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

J Korean Soc Spine Surg. 2014 Mar;21(1):8-14. Korean.
Published online March 31, 2014.  https://doi.org/10.4184/jkss.2014.21.1.8
© Copyright 2014 Korean Society of Spine Surgery
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. and 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, Email: adkajs@hanmail.net
Received July 05, 2013; Revised July 10, 2013; Accepted November 28, 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 postprocedure.

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

Figures


Fig. 1
A diagram of conspectus which shows number of initial selected cases, drop out cases final included cases.
Click for larger image


Fig. 2
A graph which shows serial clinical improvement according to the elapsed time.
Click for larger image

Tables


Table 1
Homogeneity of two groups
Click for larger image

References
1. Cervero F. Visceral nociception: peripheral and central aspects of visceral nociceptive systems. Philos Trans R Soc Lond B Biol Sci 1985;308:325–337.
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;78:606–612.
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;34:2008–2013.
4. Murata Y, Takahashi K, Yamagata M, Takahashi Y, Shimada 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;19:379–383.
5. Murata Y, Takahashi K, Yamagata M, Takahashi Y, Shimada Y, Moriya H. Sensory innervation of the sacroiliac joint in rats. Spine (Phila Pa 1976) 2000;25:2015–2019.
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;221:41–44.
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;12:224–233.
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;15:171–178.
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;10:229–253.
11. Manchikanti L, Singh V, Falco FJ, Cash KA, Fellows B. Comparative outcomes of a 2-year follow-up of cervical medial branch blocks in management of chronic neck pain: a randomized, double-blind controlled trial. Pain Physician 2010;13:437–450.
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;12:565–570.
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 standard evaluation of the "discogenic pain" diagnosis as determined by provocative discography. Spine (Phila Pa 1976) 2006;31:2115–2123.
15. Ness TJ, Gebhart GF. Visceral pain: a review of experimental 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;188:282–296.
17. Nakamura S, Takahashi K, Takahashi Y, Morinaga T, Shimada Y, Moriya H. Origin of nerves supplying the posterior portion of lumbar intervertebral discs in rats. Spine (Phila Pa 1976) 1996;21:917–924.
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;8:55–59.
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;15:731–736.
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;10:870–875.
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;103:416–419.
22. Bogduk N. The innervation of the lumbar spine. Spine (Phila Pa 1976) 1983;8:286–293.
23. El-Mahdi MA, Abdel Latif FY, Janko M. The spinal nerve root "innervation", and a new concept of the clinicopathological interrelations in back pain and sciatica. Neurochirurgia (Stuttg) 1981;24:137–141.
24. Fairbank JC, Park WM, McCall IW, O'Brien JP. Apophyseal 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;22:477–485.
26. Bernard TN Jr, Kirkaldy-Willis WH. Recognizing specific characteristics of nonspecific low back pain. Clin Orthop Relat Res 1987;(217):266–280.
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;21:2594–2602.
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;21:1889–1892.
29. Murata Y, Takahashi K, Ohtori S, Moriya H. Innervation of the sacroiliac joint in rats by calcitonin gene-related peptide-immunoreactive nerve fibers and dorsal root ganglion neurons. Clin Anat 2007;20:82–88.
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.