When is the Optimal Time Point for Predicting the 1-Year Follow-up Outcome of Selective Nerve Root Block for Cervical Radiculopathy?

Whee Sung Son; Myun-Whan Ahn; Gun Woo Lee

doi:10.4184/jkss.2019.26.2.40

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Son, Ahn, and Lee: When is the Optimal Time Point for Predicting the 1-Year Follow-up Outcome of Selective Nerve Root Block for Cervical Radiculopathy?

Original Article

Journal of Korean Spine Surg 2019;26(2):40-49.

Published online: 30 June 2019

DOI: https://doi.org/10.4184/jkss.2019.26.2.40

When is the Optimal Time Point for Predicting the 1-Year Follow-up Outcome of Selective Nerve Root Block for Cervical Radiculopathy?

Whee Sung Son, M.D., Myun-Whan Ahn, M.D., Gun Woo Lee, M.D., Ph.D.

Department of Orthopaedic Surgery, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea

Corresponding author: Gun Woo Lee, M.D., Ph.D. ORCID ID: Gun Woo Lee: https://orcid.org/0000-0002-8441-0802 Whee Sung Son: https://orcid.org/0000-0002-4573-7749 Myun-Whan Ahn: https://orcid.org/0000-0003-3245-1714 Department of Orthopaedic Surgery, Spine Center, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-Gu, Daegu 42415, Republic of Korea TEL: +82-53-620-3642, FAX: +82-53-628-4020 E-mail: gwlee1871@gmail.com

Received 23 January 201924 January 2019 Accepted 10 April 2019

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 study.

Objectives

In the current study, we aimed to (1) evaluate the early and late therapeutic effects of selective nerve root block (SNRB) for cervical radiculopathy, and (2) to determine the optimal time point for predicting the long-term effectiveness of cervical SNRB.

Summary of Literature Review

Although SNRB is an important option for cervical radiculopathy, various studies of cervical SNRB have failed to specify its efficacy, especially long-term effectiveness.

Materials and Methods

We retrospectively enrolled 35 patients with cervical radiculopathy who were regularly followed-up for at least 1 year after SNRB. Clinical outcomes were evaluated using a visual analogue scale (VAS) for pain intensity and the modified Kim's method for patient satisfaction at regular follow-up intervals. In the correlation analysis, stepwise multiple linear regression was used to identify selected and unselected factors.

Results

The average VAS score decreased over time (p<0.05); the values just before the injection and at 1 week, 3 weeks, and 1 year of follow-up were 6.11, 3.29, 2.89, and 1.37, respectively. In the stepwise multiple regression analysis, the 1-week VAS score was related to the initial VAS score, the 3-week VAS score was related to the 1-week VAS score, and the last VAS score was related to the 3-week VAS score and symptom duration before the injection. The degree of satisfaction at the 1-year follow-up point was significantly associated with the 3-week VAS score (p=0.011).

Conclusions

The current study showed that pain intensity at the 3-week time point after cervical SNRB might be the optimal time point for predicting long-term effectiveness.

Keywords: Cervical spine, Radiculopathy, Selective nerve root block, Long-term effectiveness, Predictor

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Fig. 1.

Flow diagram of patient enrollment.

Fig. 2.

Provocation test using contrast.

Table 1.

Modified Kim's questionnaire

No	Questionnaire	Answer
I	From the SNRB, did you have duration of relief?	0 (No relief)
		1 (Relief <2 months)
		2 (Relief <2 months)
II	How would you rate the overall pain relief that you have had from the SNRB?	Early
		0 (None)
		1 (Partial)
		2 (Full)
		Current
		0 (None)
		1 (Partial)
		2 (Full)
III	Do you think the SNRB have improved your ability to perform your daily activities?	0 (None)
		1 (Partially)
		2 (Yes)
IV	What was your overall satisfaction with the SNRB?	0 (Unsatisfied)
		1 (Satisfied)
		2 (Very satisfied)
V	Would you repeat the SNRB, if necessary?	0 (No)
		1 (Yes)

SNRB: selective nerve root block.

Table 2.

Cross tabulation of the provocative test and relief test

		Relief test
		1 (equivocal relief)	2 (relief)	3 (dramatic relief)	Total
Provocative test	2 (dissimilar pain)3 (concordant pain)	1 0	10 5	0 19	11 24
	Total	1	15	19	35

^∗ Fisher's exact test; p=0.000.

