were utilized for analysis. Studies scoring less than 50% are presented descriptively and analyzed critically. The level of evidence was classified as good, fair, or limite...
International Journal of Orthopaedics Sciences, 2021
Background: The lifetime prevalence of radiculopathy due to a herniated lumbar disc is estimated to be around 4% in females and 5% in males. The efficacy of SNRB in acute LDH has been quoted variedly in previous studies ranging from 30% to 80% [6]. There are only a few studies which identify the various clinical parameters that can predict successful outcomes in patients undergoing SNRB. Methods: The prospective study was conducted at Mahatma Gandhi Missions Hospital Navi Mumbai, between March 2019 and February 2020.During the study period, total 60 patients with documented LDH on magnetic resonance imaging (MRI), presenting with unilateral radiculopathy, with symptom duration of less than 3 months who had failed adequate conservative management of about 3 weeks duration were treated with transforaminal. Result: Out of the 60 patients which were included in the study, 50 patients had adequate pain relief for the study period of one year while 10 patients did not have sufficient relief of pain. Thus Transforaminal SNRB had an efficacy of 83.33% in our study. In our study out of the 60 patients 32 had right side involvement and 28 had left side involvement. Out of those having right side involvement 26 had successful and 6 had unsuccessful outcome while 28 had left side involvement in which 25 had successful outcome and 3 had unsuccessful outcome and the p value was insignificant for this clinical parameter. Conclusion: Transforaminal Selective Nerve Root Block had an efficacy of 83.33% in our study. It is an efficient technique which provides adequate pain relief for about one year.
Patients With Persistent Low Back Pain and Nerve Root Involvement
Spine, 2019
Objective. The aims of this study were to evaluate the outcome of surgical as well as nonsurgical treatment for patients with lumbar herniated disc (LHD) or lumbar spinal stenosis (LSS) after two years and to identify predictors for non-success. Summary of Background Data. Studies regarding the clinician's ability to identify patients with a poor prognosis are not in concurrence and further studies are warranted. Methods. This study included 390 patients with LHD or LSS referred for surgical evaluation after unsuccessful conservative treatment. Non-success was defined as a Roland Morris Disability score above 4 (0-23) or a Numeric Rating Scale back and leg pain score above 20 (0-60). Uni-and multivariate logistic regression analyses were used to investigate potential predictive factors including sociodemographic characteristics, history findings, levels of pain and disability, and MRI findings. Results. Rates of non-success at 2 years were about 30% in surgically treated patients with LHD, about 60% in patients with LSS for disability, and 30% and 40% respectively for pain. For the main outcome variable, disability, in the final multiple logistic regression model, nonsuccess after surgery was associated with male gender (OR 2.04, 95%
The clinical management of sciatica and brachial neuralgia can be a complicated process. There are numerous causes of nerve root tension, compression and irritation. However, pathologies involving the intervertebral disc are the most common. The system of clinical assessment described by McKenzie enables the trained practitioner to accurately determine the presence or absence of relevant discal pathology.