The Effectiveness and Safety of Selective
Lumbar Decompression in Diagnostic Doubt
Patients: A Retrospective Control Study

Background: Our previous study demonstrated that selective nerve root block (SNRB) can influence decision-making in lumbar surgery by guiding the selection of nerve roots targeted for decompression in diagnostic doubt patients (DDPs). However, further studies were needed to determine whether this selective decompression (SD) procedure would result in similar clinical outcomes and reduce the perioperative parameters and postoperative complications as compared to the non-selective decompression (NSD) procedure. Objective: The specific goal of this study is to compare clinical outcomes, perioperative parameters, and complications between SD and NSD procedures in DDPs. Study Design: A retrospective control study. Setting: Gaozhou People’s Hospital. Methods: From January 2009 to January 2011, 57 lumbar surgery patients with diagnostic doubt were retrospectively reviewed. Basic patient parameters, as well as perioperative and postoperative data were compared between the selective and non-selective decompression groups. Clinical outcomes were evaluated using the visual analog scale (VAS), Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) scores, and JOA recovery rates. Results: Both groups showed significant improvement in VAS, ODI, and JOA scores between preoperative and postoperative measurements. The differences in VAS and ODI scores between groups were not significant at 3 and 60 months postoperatively (both P > 0.05). In addition, there was no significant difference in JOA recovery rate (P = 0.659) and survival rate (P = 0.586) during the 60 months following surgery. However, distinctly superior perioperative parameters (operation time and hospital stay, blood loss and drainage volume, laminectomy numbers, and fusion segment numbers) were observed in the SD group (P < 0.001 for each score). Moreover, the SD-treated group experienced significantly fewer adverse events postoperatively (P = 0.036). Limitations: The limitations of this study lie in the size of the study and selection of patients and in the fact that it was not feasible to include all cases of diagnostic doubt. Conclusions: On the basis of the 5-year follow-up data, we suggest that the SD procedure guided by SNRB is an effective and safe method for the surgical treatment of DDPs. This procedure produces superior perioperative parameters when compared with the conventional NSD procedure, but has a comparable clinical outcome. Moreover, the benefits of SD surgery include fewer perioperative and postoperative complications. Key words: Lumbar spinal surgery, diagnostic doubt, selective nerve root block (SNRB), selective decompression (SD)

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Selective Nerve Root Block in Patient Selection for Lumbar Surgery

Journal of Spinal Disorders ◽

10.1097/00002517-198906000-00002 ◽

1989 ◽

Vol 2 (2) ◽

pp. 75???79 ◽

Cited By ~ 47

Author(s):

Larry D. Herron

Keyword(s):

Patient Selection ◽

Nerve Root ◽

Lumbar Surgery ◽

Nerve Root Block ◽

Selection For ◽

Selective Nerve Root Block

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

January 2018 - Pain Physician ◽

10.36076/ppj.2007/10/461 ◽

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

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Necessity of contrast agents to identify the injection site in selective nerve root block

10.21203/rs.3.rs-31300/v1 ◽

2020 ◽

Author(s):

Sangbong Ko ◽

Sukkyoon Song ◽

Jaejun Lee

Keyword(s):

Lower Extremity ◽

Contrast Agents ◽

Nerve Root ◽

Short Form ◽

Physical Component Score ◽

Contrast Injection ◽

Component Score ◽

Nerve Root Block ◽

Significant Difference ◽

Selective Nerve Root Block

Abstract Study Design: Control arm of randomized trial Background While injecting contrast agents may give patients additional lower extremity radiating pain, additional radiation exposure, or delay in procedure time, care should be taken when they are used in patients with renal disease. Therefore, it is hypothesized that if it is confirmed that the pain caused by the injection needle coincides with the radiating pain that the patient mainly complains of, then the contrast agents may be used less. The purpose of this study is to understand if the identification of lancinating identical pain in the procedure could replace the use of contrast agents. Methods This retrospective study included 165 patients who met exclusion criteria from among patients who underwent selective nerve root block (SNRB) for the treatment of radiating lower extremity pain from January 2015 to November 2019. With the identical and lancinating pain confirmed in the same site of the patient, consistent with that of the original symptom, the subjects were divided into two groups: one without contrast injection (Non-Dye (ND) group; 57 patients) and the other with contrast injection (Dye (D) group; 108 patients). The degree of lower extremity radiating pain in the two groups was evaluated using visual analog scale (VAS) before injection, 1, 2, 6, and 12 weeks after injection. Functional outcomes were measured using Oswestry Disability Index (ODI) and Rolland Morris Disability Questionnaire (RMDQ), whereas quality of life was measured using Physical Component Score (PCS) and Mental Component Score (MCS) of Short Form – 36 (SF-36) before injection and 3 months after injection. Results There was no statistically significant difference in the lower extremity radiating pain severity in both groups at all times and no statistical difference in the degree of VAS improvement relative to the before-injection VAS value between the two groups at 2 and 6 weeks after injection. At 12 weeks after injection, there was a statistically significant difference, with group ND 4.37 ± 2.81 and group D 3.48 ± 2.43 (p = 0.037), but they were below Minimal Clinically Important Difference (MCID), bearing little clinical implications. Conclusions Instead of contrast agent injections that have been used for accurate nerve root identification during SNRB, the method of merely checking if the needle-induced pain under fluoroscopic imaging is consistent with the lower extremity radiating pain that the patient predominantly experiences shows the same effect in the patient’s pain control and functional outcome.

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