Journal List > J Korean Soc Spine Surg > v.20(3) > 1076019

Ahn, Yang, Yi, Kim, Jung, Lee, and Choi: The Short Term Results of Selective Nerve Root Block in Spinal Stenosis by Contrast Pattern

Abstract

Study Design

Retrospective study.

Objectives

To observe the short term effect of selective nerve root block (sNRB) depending on the contrast pattern and spinal canal size.

Summary of Literature Review

A number of studies have demonstrated that sNRB is quite effective not only for patients with herniated intervertebral discs but also for those with spinal stenosis.

Materials and Methods

The Visual Analog Scale(VAS) score was collected before and after the procedure from 217 subjects with lumbar spinal stenosis and underwent sNRB. Two types were classified after observing the contrast's spreading pattern, Type I contrast reaching the spinal canal and Type II not reaching the spinal canal. Efficacy of the treatment for each type was also compared. In addition, the spinal canal size was classified into three categories. Treatment efficacy depending on the contrast pattern was also compared in each category.

Results

When divided into two types based on the contrast pattern, type I showed a more significant reduction in VAS score according to T-test although both types showed a decrease in VAS score after the procedure. In regards to spinal canal dimension, both types showed decreased VAS scores after the procedure in patients with spinal canal size larger than 172.2mm2; however, there were no changes in VAS score before and after the procedure for those with spinal canal size smaller than 73mm2.

Conclusions

There was a short term effect of selective nerve root block (sNRB) in patients with spinal stenosis regardless of their contrast pattern, type I group showing a stronger correlation. In regards to spinal canal dimension, patients with larger spinal canal sizes not only showed a significant decrease in VAS score after selective nerve root block (sNRB) but also showed differences depending on the contrast pattern. On the contrary, there was no significant difference in VAS score before and after selective nerve root block (sNRB) in patients with small spinal canal sizes, and there was also no difference in the outcome depending on the contrast pattern in patients with small spinal canal sizes. Therefore, when performing selective root nerve block (sNRB), the operator should remember to manipulate the angle and position of the spinal needle when injecting the appropriate drug after confirming that the contrast material reached the spinal canal. The operator should also consider surgical management when performing selective nerve root block (sNRB) in patients with severe central spinal stenosis.

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Figures and Tables%

Fig. 1.
Fluorography shows the contrast flowing through the spinal canal.
jkss-20-92f1.tif
Fig. 2.
Fluorography shows contrast extending to proximal and distal portion of L5 nerve root but not the spinal canal.
jkss-20-92f2.tif
Fig. 3.
We measured the spinal canal dimension by using free line ROI calculator of Infinitt PACS system.
jkss-20-92f3.tif
Table 1.
Demographics of study participants
(Age) Male Female Total
30-39 7 4 11 (5.0%)
40-49 14 11 25 (11.5%)
50-59 38 21 59 (27.1%)
60-69 44 23 67 (30.8%)
70-79 24 16 40 (18.4%)
80- 8 7 15 (6.9%)
Total 135 (62.2%) 82 (37.8%) 217 (100%)
Table 2.
Comparison of VAS score before and after 1 hour, 1month and 3months in conjunction with Type I and II in each time period
Contrast Type N Before After 1hour After 1 month After 3months
VAS* VAS p-value VAS p-value VAS p-value
Type I 142 5.5±1.3 4.6±1.2 0.067 0.164 2.8±1.3 <0.001 <0.001 2.9±0.9 <0.001 <0.001
Type II 75 5.6±1.7 4.9±1.3 0.104 3.9±1.2 0.027 3.6±1.3 0.005

* VAS; visual analogue scale

Table 3.
Comparison of VAS score for Type I and Type 1month and 3months depending on the canal size
Canal size F/U period Contrast type VAS P-value
After 1hour I 4.4 (±1.4) 5.3 (±1.9) p=0.132
II
I 1.6 (±1.3)
172.2- After 1month II 3.4 (±1.6) 1.5 (±0.9) p=0.002
I
After 3months II 2.8 (±1.4) P=0.029
I 4.6 (±1.5)
After 1hour II 4.8 (±1.6) p=0.159
73-172.2 After 1month I 3.1 (±1.6) 4.0 (±1.7) p=0.016
II
After 3months I 3.3 (±1.4) 3.8 (±1.6) P=0.132
II
I 5.1 (±1.8) 5.3 (±2.0) P=0.235
After 1hour II
-73 I 4.3 (±1.8) 4.7 (±1.9) P=0.153
After 1month II
I 5.0 (±1.9) 5.2 (±1.9) P=0.213
After 3months II
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