The diagnostic utility and cost-effectiveness of selective nerve root blocks in patients considered for lumbar decompression surgery: a systematic review and economic model

Abstract

Reports are published in Health Technology Assessment (HTA) if (1) they have resulted from work for the HTA programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors.Reviews in Health Technology Assessment are termed 'systematic' when the account of the search appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. HTA programmeThe HTA programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care.The journal is indexed in NHS Evidence via its abstracts included in MEDLINE and its Technology Assessment Reports inform National Institute for Health and Care Excellence (NICE) guidance. HTA research is also an important source of evidence for National Screening Committee (NSC) policy decisions.For more information about the HTA programme please visit the website: www.hta.ac.uk/ This reportThe research reported in this issue of the journal was funded by the HTA programme as project number 09/111/01. The contractual start date was in August 2010. The draft report began editorial review in February 2012 and was accepted for publication in October 2012. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HTA editors and publisher have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HTA programme or the Department of Health.

Epidemiology, Diagnosis, and Treatment of Neck Pain

“…68 One recent review concluded that adding SNRB to diagnostic work-ups in patients with lumbar radiculopathy being considered for surgery was not cost-effective. 112 Surgery Few randomized studies have evaluated surgical treatment for neck pain, and none have done so for mechanical pain. In a randomized study comparing anterior decompression and fusion operations, physical therapy, and hard collar immobilization in 81 patients with cervical radiculopathy, Persson et al 113,114 found greater reductions in pain (29% for surgery, 19% for physical therapy, and 4% for cervical collar) and improvements in muscle strength and sensory loss in the surgical group than in the other treatment groups.…”

Failed back surgery syndrome: current perspectives

“…Selective nerve root blocks with only local anesthetic have been done historically as a mode of diagnosis and as a predictive guideline for patients considering lumbar decompression surgery despite its accuracy having been questioned 40,41. Adding steroid to local anesthetic can improve the duration of pain relief of injections, thus many injections can be both diagnostic and therapeutic.…”

Cost-effectiveness of three treatment strategies for lumbar spinal stenosis: Conservative care, laminectomy, and the Superion interspinous spacer

“…Additionally, probabilistic sensitivity analysis, a standard method of integrating uncertainty about many variables simultaneously, was performed. 26 …”