Effectiveness of Selective Nerve Root Block for the Treatment of Single-Segment Lumbar Spinal Stenosis and Disc Herniation

Tae Kyun Kim; Chang Su Kim; Young Chae Choi; Dae Moo Shim

doi:10.4184/jkss.2017.24.1.32

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Kim, Kim, Choi, and Shim: Effectiveness of Selective Nerve Root Block for the Treatment of Single-Segment Lumbar Spinal Stenosis and Disc Herniation

Original Article

Journal of Korean Spine Surg 2017;24(1):32-38.

Published online: 31 March 2017

DOI: https://doi.org/10.4184/jkss.2017.24.1.32

Effectiveness of Selective Nerve Root Block for the Treatment of Single-Segment Lumbar Spinal Stenosis and Disc Herniation

Tae Kyun Kim, M.D., Chang Su Kim, M.D.^∗, Young Chae Choi, M.D., Dae Moo Shim, M.D.

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

^∗Department of Orthopedic Surgery, Kosin University College of Medicine, Busan, Korea

Corresponding author: Tae Kyun Kim, M.D. Department of Orthopedic Surgery, School of Medicine, Wonkwang University, 344-2 Shinyong-dong, Iksan, Chunbuk, Korea TEL: +82-63-859-1360, FAX: +82-63-852-9329 E-mail: osktg@wonkwang.ac.kr

^∗ This paper was supported by wonkwang university in 2017.

Received 23 March 20156 September 2016 Accepted 13 February 2017

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

Study design

Retrospective clinical study.

Objectives

To determine and compare the therapeutic effectiveness of selective nerve root block performed for single-segment spinal stenosis and disc herniation.

Summary of Literature Review

The usefulness of selective nerve root block has been reported in several previous studies, but those results were aggregated across many diseases, making it difficult to estimate its effectiveness for each disease.

Materials and Methods

From January 2008 to January 2013, among patients who had undergone selective nerve root block, those who were diagnosed with single-segment spinal stenosis or disc herniation were enrolled in this study. Among a total of 103 patients, 47 spinal stenosis patients were classified as group 1, and 56 disc herniation patients as group 2. Visual analog scale (VAS) scores and Kim's criteria were used to compare the reductions in radiating pain in each group.

Results

In group 1, the VAS scores improved from 7.6 before the procedure to 2.6 and 3.3 at 1-month and 6-month follow-up visits, respectively. Kim's criteria also improved from a mean of 1.6 before the procedure to 2.9 at the 6-month follow-up. In group 2, the VAS scores improved from 7.8 before the procedure to 2.1 and 2.7 at 1-month and 6-month follow-up visits, respectively. Kim's criteria also improved from a mean of 1.8 before the procedure to 3.2 at the 6-month follow-up.

Conclusions

Radiating pain in the lower limb due to spinal stenosis or disc herniation limited to a single segment was effectively controlled by selective nerve root block.

Keywords: Spinal stenosis, Disc herniation, Selective root block

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Fig.1.

Grade of nerve root compression.

Fig.2.

Measurements were performed on a picture archiving and commu-nication system where the herniation was visualized.

Table 1.

	Group I (Spinal stenosis)	Group II (HIVD)
Total cases	47	56
Sex (Male:Female)	22:25	31:25
Age (year)	61(50∼72)	42.3(21∼57)
Duration of symptom (week)	18.3(8∼62)	12.7(2∼51)
Average follow-up (month)	21.2(13∼42)	18.6(12∼38)

Table 2.

Criteria or clinical results (Kim, 1986)

Excellent	∗ Complete relief of pain in back and lower limbs
	∗ No limitation of physical activity
	∗ Analgesics not used at all
	∗ Able to squat on floor
	∗ Relief of most of pain in back and lower limbs
Good	∗ Able to return to accunstomsed employment
	∗ Physical activities sightly limited
	∗ Analgesics used only infrequently
	∗ Able to squat on the floor
	∗ Partial relief of pain in back and lower limbs
Fair	∗ Able to return to accustomed employment with limityat-ion or return to lighter work
	∗ Physical activities definitely limited
	∗ Mild analgesic medication used frequently
	∗ Mild limitation to squat on the floor
	∗ Little or no relief of pain in back and lower limbs
Poor	∗ Physical activities greatly; limited
	∗ Unable to return toaccustomed employment
	∗ Analgesic medication used regularly
	∗ Unable to squat on the floor

Table 3.

Comparison of group I (Spinal stenosis) and Group II (HIVD)

	VAS		Kim's criteria		p-value
	Pre injection	Post 6months	Pre injection	Post 6months	p-value
Group I (47)	7.6	3.3	1.6	2.9	p<0.05
Group II (56)	7.8	2.7	1.8	3.2	p<0.05

Table 4.

Result of group I (Spinal stenosis)

Group I	VAS		p-value (Paired T test)	Kim's criteria		p-value (Paired T test)
Group I	Pre injection	Post 6months	p-value (Paired T test)	Pre injection	Post 6months	p-value (Paired T test)
Total (47)	7.6	3.3	p<0.05	1.6	2.9	p<0.05
Level involved (cases)
L3/4 (2)	8.0	3.5		1.5	3.0
L4/5 (28)	8.07.5	3.1	p<0.05	1.7	2.8	p<0.05
L5/S1 (17)	7.57.7	3.3		1.5	3.2
p-value	7.7	p=0.314			p=0.235
Type (cases)
central stenosis (22)	7.8	3.6		1.5	2.6
lateral recess stenosis (2)	7.5	3.5	p<0.05	1.7	3.0	p<0.05
foramen stenosis (23)	7.4	2.9.		1.8	3.4
p-value		p<0.005			p<0.005
Symptom duration (cases)
<3 months (19)	7.4	2.8	p<0.05	1.9	3.3	p<0.05
>3 months (28)	7.9	3.7		1.4	2.4
p-value		p<0.005			p<0.005

Table 5.

Result of group II (HIVD)

Group II	VAS		p-value (Paired T test)	Kim's criteria		p-value (Paired T test)
Group II	Pre injection	Post 6months	p-value (Paired T test)	Pre injection	Post 6months	p-value (Paired T test)
Total (56)	7.8	2.7	p<0.05	1.8	3.2	p<0.05
Root involved (cases)
L3 (1)	7.0	3.0		2.0	3.0
L4 (17)	7.6	2.9		1.7	2.8
L4 (17) L5 (23)	7.68.1	2.92.4	p<0.05	1.71.9	2.83.3	p<0.05
S1 (15)	7.9	2.8		1.8	3.1
p-value		p<0.005			p<0.005
Type (cases)
central (39)	7.6	3.1	p<0.05	1.7	2.9	p<0.05
far lateral (17)	8.0	2.2	p<0.05	1.9	3.4	p<0.05
P-value		p<0.005			p<0.005
Symptom duration (cases)
<3 months (32)	7.5	2.3	p<0.05	2.1	3.4	p<0.05
>3 months (24)	7.9	2.9		1.6	2.9
p-value		p<0.005			p<0.005

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