Effectiveness of Selective Nerve Root Block on the Need for Surgical Treatment of Patients with Cervical Radicular Pain: A Minimum 5 Years Follow-Up

Ho Yun Joung; Tae Kyun Kim; Sung Kyun Oh; Dong Jin Shin; Dae Moo Shim

doi:10.4055/jkoa.2016.51.1.61

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Joung, Kim, Oh, Shin, and Shim: Effectiveness of Selective Nerve Root Block on the Need for Surgical Treatment of Patients with Cervical Radicular Pain: A Minimum 5 Years Follow-Up

Original Article

Journal of the Korean Orthopaedic Association 2016; 51(1): 61-68.

Published online: 23 February 2016

DOI: https://doi.org/10.4055/jkoa.2016.51.1.61

Effectiveness of Selective Nerve Root Block on the Need for Surgical Treatment of Patients with Cervical Radicular Pain: A Minimum 5 Years Follow-Up

Ho Yun Joung, M.D.^*, Tae Kyun Kim, M.D., Sung Kyun Oh, M.D.^*, Dong Jin Shin, M.D.^*, Dae Moo Shim, M.D.

Department of Orthopaedic Surgery, Wonkwang University Hospital and Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea.

^*Department of Orthopaedic Surgery, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, Korea.

Correspondence to: Sung-Kyun Oh, M.D. Department of Orthopaedic Surgery, Wonkwang University Sanbon Hospital, 327 Sanbon-ro, Gunpo 15865, Korea. TEL: +82-31-390-2224, FAX: +82-31-398-2223, niceo@daum.net

Received 4 February 2015 Revised 27 March 2015 Accepted 5 October 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study is to assess the 5-year outcome of patients considering surgery for complaint of cervical and radiating pain treated by selective nerve root block (SNRB).

Materials and Methods

Between January 2001 and December 2007, 39 cases were selected from patients who underwent SNRB before the operation and were followed-up for more than five years. The mean follow-up period was 64.3 months and the mean age was 57.7 years. The patients were divided into the operation group and the only cervical SNRB group. The groups were compared for gender, age, duration, disease, single or multi-level, and root compression rate on magnetic resonance imaging. The clinical results were analyzed using the neck disability index (NDI) and the visual analogue scale (VAS) score.

Results

Among the 39 cases scheduled for the operation, 20 cases (51.3%) did not proceed to the operation and 13 cases among them were treated with additional conservative treatment. The average VAS score for the operation group and the cervical SNRB group was 8.1 points and 7.5 points at the preoperative state and the pre-injection state. After surgical treatment and cervical nerve root block, the scores were 3.0 points for all. The NDI for the operation group was 11.3 points at the last follow-up. The NDI for the cervical nerve root block group was 13.6 at the last follow-up. There was no significant difference between the two groups. Shorter duration and younger age tended to show a higher operation rate. At the last follow-up, 7 cases (17.9%) after cervical SNRB had persistent symptom relief without other treatment.

Conclusion

Cervical SNRB is considered an effective treatment for patients with cervical disease with radiating pain and who are scheduled for an operation.

Keywords: cervical radiculopathy, epidural injections, cervical pain

Figures and Tables

Figure 1

Root compression rate (a/b).

Table 1

Follow-Up Result of Initial Only Selective Nerve Root Block Group (24 Cases)

Values are presented as number (%).

Table 2

Clinical Results of SNRB Group and Operation Group

SNRB, selective nerve root block; VAS, visual analogue scale; NDI, neck disability index; F/U, follow-up.

Table 3

Operation Ratio of Sex, Disease, Age, and Duration

Values are presented as number only. SNRB, selective nerve root block.

Table 4

Average of Age and Duration of SNRB Group and Operation Group

SNRB, selective nerve root block. ^*Chi-square test.

Table 5

Clinical Results of Only SNRB Group and Operation Group, Comparison of Single Level Group vs. Multiple Level Group

^*Mann-Whitney U-test; ^†Wilcoxon signed-rank test. SNRB, selective nerve root block; VAS, visual analogue scale; F/U, follow-up; NDI, neck disability index.

Notes

This paper was supported by Wonkwang University in 2016.

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

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