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

Abstract

Background: Reducing surgical trauma has always been a clinical challenge for patients with degenerative scoliosis.Ultrasound-guided Selective Nerve Root Block is likely to be an effective and safe option for the minimally invasive and limited treatment of Degenerative Scoliosis. Objectives:To explore the application and clinical values of ultrasound-guided selective nerve root block(US-SNRB) in the limited treatment of degenerative scoliosis (DS). Study Design:A retrospective design was used. Setting: This study was conducted in a university-affiliated tertiary hospital in China. Method: The clinical data of 26 patients diagnosed with DS in our hospital between June 2018 and June 2020 and who had treatment plans determined based on the outcomes of US-SNRB, were retrospectively analyzed. All patients had preoperative and 2-year follow-up assessments using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI) Questionnaire. Results: All patients had successful SNRB procedures. 5 patients showed significant decreases in VAS scores in immediately and 1 week after the US-SNRB,did not undergo surgical treatment. 18 patients showed significant decreases in VAS scores immediately after the US-SNRB, with a return of the VAS scores to the preoperative levels after 1 week,and according to the responsible segments determined by US-SNRB, short-segment modified transforaminal lumbar interbody fusion (TLIF) surgeries were performed. 3 patients did not improve in 1 week after US-SNRB,underwent posterior long-segment orthopedic internal fixation and modified TLIF of the responsible segments. Among patients undergoing single-puncture US-SNRB, the success rate was 86.8%, the average operative time was 636 ± 191 s, the average VAS for puncture pain was 2.2 ± 0.7, and the complication rate was 3.8%. Among patients undergoing fusion, the average operative time was 143.3 ± 24.1 minutes (90–230 minutes), the average intraoperative blood loss was 199.7 ± 88.3 mL (80–600 mL), the average length of hospital stay was 9.7 ± 1.5 days (8–14 days), and the average time to first off-bed activity was 4.1 ± 1.3 days (3–7 days). The 26 patients had average VAS scores for low back pain of 7.7 ± 1.3 and 2.8 ± 0.8 before and after the surgery, respectively (P < 0.05). The average VAS scores for leg pain were 7.4 ± 1.2 and 2.7 ± 1.0 before and after the surgery, respectively (P < 0.05). The average ODI scores preoperatively and at the last follow-up were 61.4 ± 14.3% and 24.1 ± 8.1% (P < 0.05), respectively. The 26 patients had mean Cobb angles of 18.6 ± 6.4° and 13.4 ± 5.9° before and after the surgery, respectively (P < 0.05), with a correction rate of 28.0%. Limitations: This study used a retrospective design with relatively small sample size and medium follow-up duration. Conclusion: Formulating individualized treatment plans for DS based on US-SNRB outcomes can reduce the surgical operation rate and surgical trauma and also allow the limited treatment of DS. However, the value of US-SNRB in the limited treatment of patients with severe DS with Lenke-Silva Treatment Levels V and above requires further study with more cases.