Surgery versus Nerve Blocks for Lumbar Disc Herniation : Quantitative Analysis of Radiological Factors as a Predictor for Successful Outcomes

Abstract

ObjectiveTo assess the clinical and radiological factors as predictors for successful outcomes in lumbar disc herniation (LDH) treatment.MethodsTwo groups of patients with single level LDH (L4–5) requiring treatment were retrospectively studied. The surgery group (SG) included 34 patients, and 30 patients who initially refused the surgery were included in the nerve blocks group (NG). A visual analogue scale (VAS) for leg and back pain and motor deficit were initially evaluated before procedures, and repeated at 1, 6, and 12 months. Radiological factors including the disc herniation length, disc herniation area, canal length-occupying ratio, and canal area-occupying ratio were measured and compared. Predicting factors of successful outcomes were determined with multivariate logistic regression analysis after the optimal cut off values were established with a receiver operating characteristic curve.ResultsThere was no significant demographic difference between two groups. A multivariate logistic regression analysis with radiological and clinical (12 months follow-up) data revealed that the high disc herniation length with cutoff value 6.31 mm [odds ratio (OR) 2.35; confidence interval (CI) 1.21–3.98] was a predictor of successful outcomes of leg pain relief in the SG. The low disc herniation length with cutoff value 6.23 mm (OR 0.05; CI 0.003–0.89) and high baseline VAS leg (OR 12.63; CI 1.64–97.45) were identified as predictors of successful outcomes of leg pain relief in the NG.ConclusionThe patients with the disc herniation length larger than 6.31 mm showed successful outcomes with surgery whereas the patients with the disc herniation length less than 6.23 mm showed successful outcomes with nerve block. These results could be considered as a radiological criteria in choosing optimal treatment options for LDH.

Predictors of Successful Outcomes of Selective Nerve Root Blocks for Acute Lumbar Disc Herniation

“…Kim et al, 22 in a retrospective, small study group of 64 patients, noted that a small disc herniation length with a cutoff value of 6.23 mm and high baseline VAS leg pain were identified as predictors of successful outcomes of leg pain relief in the 30 patients who had a successful NRB. 22…”

“…Lee et al 21 studied the MRI-based outcome predictors of lumbar transforaminal steroid injections in patients with LDH (n ¼ 149) and showed that LDH in the foraminal-extraforaminal zone had significantly better outcomes with nerve blocks while other factors such as T2-high signal, relation to nerve root, corner change, Modic change, disc height loss, grade of disc degeneration, and osteophyte were not statistically significant. Kim et al, 22 in a retrospective, small study group of 64 patients, noted that a small disc herniation length with a cutoff value of 6.23 mm and high baseline VAS leg pain were identified as predictors of successful outcomes of leg pain relief in the 30 patients who had a successful NRB. 22 In our study, among several radiological factors studied, we noted that those with sacralized L5 had a poor outcome with SNRB.…”

“…Kim et al, 22 in a retrospective, small study group of 64 patients, noted that a small disc herniation length with a cutoff value of 6.23 mm and high baseline VAS leg pain were identified as predictors of successful outcomes of leg pain relief in the 30 patients who had a successful NRB. 22 In our study, among several radiological factors studied, we noted that those with sacralized L5 had a poor outcome with SNRB. This was very significant since in the multivariate logistic regression analysis, this was the only highly significant factor with an odds ratio of 20.1.…”

A study on effectiveness of selective nerve root blocks in lumbar radiculopathies

“…While in a study by Anne Thackeray et al [27] out of total 44 patients, 64% were males, with male and female ratio being 1.77:1 but this ratio is almost 1:1 in Mistry et al [12] study. In results of Joohyun Kim et al [28] study a group of 34 patients having SNRB, 14 (41%) were female with ratio M: F=1.43:1. Surprisingly, Arun Kumar et al [29] study had 9 males and 31 female, with ratio 0.29:1.…”

“…In Mistry et al [12] series total 100 patients were included with 82 patients treated with SNRB, maximum number of patients were found in age group of 31 to 40 years (41%) with mean age of 41.7 years. In Joohyun Kim et al [28] series of 34 patients undergone SNRB, the mean age was 46.1 ± 11.4years. Arun Kumar K et al [29] studied on 40 patients, between age of 23 to 61 years, with mean age being 42.6 years.…”