Analysis of SNRB in patients with lumbar radiculopathy resistant to conservative treatment

Sundar Suriyakumar, Ganesan Ganesan Ram, Kunal Patel, Laxman Balaji, Nitesh Kumar Rathi

Abstract


Background:The transforaminal application performed with SNRB (Selective nerve root blocks) should be more accurate. Moreover, the amount of corticosteroid and local anesthetic can be reduced compared to the amount of these agents administered with the epidural steroid.

Methods:Prospective study of 72 patients with low back pain done in Sri Ramachandra medical centre, Chennai during April 2012 to April 2014. 46 patients were diagnosed to have inter vertebral disc and 26 patients with Lumbar canal stenosis. The patients were evaluated using VAS score and Oswestry disability index. The indication and determination of the therapeutic SNRB level was established by the spine surgeon after all the diagnostic test results had been obtained and after a detailed discussion with the patient. After confirming the correct placement of spinal needle with a short bevel with the help of contrast, a solution of 1ml of 0.5% sensorcaine with 1 ml of triamcinolone acetonide (Inj. kenocort) is injected.

Results:Only 2 patients out of 72 had persistent pain and underwent surgery. 60 of our patients were comfortable and were able to proceed with their normal life/day to day activities following the administration of one block.

Conclusion:Selective nerve root block is effective and less invasive intervention, and serves as an adjunct to non-operative treatment. The blocks give the best result in disc herniation cases, followed by favorable results in foraminal stenosis.

 


Keywords


Spinal nerve root block, Intervertebral disc prolapsed, Canal stenosis

Full Text:

PDF

References


Cassidy JD, Carroll LJ, Cote P. The Saskatchewan health and back pain survey: The prevalence of low back pain and related disability in Saskatchewan adults. Spine. 1998;23:1860-6.

Anderson GBJ. Epidemiology of spinal disorders. In: Frymoyer JW, eds. The Adult Spine: Principles and Practice. 2nd ed. New York, NY: Raven; 1997: 93-141.

Rydevik B, Garfin S. Spinal root nerve compression. In: Szabo RM, eds. Nerve Root Compression Syndromes; Diagnosis & Treatment. 2nd ed. New York: Slack Medical; 1989: 247-261.

Olmarker K, Rydevik B. Pathophysiology os sciatica. Orthop Clin North Am. 1991;22:223-34.

McCarron RF, Wimpee MW, Hudkins PG, Laros GS. The inflammatory effect of nucleus pulposus: a possible element in the pathogenesis of low-back pain. Spine. 1987;12:760-4.

Bogduk N, April C, Derby R. Epidural steroid injections. In: White AH, eds. Spine Care. 1st ed. St. Louis, Mo: Mosby; 1995: 322-343.

Jensen MP, Chen C, Brugger AM. Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain. J Pain. 2003 Sep;4(7):407-14.

Mehra A, Baker D, Disney S, Pynsent PB. Oswestry disability index scoring made easy. Ann R Coll Surg Engl. 2008 Sep;90(6):497-9.

Weiner BK, Fraiser RD. Foraminal Injection for lateral lumbar disc herniation. JBJS Br. 1997;79:804-7.

Navozny M, Zaretti M, Boos N. Therapeutic efficacy of selective nerve root blocks in the treatment of lumbar radicular pain. Swiss Med Wkly. 2001;131:75-80.

Viton JM, Peretti-Viton P, Rubino T, Delarque A, Salamon N. Short term assessment of periradicular corticosteroid injections in lumbar radiculopathy associated with disc pathology. Neuroradiology. 1998;40:59-62.

Hui CWF, Chan PHA, Cheung KK. Selective nerve root block in sciatica. Hong Kong J Orthop Surg. 2005;9(1):22-7.