scholarly journals Selective extraforaminal nerve root block for management of lumbar radiculopathy

2021 ◽  
Vol 9 (3) ◽  
pp. 147-154
Author(s):  
Vihar SJ ◽  
Naveen DS ◽  
Agrawal NK
Keyword(s):  
Nerve Root ◽  
Therapeutic Modality ◽  
Lumbar Radiculopathy ◽  
Factors Affecting ◽  
Nerve Root Block ◽  
Medical College ◽  
Vas Score ◽  
Post Procedure ◽  
Vas Scores ◽  
Selective Nerve Root Block

Lower back pain with radiculopathy is one of the common complaints that patient presents to an orthopaedician. Study was done to assess effect of extraforaminal Selective Nerve Root Block (SNRB) in management of lumbar radiculopathy in 50 patients between December 2019 and June 2020 at Bapuji Medical College and Chigateri General Hospital, Davanagere, Karnataka, India. Extraforaminal SNRB was performed and Visual Analogue Scale (VAS) scores recorded pre procedure, immediate post procedure, one month and 6 months post procedure. Significant decrease (p<0.001) in VAS scores immediate post procedure by 5 or more points in 25%; by 3-4 points in 44% and 1-2 points in 6% of the patients obtained. One month post procedure showed statistically significant results (p<0.005) owing to change in VAS score by 1-2 points in 84% (42) patients and no change or increase in the VAS scores only in 10%(5) patients. VAS scores at 6th month showed statistically significant results (p<0.005) with reduction of VAS scores in 46.34% (19), retention of VAS score 0 in 31.70% (13) and no change or increase in VAS scores in only 21.95% (9) patients. Our study concludes that extraforaminal SNRB acts as excellent diagnostic tool and therapeutic modality for immediate and long term pain management in lumbar radiculopathy. Increase in the pain scores at 6th month (p=0.2) shows that recurrence of symptoms is a possibility. Further randomized control studies with larger study population, association of patient factors affecting extraforaminal SNRB would give better insight and knowledge of the factual data.

scholarly journals The Effectiveness of a Selective Nerve Root Block for Lumbar Radiculopathy

2011 ◽  
Vol 60 (1) ◽  
pp. 95-100
Author(s):  
Tomonao Chikama ◽  
Ko Ikuta ◽  
Nobuhiko Yokoyama ◽  
Yusuke Takahashi ◽  
Takahiro Kitamura ◽  
...  
Keyword(s):  
Nerve Root ◽  
Lumbar Radiculopathy ◽  
Nerve Root Block ◽  
Selective Nerve Root Block

scholarly journals Clinical Efficacy of Selective Nerve Root Block in Lumbar Radiculopathy due to Disc Prolapse

2019 ◽  
Vol 17 (2) ◽  
pp. 242-246 ◽  
Author(s):  
Gaurav Raj Dhakal ◽  
Pawan Kumar Hamal ◽  
Siddhartha Dhungana ◽  
Yoshiharu Kawaguchi
Keyword(s):  
Nerve Root ◽  
Index Score ◽  
Lumbar Radiculopathy ◽  
Disc Prolapse ◽  
Visual Analogue Pain Score ◽  
Visual Analogue Pain ◽  
Nerve Root Block ◽  
Oswestry Disability Index Score ◽  
One Year ◽  
Selective Nerve Root Block

Background: Selective Nerve Root Block using steroid is a proven technique for management of lumbar radiculopathy. The aim of the study was to determine the effectiveness of selective nerve root block in lumbar radiculopathy.Methods: A prospective observational study was conducted for duration of one year in patients diagnosed with lumbar radiculopathy. Patients with leg pain, positive straight leg raising test and single level disc prolapse were included in the study. The procedure was performed under fluoroscopic guidance and Visual Analogue Pain rating scale and Oswestry Disability Index score was used for assessment pre-injection, 1 week, 1 month, 6 months and 1-year post injection.Results: Total 35 patient with mean age of 37.7± 9.31 years were included in the study. The pre-injection Visual Analogue Pain Score(Mean ± S.D:7.8±0.7) was significantly reduced at one week (4.2±1.47, p <0.00001), one month (2.74±1.06, p <0.00001), six months (2.31±0.75, p <0.00001) and one year (2.62±0.84, p <0.00001). Similarly, pre-injection Oswestry Disability Index score (Mean ± S.D: 32.09±5.95) was significantly reduced at one week (19.51±7.26, p <0.00001), one month (12.71±4.56, p <0.00001), six months (9.8±2.87, p <0.00001) and one year (10.09±2.97, p <0.00001) but not significantly improved when compared at 6 months and 1 year (p < 0.44).Conclusions: Selective Nerve Root Block in lumbar radiculopathy significantly reduces Visual Analogue Pain Score up to a year, however, the reduction in pain plateaus around six months.Disability index score only reduces for first 6 months but doesn’t significantly reduce from six months to one year.Keywords: Lumbar; radiculopathy; selective nerve root block; steroid.

scholarly journals A comparative study of efficacy between transforaminal epidural injection and selective nerve root block in disc prolapse of L4-L5 and L5-S1

2020 ◽  
Vol 9 (1) ◽  
pp. 155
Author(s):  
Arindam Ghosh ◽  
Debayan Ghorai ◽  
Dibyendu Dutta
Keyword(s):  
Nerve Root ◽  
Epidural Injection ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Open Label ◽  
Post Intervention ◽  
Nerve Root Block ◽  
Vas Score ◽  
Transforaminal Epidural Injection ◽  
Selective Nerve Root Block

