The Usefulness of Selective Nerve Root Block as a Predictor of Prognosis of Lumbar Disc Herniation / 대한척추외과학회지

ABSTRACT

STUDY DESIGN: A prospective study. OBJECTIVES: To investigate the usefulness of selective nerve root block (SNRB) as a prognosis predictor of a lumbar disc herniation. SUMMARY OF LITERATURE REVIEW The biochemical factors of radiculopathy, as opposed to the biomechanical factors, are more reversible and responsive to a corticosteroid injection. MATERIALS AND METHODS: Fifty patients underwent SNRB for the radiculopathy caused by a herniated lumbar disc and were followed for at least 1 year. The straight leg raising (SLR) angle, visual analog scale (VAS) and the patients' subjective satisfaction, using the Weber criteria, were initially investigated, and again at 1 week and 1 month after the procedure, and finally at the final follow-up. The patients were divided into two groups according to the final satisfaction. Group 1 (satisfactory prognosis, N=32) had Excellent/Good results at the final follow-up, whereas Group 2(unsatisfactory prognosis, N=18) had Fair/Poor final results, or underwent surgical treatment. The improvements in the SLR and VAS at 1 week and 1 month were compared between two groups. The subjective satisfaction each time was compared to the final outcome; the relative risks were also calculated. RESULTS: The improvements in the SLR and VAS for Group 1 were significantly better than those for Group 2 at both 1 week and 1 month (p<0.05). Those patients with Excellent/Good results at 1 week and 1 month manifested satisfactory final outcomes (p<0.05). The risks of the patients with Fair/Poor results at 1 week and 1 month manifesting unsatisfactory final outcomes were 6.8 and 15.2 times higher than those with Excellent/Good results. CONCLUSION: Selective nerve root block could be a useful method, not only to relieve acute leg pain, but also to predict the longterm prognosis of a herniated lumbar disc. Early surgical treatment could be considered for the patients not manifesting significant improvement until 1 month after SNRB.