Table 3.

Cross tabulation of initial VAS and 1-week VAS

		1 week VAS
		1	2	3	4	5	6	7	8	Total
	3	1	0	0	0	0	0	0	0	1
	4	0	1	2	0	0	0	0	0	3
Initial VAS	5	0	2	0	3	0	0	0	0	5
	6	1	3	7	2	0	0	0	0	13
	7	1	2	1	2	1	0	1	0	8
	8	0	1	0	1	1	0	1	1	5
	Total	3	9	10	8	2	0	2	1	35

^∗ Fisher's exact test; p=0.146. VAS: visual analog scale.

Table 4.

Selected variables according to the result of stepwise method of multiple regression

Selected variable Model II^∗	Coefficient
Selected variable Model II^∗	Unstand B	SE Be	eta p
(Constant)	−0.278	1.245	0.825
Initial VAS	0.548	0.200 0.4	418 0.010
Hoffman sign	2.440	1.054 0.3	352 0.028
R=0.590, R-square=0.349, p=0.002

^∗ Dependent variable: 1 week VAS VAS: visual analog scale, SE: standard error.

Table 5.

Cross tabulation of 1-week VAS and 3-week VAS

		3-week VAS
		0	1	2	3	4	5	6	7	8	Total
1-week VAS	3	1	0	0	0	0	0	0	0	0	1
	4	0	1	0	2	0	0	0	0	0	3
	5	0	0	2	2	0	1	0	0	0	5
	6	0	2	5	1	5	0	0	0	0	13
	7	0	3	1	1	2	0	0	1	0	8
	8	1	0	1	0	0	1	1	0	1	5
	Total	2	6	9	6	7	2	1	1	1	35

^∗ Fisher's exact test; p=0.001. VAS: Visual analog scale.

Table 6.

Selected variables according to the result of stepwise method of multiple regression

Selected variable Model I^∗	Coefficient
Selected variable Model I^∗	Unstand B	SE	Beta	p
(Constant)	−0.339	0.355	-	0.348
1-week VAS	0.989	0.097	0.881	0.000
R=0.881, R-square=0.775, p=0.000

^∗ Dependent variable = 3-week VAS. VAS: visual analog scale, SE: standard error.

Table 7.

Cross tabulation of 3-week VAS and final VAS

		Final VAS
		0	1	2	3	4	5	Tota
3-week VAS	0	2	0	0	0	0	0	2
	1	4	2	0	0	0	0	6
	2	2	6	1	0	0	0	9
	3	3	0	3	0	0	0	6
	4	1	1	0	3	0	2	7
	5	0	0	0	1	1	0	2
	6	1	0	0	0	0	0	1
	7	0	0	0	0	0	1	1
	8	1	0	0	0	0	0	1
	Total	14	9	4	4	1	3	35

^∗ Fisher's exact test; p=0.002. VAS: Visual analog scale.

Table 8.

Selected variables according to the result of stepwise method of multiple regression

Selected variable Model III^∗	Coefficient
Selected variable Model III^∗	Unstand B	SE	Beta	p
(Constant)	−0.539	0.486	-	0.277
3-week VAS	0.362	0.125	0.424	0.007
Recent duration	0.104	0.040	0.372	0.014
Remote duration	0.021	0.010	0.324	0.035
R=0.662, R-square=0.438, p=0.001

^∗ Dependent variable: final VAS. VAS: visual analog scale, SE: standard error.

Table 9.

Selected variables according to the result of stepwise method of multiple regression

Selected variable Model II^∗	Coefficient
Selected variable Model II^∗	Unstand B	SE	Beta	p
(Constant)	2.770	0.392	-	0.000
Remote duration	−0.14	0.003	−0.559	0.000
Age	−0.21	0.007	−0.407	0.005
R=0.700, R-square=0.49

^∗ Dependent variable: duration of relief. SE: standard error.

Table 10.

Selected variables according to the result of stepwise metho of multiple regression

Selected variable Model I^∗	Coefficient
Selected variable Model I^∗	Unstand B	SE	Beta	p
(Constant)	2.513	0.323	-	0.000
3-week VAS	−0.254	0.094	−0.443	0.011
R=0.443, R-square=0.196, p=0.011

^∗ Dependent variable: degree of satisfaction. VAS: Visual analog scale, SE: Standard error.

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