Management of Patients with L2 Spinal Nerve Root Block Who Are Suffering from Low Back and Referred Pain

Dong Ki Ahn; Song Lee; Tae Woo Kim; Sung Won Hong; Woo Sik Jung

doi:10.4184/jkss.2014.21.1.8

Journal List > J Korean Soc Spine Surg > v.21(1) > 1076048

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Ahn, Lee, Kim, Hong, and Jung: Management of Patients with L2 Spinal Nerve Root Block Who Are Suffering from Low Back and Referred Pain

Original Article

Journal of Korean Spine Surg 2014;21(1):8-14.

Published online: 21 March 2014

DOI: https://doi.org/10.4184/jkss.2014.21.1.8

Management of Patients with L2 Spinal Nerve Root Block Who Are Suffering from Low Back and Referred Pain

Dong Ki Ahn, M.D., Song Lee, M.D., Tae Woo Kim, M.D., Sung Won Hong, M.D., Woo Sik Jung, M.D.

Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea

Corresponding author: Dong Ki Ahn, M.D. Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital 40-12 Chungryangni-dong, Dongdaemun-gu, Seoul 130-010, Korea TEL: 82-2-966-1616, FAX: 82-2-968-2394 E-mail: adkajs@hanmail.net

Received 5 July 2013 Revised 10 July 2013 Accepted 28 November 2013

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

Prospective clinical study.

Objectives

The aim of the study was to verify the effectiveness of L2 spinal nerve root block for patients who are suffering from low back pain and referred pain with compound causes.

Summary of Literature Review

Most of low back pain and referred pain arises from discs, facet joints and sacroiliac joints. All structures above have the pain perception pathway through sympathetic nerves with a connection to L2 spinal nerves.

Materials and Methods

We selected patients with low back pain and referred pain for more than 2 weeks. Each 50 patients were randomly allocated to an experimental and a control group. The experimental group underwent a L2 spinal nerve root block with 2cc of 0.25% bupibacaine at the symptom dominant side. The control group underwent a skin infiltration with 2cc of 2% lidocaine only. The pain was assessed with a visual analogue scale (VAS) consisting of 100 points at 5minutes, day 1, day 3, day 5, day 7 and day 30 post-procedure.

Results

Both groups showed a significant improvement after the procedures(p=0.000). However, a greater improvement was shown in the experimental group(p=0.000). In the individual analysis, the experimental group had improved as time elapsed and the significancewas maintained until 30 days. However, in control group, the significance was lost at day 30.

Conclusion

L2 spinal nerve root block is recognized to reduce the low back and referred pains which arise from compound causes in a degenerative spinal disease.

Keywords: L2 spinal nerve root block, low back pain and referred pain, intervertebral disc, facet joint, sacroiliac joint Running Title, Efficacy of L2 Spinal Nerve Root Block

REFERENCES

1. Cervero F. Visceral nociception: peripheral and central aspects of visceral nociceptive systems. Philos Trans R Soc Lond B Biol Sci. 1985; 308:325–37.

2. Nakamura SI, Takahashi K, Takahashi Y, Yamagata M, Moriya H. The afferent pathways of discogenic low-back pain. Evaluation of L2 spinal nerve infiltration. J Bone Joint Surg Br. 1996; 78:606–12.

3. Murata Y, Kato Y, Miyamoto K, Takahashi K. Clinical study of low back pain and radicular pain pathways by using l2 spinal nerve root infiltration: a randomized, controlled, clinical trial. Spine (Phila Pa 1976). 2009; 34:2008–13.

4. Murata Y, Takahashi K, Yamagata M, Takahashi Y, Shi-mada Y, Moriya H. Origin and pathway of sensory nerve fibers to the ventral and dorsal sides of the sacroiliac joint in rats. J Orthop Res. 2001; 19:379–83.

5. Murata Y, Takahashi K, Yamagata M, Takahashi Y, Shi-mada Y, Moriya H. Sensory innervation of the sacroiliac joint in rats. Spine (Phila Pa 1976). 2000; 25:2015–9.

6. Suseki K, Takahashi Y, Takahashi K, Chiba T, Tanaka K, Moriya H. CGRP-immunoreactive nerve fibers projecting to lumbar facet joints through the paravertebral sympathetic trunk in rats. Neurosci Lett. 1996; 221:41–4.

7. Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med. 1994; 331:69–73.

8. DePalma MJ, Ketchum JM, Saullo T. What is the source of chronic low back pain and does age play a role? Pain Med. 2011; 12:224–33.

9. Laplante BL, Ketchum JM, Saullo TR, Depalma MJ. Multivariable Analysis of the Relationship between Pain Referral Patterns and the Source of Chronic Low Back Pain. Pain Physician. 2012; 15:171–8.

10. Boswell MV, Colson JD, Sehgal N, Dunbar EE, Epter R. A systematic review of therapeutic facet joint interventions in chronic spinal pain. Pain Physician. 2007; 10:229–53.

