The Outcomes of Selective Nerve Root Block for Disc Induced Lumbar Radiculopathy

Abstract

Introduction : Use of Selective Nerve Root Block (SNRB) in lumbar region to relieve radicular pain along the course of a particular nerve is being practiced in the recent past. We observed and tabulated therapeutic outcomes of this procedure in management of radiculopathy induced by a prolapsed disc affecting a particular lumbar nerve root.Methods : 40 patients with various grades of disc prolapse affecting a particular lumbar nerve root presenting with chronic radicular pain were identified irrespective of age and sex. All were injected with a combination of 40 mg of Methylprednisolone based suspension with local anaesthetic over the affected nerve root and results were analyzed.Results : Those graded mild had 4.3 months relief and those graded moderate had 2.5 months relief. Those with severe disc prolapse had no relief except for the immediate postprocedural relief. Only 20% patients had relief up to 6 months.Conclusion : Effect of SNRB is typically short acting in majority of patients and recurrence is expected. It creates a window period with reduced pain but of varied intervals depending on the pathology. It did not alter the prognosis in those with severe disease where surgery is well indicated.Level of Evidence – Level 4

<p>The Efficacy of Therapeutic Selective Nerve Block in Treating Lumbar Radiculopathy and Avoiding Surgery</p>

“…Lumbar radiculopathy is defined as pain in the lower back, radiating to the lower limb along the course of a certain lumbar nerve caused by a pathological process such as inflammation or mechanical compression of that nerve root. 1,2 It can affect the quality of life and limit the activities of affected patients. It is mostly caused by lumbar disc prolapse (LDP) compressing the nerve root or nerve root foraminal stenosis.…”

“…SNRB can be used in multiple sites, including cervical and lumbar . 2,9 Steroids are usually injected near the spinal nerve as it exits from the intervertebral foramen. The use of steroids is due to their ability to reduce inflammation and induce numbness to the pain transmission through the nerve.…”

“…16 Still, it can create a time window for pain relief. 2 Although long-lasting improvement is possible, the long-term effects of the medications cannot be predicted. 16,18 Usually, the immediate effect is from the local anesthetic injected; this wears off in a few hours.…”

“…This was also seen in a study that showed relief of symptoms in 20% of patients throughout the follow-up period of six months. 2 This made our primary focus on the clinical benefits of SNRB in treating patients with lumbosacral radiculopathy caused by LDP or FS to find out the percentage of longterm pain relief; therefore, SNRB can delay and sometimes cease the need for surgery.…”

<p>Ultrasound-Guided Lumbar Paravertebral Block After Pre-Designed Route on X-Ray Film for Radicular Pain Following Failed Back Surgery Syndrome: A Case Report</p>

“…In general, pain physicians prefer lumbar selective nerve root block/radiofrequency or transforaminal injection under fluoroscopic guidance for radicular pain caused by lumbar disc herniation. 6,7 After the puncture needle is in place, the contrast agent is injected, and the contrast agent can be seen spreading along the nerve root and epidural space. However, PVB involves injection of local anesthetic in a space immediately lateral to where the spinal nerves emerge from the intervertebral foramina.…”