Factors that affect the efficacy of fluoroscopically guided selective spinal nerve root block in the treatment of radicular pain: a prospective cohort study.
OBJECTIVE
The fluoroscopically guided selective nerve root block (SNRB) is being used increasingly as a therapy for radicular pain as well as a diagnostic tool. However, studies and the literature reviews have yet to reach a definite conclusion on the efficacy in this setting. Our aim was to prospectively investigate factors that may affect the success of this procedure.


METHODS
A total of 301 treatment episodes with 283 patients were assessed over 25 months by patient questionnaire over a 7-day period. Changes in analgesic benefit over time, by operating consultant, referring specialty, spinal level, and the presence of periprocedural symptom provocation were evaluated. Statistical analysis was performed by using the χ(2) test, Wilcoxon test, and Kruskal-Wallis rank sum test, and the asymptotic marginal-homogeneity test. P < .05 was considered significant.


RESULTS
There was a statistically significant increase in pain relief over the 7 days after the procedure. Pain provocation during the procedure did not improve analgesic success. Cervical, lumbar, and sacral level procedures were equally efficacious. The specialist who referred the patient and the use of contrast to verify needle position during the procedure also did not affect the analgesic outcome. Overall, 69.1% of patients experienced some pain relief by day 7.


CONCLUSIONS
Analgesic success rates of selective nerve root blocks did not vary with spinal level, or use of contrast or periprocedural replication of symptoms, when using fluoroscopic guidance. Patients may expect a continued significant improvement in their symptoms for at least a week after the procedure.
Department of Radiology, Hull Royal Infirmary, Hull, Yorkshire, United Kingdom. Electronic address: dr_pmallinson@hotmail.com.
Paul I
PI
Mallinson
Charles R
CR
Tapping
Richard
R
Bartlett
Paul
P
Maliakal
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use; D015331:Cohort Studies; D003287:Contrast Media / Q000008:administration & dosage; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement / Q000379:methods; D011446:Prospective Studies; D011843:Radiculopathy / Q000150:complications; D013126:Spinal Nerve Roots / Q000187:drug effects*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014221:Triamcinolone / Q000008:administration & dosage / Q000627:therapeutic use; D055815:Young Adult
D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D003287:Contrast Media; D014221:Triamcinolone; D008012:Lidocaine; D002045:Bupivacaine
Factors; Fluoroscopic; Nerve root block; Radicular pain; Therapeutic; Treatment