Pain Relief After Selective Nerve Root Block as a Predictor of Postoperative Functional Outcome in Patients with Degenerative Lumbar Spinal Stenosis Patients Undergoing Decompressive Surgery

Abstract

Study Design. Retrospective study of data collected prospectively. Objective. To investigate changes in the degree of lower leg radiating pain (LLRP) after selective nerve root block (SNRB) and to evaluate associations of this change with postoperative improvements in symptom severity, functional outcomes, and quality of life. Summary of Background Data. SNRB is routinely performed as an initial treatment for lumbar foraminal or lateral recess stenosis with LLRP. The degree of improvement after SNRB has been suggested to predict the improvement in postoperative pain and functional outcomes. However, there have been no studies on the predictive value of this parameter.Methods. We enrolled 60 patients who underwent SNRB followed by decompressive surgery. They were divided into three groups. The degree of improvement was evaluated as a percentage of the pre-injection values. Functional outcomes of the spine were assessed using the Oswestry Disability Index (ODI) and Roland-Morris Disability Questionnaire (RMDQ). Quality of life was assessed using the 36-item Short Form Survey (SF-36) physical component score (PCS) and mental component score (MCS). The degree of LLRP was measured preoperatively and at 6, 12, and 24 months after surgery. These functional outcomes were evaluated preoperatively and at 12 and 24 months after surgery. Results. The improvement in LLRP in the short term (6 hours after SNRB) was found to be statistically significantly associated with the improvement in LLRP at 12 months after SNRB (P ¼ 0.044, correlation coefficient ¼ 0.261). No relationship between pain improvement after SNRB and functional outcome was identified. Conclusion.The degree of improvement in symptoms 6 hours after SNRB can predict the degree of improvement in LLRP at 12 months after surgery. However, symptomatic improvement after SNRB does not predict postoperative functional outcome or quality of life.

Spine

“…However, until this work from Daegu (South Korea) , no study has previously assessed the predictive value of this intervention in terms of postoperative pain and functional outcome. 2 The study recruited 60 patients who underwent a selective nerve root block (SNRB) followed by decompressive surgery for lumbar foraminal or lateral recess stenosis. In terms of outcomes, the patients’ experience of radicular pain symptoms was recorded via a visual analogue scale.…”

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

“…2,3 In most cases, radicular pain resolves spontaneously or after conservative treatment, but a small number of patients suffer from chronic or recurrent pain, some even aggravated by numbness or muscle weakness, and require surgical treatment. 3,4 With an aging population, surgical procedures that require less anesthesia, shorter hospital stays, and result in less blood loss and fewer injuries are crucial to the success of surgery in older patients. Clinical outcomes of minimally invasive surgeries like percutaneous transforaminal endoscopic discectomy (PTED) for lumbar disc herniation are promising.…”

“…5 The prerequisite for minimally invasive surgery is an accurate diagnosis of the responsible segment that relies on the patient's symptoms, physical examinations, and imaging findings. [4][5][6] However, it is not easy for the elderly population with multilevel lumbar spine degeneration or atypical pain, increasing diagnostic uncertainty. 6,7 Selective nerve root block (SNRB) was first described by Macnab et al in 1971 to treat lower leg radicular pain and remains a popular therapeutic and diagnostic option for radicular pain.…”

“…6,7 Selective nerve root block (SNRB) was first described by Macnab et al in 1971 to treat lower leg radicular pain and remains a popular therapeutic and diagnostic option for radicular pain. 3,4,[6][7][8][9] Despite the fact that many studies have demonstrated that SNRB is a viable diagnostic tool for determining the responsible segment, only a few studies have focused on elderly patients with multilevel lumbar spine degeneration. 7 Hence, this retrospective study included a group of elderly patients with radicular pain as the primary complaint but a doubtful diagnosis, to investigate the clinical outcomes of selective nerve root block combined with percutaneous transforaminal endoscopic discectomy.…”

Concerning “Pain Relief After Selective Nerve Root Block as a Predictor of Postoperative Functional Outcome in Patients With Degenerative Lumbar Spinal Stenosis Patients Undergoing Decompressive Surgery,” by Ko et al

“…We were intrigued by the article by Ko et al , 1 which concluded that the improvement in symptoms 6 hours after selective nerve root block (SNRB) could predict the improvement in lower leg radiating pain at 12 months postoperatively. However, we have some criticisms about this paper.…”