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

Dae Moo Shim; Jin Young Park; Jung Hwan Yang; Byong San Choi

doi:10.4055/jkoa.2008.43.4.413

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Shim, Park, Yang, and Choi: Effectiveness of Selective Nerve Root Block on the Need for Surgical Treatment of Lumbar Disc Herniation

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2008; 43(4): 413-419.

Published online: 31 August 2008

DOI: https://doi.org/10.4055/jkoa.2008.43.4.413

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

Dae Moo Shim, M.D., Jin Young Park, M.D., Jung Hwan Yang, M.D., Byong San Choi, M.D.

Department of Orthopaedic Surgery, School of Medicine, Wonkwang University, Iksan, Korea.

Address reprint requests to Jung Hwan Yang, M.D. Department of Orthopaedic Surgery, School of Medicine, Wonkwang University, 344-2, Shinyong-dong, Iksan 570-711, Korea. Tel: +82.63-859-1360, FAX: +82.63-852-9329, bakgom95@naver.com

Abstract

Purpose

The purpose of the study is to evaluate the effectiveness of selective nerve root block (SNRB) in advance to the patient who is going to undergo the operation for lumbar herniated intervertebral disc (HIVD).

Materials and Methods

103 cases were selected from among SNRB conducted to the patients who had been diagnosed by this hospital to have lumbar HIVD from December 2004 to November 2005 and assigned for operations. The follow-up period was 10 months in average (2.5-30 months) and the average age was 35.5 years (19-72 years). Patients had been monitored by means of clinical records, interviews and telephone and features of symptoms and stage of nerve root compression were compared between the group of operated patients and that of the non-operated.

Results

As for stages of nerve root compression, 15 cases could be classified to belong to the 1st stage, 4 cases to the 2nd stage and 1 case to the 3rd stage. Among 42 cases for which operations were conducted because there was no improvement after SNRB. Divided by stages of nerve root compression, 13 cases belonged to the 1st stage, followed by 10 cases to the 2nd stage and 4 cases to the 3rd stage. No statistically significant difference turned out to exist the clinical results between 42 cases which underwent operations and 61 cases which experienced improvement after nerve root block. No significant difference, either, was confirmed from the statistical outcomes between SNRB group and operations.

Conclusion

The preserving treatment using SNRB for the patients with lumbar HIVD seems to have positive clinical effects. Features of radiating pains or stages of nerve root compression, however, can't be regarded to be factors foretelling the treatment effects of SNRB.

Keywords: Lumbar, Herniated intervertebral disc, Selective nerve root block

Figures and Tables

Fig. 1

L4 selective nerve root block.

Fig. 2

Grade of nerve root compression. Grade I (abutment): the herniated disc abuts the nerve root, but the root is in its normal position. Grade II (displacement): the herniated disc material displaces the nerve root, but the displaced nerve root can be seen by MRI. Grade III (entrapment): the nerve root is entrapped between the herniated disc and the lamina or facet. The entrapped nerve root is hardly detected by MRI.

Table 1

Criteria or Clinical Results (Kim, 1986)

Table 2

Comparison between Spinal Nerve Root Block Group and Operating Group

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