Cervical nerve root blocks for chronic cervical radiculopathy - Does it influence surgical decision making?

Abstract

Objective: It is often difficult to pinpoint the affected nerve root/roots from clinical symptoms and Magnetic Resonance Imaging (MRI) alone in patients with chronic cervical radiculopathy and multilevel degenerative changes. MRI often shows degenerative changes at more than one level. Degenerative changes can occur in patients without symptoms and clinical diagnosis. Analyses of referred pain distribution from cervical nerve roots have shown only 50% correlation to the classical sensory dermatome. Surgical treatment of patients with cervical radiculopathy attributed to degenerative disease is associated with moderate outcome results. Our aim was to assess the diagnostic value of cervical selective nerve root blocks (SNRB) in our Trust in surgical decision making. Methods: The data was collected retrospectively from electronic hospital records on CRIS, PACS and NOTIS on consecutive patients who underwent cervical nerve root blocks for diagnostic purpose between 1st Jan 2011 and 31st December 2011. Results: Total of 50 patients had cervical SNRB for diagnostic reasons. It influenced surgical decision making in 84% (42) of these patients and not in 2% cases. 10% did not have any follow up after cervical SNRB. Decision in favour of surgery was made in 71.5% of these 42 patients. Conclusions: In chronic cervical brachialgia, cervical SNRB is extremely influential in surgical decision making, in both whether to operate and which levels scenario.