RESULTS OF TREATMENT OF ACUTE LUMBAR DISC HERNIATION WITH TRANSFORAMINAL NERVE ROOT BLOCK

ABSTRACT Objective: To determine the efficacy of anesthetic transforaminal nerve root block in patients with sciatica secondary to lumbar disc herniation through a prospective observational study. Methods: The study included 176 patients from a private clinic undergoing transforaminal injection performed by a single spinal surgeon. The patients were assessed after two weeks, three months and six months regarding to the improvement of the pain radiating to the lower limbs. In case of persistent symptoms, patients could choose to perform a new nerve root block and maintenance of physical therapy or be submitted to conventional microdiscectomy. Results: By the end of six-month follow-up of the 176 patients, 116 had a favorable outcome (95 after one block and 21 after two blocks), and only 43 required surgery. Conclusion: The results of our study suggest a positive effect of transforaminal block for the treatment of sciatica in patients with lumbar disc herniation.

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Comparison of Selective Nerve Root Block and Continuous Epidural Block Efficacy for Lumbar Disc Herniation.

Orthopedics & Traumatology ◽

10.5035/nishiseisai.51.527 ◽

2002 ◽

Vol 51 (3) ◽

pp. 527-531

Author(s):

Toshiaki Takahashi ◽

Akira Fukushima ◽

Noriyuki Takasu ◽

Atsushi Yamamoto ◽

Tomofumi Ogoshi

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Nerve Root ◽

Lumbar Disc ◽

Epidural Block ◽

Nerve Root Block ◽

Selective Nerve Root Block

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Application of Gelatin Sponge Impregnated with a Mixture of 3 Drugs to Intraoperative Nerve Root Block to Promote Early Postoperative Recovery of Lumbar Disc Herniation

World Neurosurgery ◽

10.1016/j.wneu.2018.03.170 ◽

2018 ◽

Vol 114 ◽

pp. e1168-e1173 ◽

Cited By ~ 3

Author(s):

Jin Peng Du ◽

Yong Fan ◽

Ding Jun Hao ◽

Yun Fei Huang ◽

Jia Nan Zhang ◽

...

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Nerve Root ◽

Lumbar Disc ◽

Postoperative Recovery ◽

Gelatin Sponge ◽

Nerve Root Block

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Effectiveness of Selective Nerve Root Block on the Need for Surgical Treatment of Lumbar Disc Herniation

The Journal of the Korean Orthopaedic Association ◽

10.4055/jkoa.2008.43.4.413 ◽

2008 ◽

Vol 43 (4) ◽

pp. 413 ◽

Cited By ~ 5

Author(s):

Dae Moo Shim ◽

Jin Young Park ◽

Jung Hwan Yang ◽

Byong San Choi

Keyword(s):

Surgical Treatment ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Nerve Root ◽

Lumbar Disc ◽

Nerve Root Block ◽

Selective Nerve Root Block

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Intraoperative chymopapain in lumbar laminotomy for disc disease: a less invasive technique

Neurosurgical FOCUS ◽

10.3171/foc.1998.4.2.13 ◽

1998 ◽

Vol 4 (2) ◽

pp. E12 ◽

Cited By ~ 6

Author(s):

Tord D. Alden ◽

George J. Kaptain ◽

John A. Jane ◽

John A. Jane

Keyword(s):

Nucleus Pulposus ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Nerve Root ◽

Lumbar Disc ◽

Perioperative Period ◽

Invasive Technique ◽

Disc Disease ◽

Lumbar Microdiscectomy

The use of chymopapain in the treatment of lumbar disc herniation has been widely studied since Smith first described its use in humans in 1963. The authors describe the use of chymopapain intraoperatively in open lumbar microdiscectomy in 63 patients. When combined with the results of a previous study performed at the same institution, the authors found that this technique significantly reduces the rate of recurrent disc herniation when compared with traditional laminotomy with discectomy. This procedure maximizes the benefits of each approach taken separately, allowing for decompression of the nerve root from a free fragment or sequestered disc and preventing recurrence through dissolution of the nucleus pulposus. Overall, outcome was good or excellent immediately postoperatively in 73% of the 63 patients and in 64% at last follow-up evaluation. Additionally, this procedure is safe with no complications noted in the immediate perioperative period or at follow-up evaluation.

