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Ha, Shim, Kim, Oh, Kim, and Kim: Effectiveness of Selective Nerve Root Block for the Patient with a Single Level Lumbar Spinal Stenosis who is on the Operation Schedule
Original Article

Journal of Korean Spine Surg 2014;21(3):109-115.

Published online: 21 September 2014

DOI: https://doi.org/10.4184/jkss.2014.21.3.109

Effectiveness of Selective Nerve Root Block for the Patient with a Single Level Lumbar Spinal Stenosis who is on the Operation Schedule

Dae Ho Ha, M.D., Dae Moo Shim, M.D., Yu Mi Kim, M.D., Sung Kyun Oh, M.D., Chang Su Kim, M.D.∗, Sang Yul Kim, M.D.

Department of Orthopedic Surgery, School of Medicine, Wonkwang University Hospital Iksan Korea

∗Department of Orthopedic Surgery, School of Medicine, Kosin University Hospital Korea

Corresponding author: Yu Mi Kim, M.D. Department of Orthopaedic Surgery, School of Medicine, Wonkwang University, 1142 Sanbon-dong, Gunpo, Gyeonggi-do, Korea TEL: +82-31-390-2224, FAX: +82-31-390-2227 E-mail: castkim@daum.net

Received 18 June 2013       Revised 24 June 2013       Accepted 11 August 2014

Copyright © 2014 Korean Society of Spine Surgery

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

Retrospective study.

Objectives

We reported the therapeutic usefulness of a selective nerve root block (SNRB) for patients with a single level spinal stenosis.

Summary of Literature Review

Selective nerve root block for the radiculopathy due to lumbar disc herniation, spinal stenosis, and spondylolisthesis have been reported frequently.

Materials and methods

We retrospectively examined 44 patients with single-level spinal stenosis, for whom surgical treatment was considered due to the failure of other conservative treatments from January 2005 to January 2010. All 44 patients were admitted for surgical decompression. Selective nerve root block was done just before a final decision of surgical procedure; patients with his or her 50 % or more pain reduction could avoid surgery.

Results

In fourty-four cases, twenty-seven pateints underwent a surgical operation. Seventeen patients avoided surgical procedures by successful SNRB. As a result of a 3 year followup, the VAS score was significantly and continuously low on the operation group (p=0.02~0.03). K-ODI and Roland-Morris Disability scores were low in both groups until 1 year after the operation and SNRB procedure (p=0.026~0.042, p=0.03), but there was no statistically significant difference beteween the two groups after 2 years upon followup (p=0.072~0.14, p=0.06). Generally, the operation group had good results until 1 year after operation and had better tendency for improvement. The data displayed a high probability of surgical treatment among the patients with foraminal stenosis (p=0.039) highlight – this sentence says there is no difference after 1 year and there is still no difference after 2 years. If this is true, the sentence needs to be rewritten so that it says both times show no difference. If there is a difference between 1 year and 2 year then the sentence needs to be rewritten to make this more clear. The next sentence seems to say they are different.

Conclusions

Selective nerve root block avoided the surgical intervention in 39% of the patients with the spinal stenosis refractory to the conservative treatment. Thus it is one of options for the refractory spinal stenosis.

Keywords: Spinal stenosis, Root block, Foraminal stenosis

REFERENCES

1. MacNab I. N��ativ� di�c �xpl�rati�n An analy�i� �f th� ca���� �f n�rv�-r��t inv�lv�m�nt in �ixty-�i�ht pa-ti�nt�. Th� J��rnal �f B�n� and J�int S�r��ry (Am�rican). 1971; 53:891–903.
2. D��l�y J, McBr��m R, Ta��chi T, Macnab I. N�rv�.

Table 1.
Demographic Characteristics of the SNRB Group and the Surger Group
Surgery due to
failure to SNRB		 SNRB alone p-value
Patient number 27 17
 Recurrent after improve 24
 without any effect 3
Mean age(years) 63.2 63.5 0.764
Male 6 3
Female 21 14
Unemployed 13 11
Part Time Job 6 5
Full time Job 8 1
BMI(Kg/m2) 27.26 26.34 0.845
F/U Duration(month) 5.13(1-72) 8.34(3-36) 0.523
Level
 L2/3 0 2
 L3/4 3 1
 L4/5 21 6
 L5/S1 3 8
Table 2.
Anatomical location of stenosis with relation to the method of treatment
Method of treatment Anatomical location of stenosis
central lateral foraminal total
SNRB 5 12 0 17
OP 4 15 8 27
Total 9 27 8 44
p= 0.039
Table 3.
Changes of VAS Over Time in SNRB Group and Surgery Group
VAS score* p-value
OP group Non-OP group
preOP 8.1±0.5 7.5±0.8 0.12
postOP 1mon 2.7±1.2 4.8±2 0.03
postOP 6mon 2.4±2 5.3±1.8 0.03
postOP 1year 4.2±1.1 6.7±0.8 0.02
postOP 2 year 4.5±0.9 6.5±0.7 0.02
postOP 3 year 4.2±0.6 6.6±0.8 0.02

*: Visual Analog Scale.

Table 4.
Changes of ODI Over Time in SNRB Group and Surgery Group
ODI score* p-value
OP group Non-OP group
preOP 42.5±4.8 42.3±3.2 0.11
postOP 1mon 25.3±3.3 37.2±4.2 0.026
postOP 6mon 26.6±2.0.14 36.5±3.0.072 0.033
postOP 1year 30.2±3.4 36.1±3.1 0.042
postOP 2 year 31.5±4.4 36.5±3.1 0.072
postOP 3 year 33.4±4.2 36.7±3.4 0.14

*: Oswestry Disability Idex

Table 5.
Changes of Low Back Outcome Score Over Time in SNRB Group and Surgery Group
Low Back Outcome score p-value
OP group Non-OP group
preOP 27.3±1.8 27.1±2.6 0.12
postOP 1mon 42.6 37.3±1.2 0.012
postOP 6mon 47.5 36.4 0.02
postOP 1year 42.7 38.8 0.062
postOP 2 year 42.6±5.2 39.9±2.5 0.075
postOP 3 year 40.7±3.3 37.5±1.5 0.066
Table 6.
Changes of Score of Roland-Morris Disability Questionnaire Over Time in SNRB Group and Surgery Group
R.M Disability Ques. p-value
OP group Non-OP group
preOP 23.4 22.3 0.08
PostOP 1year 9.8 15.5 0.03
PostOP 2year 12.1 14.4 0.06
PostOP 3year 14.2 15.2 0.06

*: Roland-Morris Disability Questionnaire.

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