11. Manchikanti L, Singh V, Falco FJ, Cash KA, Fellows B. Comparative outcomes of a 2-year followup of cervical medial branch blocks in management of chronic neck pain: a randomized, double-blind controlled trial. Pain Physician. 2010; 13:437–50.

12. Liliang PC, Lu K, Liang CL, Tsai YD, Wang KW, Chen HJ. Sacroiliac joint pain after lumbar and lumbosacral fusion: findings using dual sacroiliac joint blocks. Pain Med. 2011; 12:565–70.

13. Liliang PC, Lu K, Weng HC, Liang CL, Tsai YD, Chen HJ. The therapeutic efficacy of sacroiliac joint blocks with triamcinolone acetonide in the treatment of sacroiliac joint dysfunction without spondyloarthropathy. Spine (Phila Pa 1976). 2009; 34:896–900.

14. Carragee EJ, Lincoln T, Parmar VS, Alamin T. A gold stan-dard evaluation of the “discogenic pain” diagnosis as determined by provocative discography. Spine (Phila Pa 1976). 2006; 31:2115–23.

15. Ness TJ, Gebhart GF. Visceral pain: a review of experiental studies. Pain. 1990; 41:167–234.

16. Groen GJ, Baljet B, Drukker J. Nerves and nerve plexuses of the human vertebral column. Am J Anat. 1990; 188:282–96.

17. Nakamura S, Takahashi K, Takahashi Y, Morinaga T, Shi-mada Y, Moriya H. Origin of nerves supplying the posterior portion of lumbar intervertebral discs in rats. Spine (Phila Pa 1976). 1996; 21:917–24.

18. Mendez R, Bailey S, Paine G, et al. Evaluation of the L2 spinal nerve root infiltration as a diagnostic tool for discogenic low back pain. Pain Physician. 2005; 8:55–9.

19. Ohtori S, Nakamura S, Koshi T, et al. Effectiveness of L2 spinal nerve infiltration for selective discogenic low back pain patients. J Orthop Sci. 2010; 15:731–6.

20. Ohtori S, Yamashita M, Inoue G, et al. L2 spinal nerve-block effects on acute low back pain from osteoporotic vertebral fracture. J Pain. 2009; 10:870–5.

21. Richardson J, Collinghan N, Scally AJ, Gupta S. Bilateral L1 and L2 dorsal root ganglion blocks for discogenic low-back pain. Br J Anaesth. 2009; 103:416–9.

22. Bogduk N. The innervation of the lumbar spine. Spine (Phila Pa 1976). 1983; 8:286–93.

23. El-Mahdi MA, Abdel Latif FY, Janko M. The spinal nerve root “innervation”, and a new concept of the clinicopatho-logical interrelations in back pain and sciatica. Neuro-chirurgia (Stuttg). 1981; 24:137–41.

24. Fairbank JC, Park WM, McCall IW, O'Brien JP. Apophy-seal injection of local anesthetic as a diagnostic aid in primary low-back pain syndromes. Spine (Phila Pa 1976). 1981; 6:598–605.

25. Suseki K, Takahashi Y, Takahashi K, et al. Innervation of the lumbar facet joints. Origins and functions. Spine (Phila Pa 1976). 1997; 22:477–85.

26. Bernard TN Jr, Kirkaldy-Willis WH. Recognizing specific characteristics of nonspecific low back pain. Clin Orthop Relat Res. 1987; 217:266–80.

27. Dreyfuss P, Michaelsen M, Pauza K, McLarty J, Bogduk N. The value of medical history and physical examination in diagnosing sacroiliac joint pain. Spine (Phila Pa 1976). 1996; 21:2594–602.

28. Maigne JY, Aivaliklis A, Pfefer F. Results of sacroiliac joint double block and value of sacroiliac pain provocation tests in 54 patients with low back pain. Spine (Phila Pa 1976). 1996; 21:1889–92.

29. Murata Y, Takahashi K, Ohtori S, Moriya H. Innervation of the sacroiliac joint in rats by calcitonin gene-related pep-tide-immunoreactive nerve fibers and dorsal root ganglion neurons. Clin Anat. 2007; 20:82–8.

30. Nikfar S, Abdollahi M, Salari P. The efficacy and tolerability of exenatide in comparison to placebo; a systematic review and meta-analysis of randomized clinical trials. J Pharm Pharm Sci. 2012; 15:1–30.

Figures and Tables%

Fig. 1.

A diagram of conspectus which shows number of initial selected cases, drop out cases final included cases.

Fig. 2.

A graph which shows serial clinical improvement according to the elapsed time.

Table 1.

Homogeneity of two groups

Group	Study Group	Control Group	p-value
Age	55.0 ± 12.7	56.5 ± 12.6	0.569
Sex (M/F)	16 / 32	6 / 32	0.083
VAS score	56.5 ± 16.5	58.4 ± 16.4	0.583
Occupation (hard/moderate/easy)	2 / 24 / 22	2 / 14 / 22	0.473

TOOLS

Similar articles