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The Usefulness of Selective Nerve Root Block as a Predictor of Prognosis of Lumbar Disc Herniation

Journal of Korean Society of Spine Surgery ◽

10.4184/jkss.2005.12.3.192 ◽

2005 ◽

Vol 12 (3) ◽

pp. 192

Author(s):

Dong-Ho Lee ◽

Min Seok Kim ◽

Kang-Sup Yoon ◽

Seung-Baik Kang ◽

Hyuh Chul Jo ◽

...

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Nerve Root ◽

Lumbar Disc ◽

Nerve Root Block ◽

Selective Nerve Root Block

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Painless Footdrop Secondary to Lumbar Disc Herniation

Neurosurgery ◽

10.1227/00006123-198104000-00017 ◽

1981 ◽

Vol 8 (4) ◽

pp. 484-486 ◽

Cited By ~ 11

Author(s):

Eddy Garrido ◽

Robert H. Rosenwasser

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Nerve Root ◽

Lumbar Disc ◽

The Other ◽

Herniated Disc

Abstract This is a report of two patients who developed a painless footdrop due to compression of the L-5 nerve root from a herniated disc at the L-4, L-5 interspace. The diagnosis was suspected clinically, supported by myelography, and confirmed at operation. One patient has regained the strength of his foot during the follow-up period; the other has remained unchanged.

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Microscopic extra-laminar sequestrectomy (MELS) for the treatment of hidden zone lumbar disc herniation: report of the surgical technique, patient selection, and clinical outcomes

BMC Surgery ◽

10.1186/s12893-021-01255-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Chunxiao Wang ◽

Yao Zhang ◽

Xiaojie Tang ◽

Haifei Cao ◽

Qinyong Song ◽

...

Keyword(s):

Blood Loss ◽

Learning Curve ◽

Clinical Outcomes ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Operation Time ◽

Operation Duration ◽

The Mean

Abstract Background The area which located at the medial pedicle, posterior vertebral body and ventral hemilamina is defined as the hidden zone. Surgical management of hidden zone lumbar disc herniation (HZLDH) is technically challenging due to its difficult surgical exposure. The conventional interlaminar approach harbors the potential risk of post-surgical instability, while other approaches consist of complicated procedures with a steep learning curve and prolonged operation time. Objective To introduce microscopic extra-laminar sequestrectomy (MELS) technique for treatment of hidden zone lumbar disc herniation and present clinical outcomes. Methods Between Jan 2016 to Jan 2018, twenty one patients (13 males) with HZLDH were enrolled in this study. All patients underwent MELS (19 patients underwent sequestrectomy only, 2 patients underwent an additional inferior discectomy). The nerve root and fragment were visually exposed using MELS. The operation duration, blood loss, intra- and postoperative complications, and recurrences were recorded. The Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and the modified MacNab criteria were used to evaluate clinical outcomes. Postoperative stability was evaluated both radiologically and clinically. Results The mean follow-up period was 20.95 ± 2.09 (18–24) months. The mean operation time was 32.43 ± 7.19 min and the mean blood loss was 25.52 ± 5.37 ml. All patients showed complete neurological symptom relief after surgery. The VAS and ODI score were significantly improved at the final follow-up compared to those before operation (7.88 ± 0.70 vs 0.10 ± 0.30, 59.24 ± 10.83 vs 11.29 ± 3.59, respectively, p < 0.05). Seventeen patients (81%) obtained an “excellent” outcome and the remaining four (19%) patients obtained a “good” outcome based the MacNab criteria. One patient suffered reherniation at the same level one year after the initial surgery and underwent a transforaminal endoscopic discectomy. No major complications and postoperative instability were observed. Conclusions Our observation suggest that MELS is safe and effective in the management of HZLDH. Due to its relative simplicity, it comprises a flat surgical learning curve and shorter operation duration, and overall results in reduced disturbance to lumbar stability.

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