Effectiveness of Selective Nerve Root Block for the Treatment of Radiculopathy in Degenerative Lumbar Scoliosis

STUDY DESIGN: Level III, Retrospective studies. OBJECTIVES: This study was conducted to evaluate the effects and usefulness of the selective nerve root block in advance for the Degenerative Lumbar Scoliosis patients, with radiating pain, who were scheduled for an operation. SUMMARY OF LITERATURE REVIEW: Selective nerve root block was introduced in 1971, by Macnab and it was used to make improvements for radiating pain, as a treatment of multiple lesions or a tool to help making a surgical decision, and to predict the result. After an introduction by Cooper, selective root block on degenerative sclerosis, with lower leg radiating pain, showed fine results on a short term follow-up and moderate to good results on long term follow-up. MATERIALS AND METHODS: Between January 2005 to December 2009, 47 cases were selected from the patients, who underwent selective nerve root block, before the operation. The mean follow-up period was 38.4 months and the mean age was 67.1 years. The patients were divided into the operation group and the only selective nerve root block group. The treatment results in the SNRB group and the operation group were analyzed using Kim's criteria and the Visual Analog Scale score. The groups were radiologically evaluated for the neural compression rate. RESULTS: Among the 47 cases that were scheduled for an operation, 30 cases did not proceed to the operation. The average VAS score for the selective root block group and the operation group were 7.56 and 8.12, at the preoperative state and the preinjection state, respectively. After the selective nerve root block and surgical treatment, the scores were 3.71 and 2.64 at 1year follow up, respectively. There was no correlation with statistical significance between the initial VAS score and the degree of stenosis noted in the MRI (P>0.05). There was no statistical significant correlation between the initial relief from selective nerve root injections and the degree of stenosis noted in the MRI (P>0.05). However, there was a correlation with statistical significance between the operation rate and the degree of stenosis noted in the MRI (P<0.05). CONCLUSION: Selective nerve root block is considered to be an effective treatment for the Degenerative Lumbar Scoliosis patients with radiating pain, who are scheduled for an operation.

The Daily Life Functions of Elderly Peritrochanteric Fracture Patients after Surgical Treatment

PURPOSE: Although most peritrochanteric fractures in old age necessitates surgical treatment, daily life functions are still impaired after discharge. We assessed the types of peritrochanteric fracture, risk factors, and functional recovery in elderly patients who were over 65 years old. We also tried to determine factors for recovery to daily life. MATERIALS AND METHODS: From January 2006 to December 2007, among 61 patients who were over 65 years old with the possibility of 1 year follow-up, 50 patients were selected through interviews. After verifying age, sex, mode, types of fracture, and method, we analyzed daily living activities with a functional recovery index and estimated recovery of daily life functions after surgery, assuming a score increase if functional recovery was good. RESULTS: The mean age was 75.8 years, and females (31 patients, 62%) exceeded males. Slipping (27 patients, 54%) was the most common cause of fracture, and the intertrochanteric femur fracture was the most common fracture type (34, 68%). The average functional recovery index decreased 16.24% compared with the pre-operation value, having a tendency to decrease more in old age and female patients. Subtrochanteric femur fracture showed a 17.6% decrease in functional recovery index among the fracture types. CONCLUSION: In elderly patients over 65 years, the functional recovery index after peritrochanteric fracture decreased 16.24% on average compared with the preoperation state. The largest decrease was in basic life ability. The functional recovery index decreased more in old age, females, and subtrochanteric femur fracture, which indicates these factors influence functional recovery.