Nerve Root Blocks in the Treatment of Lumbar Radicular Pain

Riew, K. Daniel; Park, Jong Beom; Cho, Yong Sun; Gilula, Louis A.; Patel, Alka; Lenke, Lawrence G.; Bridwell, Keith H.

doi:10.2106/jbjs.e.00278

Cited by 202 publications

(129 citation statements)

References 10 publications

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“…Unfortunately, there was no set follow-up evaluation and at the end of the study, 9/27 (33%) patients receiving bupivacaine only had avoided an operation compared with 20/28 (71%) patients receiving the combination of betamethasone and bupivacaine. Although these results were significant, in their follow up study, they went on to show positive longterm results with or without the use of steroids [16].…”

Section: Study Descriptionsmentioning

confidence: 96%

Transforaminal injection of corticosteroids for lumbar radiculopathy: systematic review and meta-analysis

Quraishi

2011

Eur Spine J

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Background Transforaminal epidural injection of steroids is used to treat lumbar radicular pain. However, there are only a few well-designed randomized, controlled studies on the effectiveness of steroid injection. Study designHence, this study aims to assess the effectiveness of steroid injection to treat lumbar radicular pain using a meta-analysis of transforaminal epidural injection therapy for low back and lumbar radicular pain. The comparison was based on the mean difference in the Visual Analogue Score (VAS) and Oswestry Disability Index (ODI) from baseline to the specified followed up. Methods The available literature of lumbar transforaminal epidural injections in managing low back and radicular pain was reviewed. Data sources included relevant literature of the English language identified through searches of PubMed and EMBASE from 1966 to 2009, and manual searches of the bibliographies of known primary and review articles. Finally, the search included the Current Controlled Trials Register and the Cochrane Database of Controlled Trials. Results The initial search identified 126 papers. After screening, five randomised controlled trials (RCTs) were studied for analysis and only three of these had followedup patients systematically with pain and disability outcome scores to 3 months and of these, only one had follow up to 12 months. A total of 187 patients ('treatment group' receiving local anaesthetic/steroid injection) were compared with 181 patients ('control' group, receiving local anaesthetic only or saline injection). Improvement in pain (standardised mean difference in VAS 0.2 in favour of 'treatment'; 95%CI: -0.41 to 0.00, p = 0.05, I squared 0%) but not disability (standardised mean difference in ODI 0; 95%CI: -0.21 to 0.20, p = 0.99, I squared 0%) was observed between 'treatment' and 'control' groups; these differences were not significant. Additionally, the one study following patients to 12 months did not find any significant difference in VAS and ODI between treatment and control groups. ConclusionThe current meta-analysis shows that transforaminal epidural steroid injections, when appropriately performed, should result in an improvement in pain, but not disability. The three RCTs that followed patients to 3 months (and the single study to 12 months) have found no benefit by the addition of steroids. The limitations of this study include the paucity of the available literature.

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Section: Study Descriptionsmentioning

confidence: 96%

Transforaminal injection of corticosteroids for lumbar radiculopathy: systematic review and meta-analysis

Quraishi

2011

Eur Spine J

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“…Uma alternativa para ajudar o tratamento conservador é o bloqueio da raiz afetada com anestésico e corticoide, que atua diretamente sobre a hérnia, reduzindo seu volume, e sobre a raiz, reduzindo a sua resposta inflamatória (26)(27)(28) . Num estudo realizado pelo Grupo de Cirurgia da Coluna do Hospital Universitário Cajuru (HUC), foram avaliados 70 pacientes portadores de hérnia discal lombar com radiculopatia, com quadro de dor por até oito semanas; após o 3.º mês do bloqueio, 77% dos pacientes estavam assintomáticos.…”

Section: Tratamento Conservadorunclassified

Hérnia discal lombar

et al. 2010

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RESUMOA hérnia discal lombar é o diagnóstico mais comum dentre as alterações degenerativas da coluna lombar (acomete 2 a 3% da população) e a principal causa de cirurgia de coluna na população adulta. O quadro clínico típico inclui lombalgia inicial, seguida de lombociatalgia e, finalmente, de dor ciática pura. A história natural da hérnia de disco é de resolução rápida dos sintomas (quatro a seis semanas). O tratamento inicial deve ser conservador, com manejo medicamentoso e fisioterápico, podendo ser acompanhado ou não por bloqueios percutâneos radiculares. O tratamento cirúrgico está indicado na falha do controle da dor, déficit motor maior que grau 3, dor radicular associada à estenose óssea foraminal ou síndrome de cauda equina, sendo esta última uma emergência médica. Uma técnica cirúrgica refinada, com remoção do fragmento extruso, e preservação do ligamento amarelo, resolve a sintomatologia da ciática e reduz a possibilidade de recidiva em longo prazo. descritores - Keywords -Lumbar disc herniation; Ligamentum flavum; Sciatica; Surgical treatment INTRODUçãOA hérnia discal lombar consiste de um deslocamento do conteúdo do disco intervertebral -o núcleo pulposo -através de sua membrana externa, o ânulo fibroso, geralmente em sua região posterolateral. Dependendo do volume de material herniado, poderá haver compressão e irritação das raízes lombares e do saco dural, representadas clinicamente pela dor conhecida como ciática. Essa dor é conhecida desde a Antiguidade, mas a sua relação com a hérnia discal não foi descoberta até o início do século 20, quando Mixter e Barr a descreveram (1) . Atualmente, a hérnia discal lombar é o diagnóstico mais comum dentre as alterações degenerativas da coluna lombar e a principal causa de cirurgia de coluna. Fatores como maior acesso a cuidados médicos, precocidade na solicitação de exames de imagem e segurança dos procedimentos cirúrgicos levam a altas taxas de cirurgia, condição que é geralmente autolimitada.O tratamento da hérnia discal lombar evoluiu das ressecções transdurais para a abordagem convencional (2,3) , seguida da microcirurgia até a cirurgia endoscópica e percutânea. Atualmente. a hérnia discal lombar é a condição que mais leva à cirurgia de coluna, principalmente em homens ao redor dos 40 anos de idade (4) . Esta revisão visa discutir os principais aspectos de epidemiologia, diagnóstico e tratamento da hérnia discal lombar.

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“…In spinal stenosis, transforaminal ESI has achieved [50% pain reduction, improved walking, and improved standing tolerance in symptomatic patients extending through 1 year follow-up [80]. Furthermore, prospective trials by Yang and Riew found patients with severe lumbar radiculopathies and spinal stenosis treated with transforaminal injections experienced such sustained functional and symptomatic benefits so as to avoid intended surgical intervention [81][82][83].…”

Section: Injection Therapy Epidural Steroid Injectionsmentioning

confidence: 99%

Lumbar Degenerative Disc Disease: Clinical Presentation and Treatment Approaches

Gupta¹,

Attry²,

Vashisth³

et al. 2016

IOSR

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Nerve Root Blocks in the Treatment of Lumbar Radicular Pain

Abstract: The majority of patients with lumbar radicular pain who avoid an operation for at least one year after receiving a nerve root injection with bupivacaine alone or in combination with betamethasone will continue to avoid operative intervention for a minimum of five years.

Cited by 202 publications

References 10 publications

Transforaminal injection of corticosteroids for lumbar radiculopathy: systematic review and meta-analysis

Transforaminal injection of corticosteroids for lumbar radiculopathy: systematic review and meta-analysis

Hérnia discal lombar

Lumbar Degenerative Disc Disease: Clinical Presentation and Treatment Approaches

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