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

Pfirrmann, Christian W. A.; Oberholzer, Patrick A.; Zanetti, M.; Boos, Norbert; Trudell, Debra; Resnick, Donald; Hodler, Juerg

doi:10.1148/radiol.2213001635

Cited by 161 publications

(155 citation statements)

References 35 publications

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“…After CIESI, follow-up was usually done at our department 2 weeks later. A 2-week follow-up has been previously proposed and relates to the duration of the therapeutic effect of corticosteroids [8,9]. When the dura was punctured and the subarachnoid space was entered, we changed the approach level and tried again.…”

Section: Injection Techniquementioning

confidence: 99%

Cervical interlaminar epidural steroid injection for neck pain and cervical radiculopathy: effect and prognostic factors

et al. 2007

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Objective To verify the usefulness of a fluoroscopy guided cervical interlaminar epidural steroid injection (CIESI) in patients with neck pain and cervical radiculopathy and to evaluate outcome predictors. Design We retrospectively analyzed 91 patients from July 2004 to June 2005 in whom CIESI was initially performed for neck pain and cervical radiculopathy. Therapeutic effects were evaluated 2 weeks after the administration of CIESI, and CIESI effectiveness was graded using a fivepoint scale, namely, whether the pain had disappeared, was much improved, slightly improved, the same, or aggravated. We also used a visual analog scale (VAS) for the clinical evaluation. According to documentation and follow-up charts, we categorized treatments as effective or ineffective. Possible outcome predictors, namely, diagnosis (spinal stenosis vs herniated disc), primary symptoms (neck pain vs radiculopathy vs both), age, gender, and duration of pain (more or less than 6 months) were also analyzed. Fisher's exact test, the chi-square test, and multiple logistic regression analysis were used for the statistical analysis. Patients After their medical records had been reviewed, 76 patients were included in this study. Inclusion criteria were: the availability of a cross-sectional image, such as a CT scan or an MR image, and a follow-up record after injection. Results and conclusions The medical records of 76 patients (male:female=41 : 35) of mean age 53.1 years (range 32 years to 82 years) were reviewed. Two weeks after injection, 55 patients (72.4%) had experienced effective pain relief. Patients with herniated discs had significantly better results than patients with spinal stenosis (86.1% vs 60.0%) (P<0.05). Other non-significant predictors of an improved outcome included: a symptom duration of <6 months, a young age, and the presence of cervical radiculopathy. Multiple regression analysis showed that the only factor that was significantly associated with outcome was the cause of the pain, i.e., herniated disc or spinal stenosis. Fluoroscopy guided CIESI is a safe and effective means of treating patients with neck pain and cervical radiculopathy. The most important outcome predictor was cause of pain, and patients with herniated disc experienced better pain relief than those with spinal stenosis.

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Section: Injection Techniquementioning

confidence: 99%

Cervical interlaminar epidural steroid injection for neck pain and cervical radiculopathy: effect and prognostic factors

et al. 2007

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“…Since then, various different terminologies have been used in the literature, which include 'selective lumbosacral block' [29], 'selective nerve root blocks' [14,26], 'transforaminal epidural injections' [15,28] and 'peri-radicular infiltration' [11].…”

Section: Discussionmentioning

confidence: 99%

“…The patient was prone, and using two-planar image intensifier, a 22-to 25-G spinal needle was guided in the so-called safe triangle [26]. The triangle is defined by the pedicle superiorly, spinal nerve medially and vertebral body laterally.…”

Section: Methodsmentioning

confidence: 99%

“…Tajima et al [29] later explored its therapeutic value and reported their results in 1980. Four studies conducted by Weiner et al [33], Lutz et al [15], Pfirrmann et al [26] and Karppinen et al [11] in the last decade have all demonstrated its value in relieving discogenic sciatic pain. However, there are relatively few prospective studies [3,27] that examine its efficacy in relieving stenotictype radicular pain.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of a prospective cohort study on peri-radicular infiltration for radicular pain in patients with lumbar disc herniation and spinal stenosis

Sell

2004

Eur Spine J

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“…However, it is disadvantageous that both methods use radiation and can have a potentially harmful effect both on patients and personnel [15 -18]. In addition, the administration of contrast agent to check for proper distribution of the subsequently administered therapeutic agent along the nerve root is associated with a low risk for allergoid reactions [19]. Treatment guidance via MRI initially for the lumbar spine and later also for the cervical spine was able to be established in recent years as an alternative to fluoroscopic methods and ultrasound guidance [20 -23].…”

mentioning

confidence: 99%

MRI-Guided and CT-Guided Cervical Nerve Root Infiltration Therapy: A Cost Comparison

Maurer

Froeling

Röttgen

et al. 2013

Fortschr Röntgenstr

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Purpose: To evaluate and compare the costs of MRI-guided and CT-guided cervical nerve root infiltration for the minimally invasive treatment of radicular neck pain. Materials and Methods: Between September 2009 and April 2012, 22 patients (9 men, 13 women; mean age: 48.2 years) underwent MRI-guided (1.0 Tesla, Panorama HFO, Philips) single-site periradicular cervical nerve root infiltration with 40?mg triamcinolone acetonide. A further 64 patients (34 men, 30 women; mean age: 50.3 years) were treated under CT fluoroscopic guidance (Somatom Definition 64, Siemens). The mean overall costs were calculated as the sum of the prorated costs of equipment use (purchase, depreciation, maintenance, and energy costs), personnel costs and expenditure for disposables that were identified for MRI- and CT-guided procedures. Additionally, the cost of ultrasound guidance was calculated. Results: The mean intervention time was 24.9 min. (range: 12???36?min.) for MRI-guided infiltration and 19.7?min. (range: 5???54?min.) for CT-guided infiltration. The average total costs per patient were EUR 240 for MRI-guided interventions and EUR 124 for CT-guided interventions. These were (MRI/CT guidance) EUR 150/60 for equipment use, EUR 46/40 for personnel, and EUR 44/25 for disposables. The mean overall cost of ultrasound guidance was EUR 76. Conclusion: Cervical nerve root infiltration using MRI guidance is still about twice as expensive as infiltration using CT guidance. However, since it does not involve radiation exposure for patients and personnel, MRI-guided nerve root infiltration may become a promising alternative to the CT-guided procedure, especially since a further price decrease is expected for MRI devices and MR-compatible disposables. In contrast, ultrasound remains the less expensive method for nerve root infiltration guidance. Citation Format: ??Maurer MH, Froeling V, R?ttgen R et?al. MRI-Guided and CT-Guided Cervical Nerve Root Infiltration Therapy: A Cost Comparison. Fortschr R?ntgenstr 2014; 186: 559???566

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

Abstract: 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.

Cited by 161 publications

References 35 publications

Cervical interlaminar epidural steroid injection for neck pain and cervical radiculopathy: effect and prognostic factors

Cervical interlaminar epidural steroid injection for neck pain and cervical radiculopathy: effect and prognostic factors

Outcomes of a prospective cohort study on peri-radicular infiltration for radicular pain in patients with lumbar disc herniation and spinal stenosis

MRI-Guided and CT-Guided Cervical Nerve Root Infiltration Therapy: A Cost Comparison

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