Comparison of the effects of corticosteroid and hyaluronic acid‐carboxymethylcellulose solution on selective nerve root block for lumbar radiculopathy: A prospective, double‐blind, randomized controlled clinical trial

Abstract

Background Selective nerve root block (SNRB) was shown to effectively control radiating pain and reduce the need for surgical intervention. However, repetitive injections may trigger corticosteroid‐induced side effects (hypercorticism, hyperglycemia, or fluid retention). This study aims to compare the potency of hyaluronic acid‐carboxymethylcellulose (HA‐CMC) solution versus that of corticosteroids regarding lower leg radiating pain (LLRP) improvement and functional outcome. Methods Among 128 patients, 44 patients who complain about having LLRP due to lumbar spinal stenosis and do not have neurological symptoms requiring surgery were enrolled for this study. Group A with 22 patients injected with cocktail A (local anesthetics and corticosteroid) and group B with 22 patients injected with cocktail B (local anesthetics and HA‐CMC). Outcome measures were the visual analog scale (VAS), Oswestry Disability Index (ODI), and short form‐36 (SF‐36). All patients were asked to fill in the questionnaires during the follow‐up assessment period at 3 days, 7 days, 2 weeks, 6 weeks, and 12 weeks. Results In all time periods, there were no statistical differences between the two groups for VAS scores and VAS improvement over time, ODI scores and ODI improvement over time, and SF‐36 PCS scores and SF‐36 mental component score scores. Additionally, the 95% confidence interval of the difference in VAS score improvement between the 2 groups in all time periods was within VAS 5.0, which is the minimum clinically relevant difference. Conclusions Considering the adverse effects of corticosteroids, and the similar LLRP improvements, functional outcome, and quality of life, the HA‐CMC solution may be an alternative option to corticosteroid in SNRB.

Limited surgery assisted by ultrasound-guided selective nerve root block for the treatment of degenerative scoliosis: a preliminary clinical report

“…This study innovatively applies SNRB to guide the development of surgical plans for degenerative scoliosis.SNRB has both diagnostic and therapeutic effects, and its bene ts in the diagnosis and treatment of radiculopathy have been reported [14,15,[29][30][31].Ko et al [32] demonstrated that the symptom improvement 6 hours after SNRB predicted the clinical e cacy 12 months after the decompression of lumbar spinal stenosis.Kanaan et al [15] showed that SNRB reduced the surgical rate of lumbar radiculopathy.…”

Global Status and Future Trends of Fascia and Pain Research in 2013–2022: Bibliometric Analysis Based on CiteSpace and VOSviewer

“… 44 A prospective, double-blind, randomized, controlled clinical trial has shown that hyaluronic acid is better for nerve blocking than traditional drugs. 45 Besides, receptors in the fascia can also change the thickness of the fascia in real time in addition to affecting the analgesic effect of a nerve block, 46 and the thickness of the fascia can affect the diffusion of blocking drugs, 47 which may be used as a reliable evaluation index of analgesic effect. Clinically, nerve blocks for neuropathic pain, 48 surgical pain, 49 primary dysmenorrhea, 50 and fibromyalgia 51 involve the central nervous system.…”

Effect of Comprehensive and Integrative Medical Services on Patients with Degenerative Lumbar Spinal Stenosis: A Pilot Study

“…A previous study reported that the administration of hyaluronic acid-carboxymethylcel lulose (HA-CMC) instead of corticosteroids, such as lidocaine and bupivacaine, which are associated with numerous complications, for SNRB prolonged the period of pain improvement [22,23]. However, if these treatments fail to treat LLRP sufficiently, surgical decompression may be indicated.…”