Background: To compare efficacy between transforaminal epidural injection (TFEI) and selective nerve root block (SNRB) in prolapsed L4-L5 and L5-S1 disc.Methods: This study was a randomized parallel group open label interventional study. Patients suffering from low back pain (LBP) with radiation due to prolapsed inter-vertebral disc (PIVD) were selected for intervention (n=78). After computer generated randomization, they were allocated into two groups (TFEI group and SNRB group) consisting 39 patients in each group. Each patient received combination of 2 ml of depot methylprednisolone acetate (40 mg/ml) and 1 ml of 0.25% preservative free bupivacaine under fluoroscopy guidance.                                                                                                            Primary outcome measures were visual analogue scale (VAS) score of LBP and VAS score of radiation pain. Secondary outcome measure was Oswestry LBP disability questionnaire (ODQ) score.Results: At 1-day post-intervention TFEI group showed statistically significant improvement in VAS score of LBP (p=0.000) as compared to SNRB group. At 1-month post-intervention TFEI group showed statistically significant improvement in VAS score of LBP (p=0.000) and VAS score of radiation pain (p=0.000) as compared to SNRB group. At 3-month post-intervention TFEI group again showed statistically significant improvement in VAS score of LBP (p=0.000), VAS score of radiation pain (p=0.000), and ODQ score (p=0.000) as compared to SNRB group.Conclusions: TFEI is better than SNRB in terms of improvement in LBP, radiation pain, and functional activity up to 3-month post-intervention.  

scholarly journals Spread of Contrast During L4 and L5 Nerve Root Infiltration Under Fluoroscopic Guidance

2007 ◽  
Vol 3;10 (5;3) ◽  
pp. 461-466
Author(s):  
Dmitri Vassiliev
Keyword(s):  
Nerve Root ◽  
Water Soluble ◽  
Fluoroscopic Guidance ◽  
Lumbar Radiculopathy ◽  
Nerve Roots ◽  
Nerve Root Block ◽  
Significant Difference ◽  
Lumbar Segment ◽  
Nerve Root Blocks ◽  
Selective Nerve Root Block

Background: Lumbar selective nerve root blocks have been performed to establish the origin of lumbar radiculopathy in clinically difficult cases. The diagnostic ability of selective nerve root blocks remains controversial because of concern over potential spread of an injectate onto adjacent structures. Objective: To investigate the spread of different volumes of water-soluble contrast during L4 and L5 selective nerve root blocks. Design: Retrospective, observational case series. Methods: Analysis of medical records and X-ray images obtained during L4 and L5 selective nerve root blocks. Results: During L4 selective nerve root block 1 ml of contrast spread onto L5 nerve roots in 46.1% of subjects and during L5 nerve root block 1 ml of contrast spread onto S1 nerve root in 57.7%. There was statistically significant difference (p<0.0001) between spread of contrast onto the medially located nerve root in the same lumbar segment and nerve roots in the lumbar segment above. Conclusions: Injection of 1 ml of contrast under fluoroscopic guidance does not guarantee selective spread of the contrast around L4 or L5 nerve roots only. There is also spread toward the more medial nerve root in the same spinal segment during L4 and L5 nerve root infiltration. These findings suggest that it is possible to differentiate between L4 and L5 nerve root pathology using a sequential nerve root blocks under fluoroscopic guidance. Key words: Selective nerve root block, Lumbar radiculopathy, Fluoroscopic guidance

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

2015 ◽  
Vol 9 (3) ◽  
pp. 17-22 ◽  
Author(s):  
Arun-Kumar K ◽  
Jayaprasad S ◽  
Senthil K ◽  
Lohith H ◽  
Jayaprakash KV
Keyword(s):  
Nerve Root ◽  
Lumbar Radiculopathy ◽  
Nerve Root Block ◽  
Selective Nerve Root Block

scholarly journals Variations in selective nerve root block technique

2013 ◽  
Vol 95 (7) ◽  
pp. 515-518 ◽  
Author(s):  
NC Eastley ◽  
V Spiteri ◽  
ML Newey
Keyword(s):  
Local Anaesthetic ◽  
Nerve Root ◽  
Lumbar Radiculopathy ◽  
Vertebral Disc ◽  
Injection Techniques ◽  
Nerve Root Blocks ◽  
Tip Position ◽  
The Uk ◽  
Selective Nerve Root Block ◽  
Prolapsed Disc

Introduction Much literature reports on selective nerve root blocks (SNRBs) in cases of lumbosacral radiculopathy. Unfortunately, authors only inconsistently reveal the exact needle tip position relative to the causative pathology at the time of injection. Different injection sites may provide different symptomatic benefits. We investigated the variation in injection techniques of practitioners working in the UK. Methods A clinical scenario was devised depicting a patient with radiculopathy secondary to an L4/5 vertebral disc prolapse. Participants were questioned on their chosen management of this patient, focusing particularly on SNRB technique. Questionnaires were sent to spinal surgeons, pain management specialists and musculoskeletal radiologists. Results A total of 100 responses were detailed enough for inclusion. The majority (83%) of respondents reported they would inject local anaesthetic and steroids, 4% would inject local anaesthetic alone and 13% would inject a different substance. Over half (53%) would target the L5 nerve root, 26% the L4 nerve root, 12% the prolapsed disc itself and 9% two separate vertebral levels. Variation was also noted in needle tip location relative to the neural sheath. Conclusions When treating lumbar radiculopathy, there are apparent variations in the use and positioning of SNRBs for a given level of disc pathology. Needle tip position may have a direct influence on clinical outcome following SNRBs. Caution is therefore required when considering the validity of previously published studies investigating SNRBs and different injectates.

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