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Cervical Radiculopathy: A Study With Selective Nerve Root Blocks

Anderberg, Leif LU (2005)
Abstract
Cervical radiculopathy is diagnosed by history, clinical examination of the patient and magnetic resonance imaging (MRI) of the cervical spine. In many of the patients undergoing this diagnostic strategy, the nerve root/roots responsible for the radicular pain is difficult to define as clinical examination and MRI investigation does not provide information enough. The information from transforaminal selective diagnostic nerve root blocks with local anaesthetics (SNRB) when used in the cervical spine in patients with radiculopathy was evaluated in two prospective studies including 20 patients with mono segmental disc disease and 30 patients with two segmental disc disease. In another prospective study including nine patients, the contrast... (More)
Cervical radiculopathy is diagnosed by history, clinical examination of the patient and magnetic resonance imaging (MRI) of the cervical spine. In many of the patients undergoing this diagnostic strategy, the nerve root/roots responsible for the radicular pain is difficult to define as clinical examination and MRI investigation does not provide information enough. The information from transforaminal selective diagnostic nerve root blocks with local anaesthetics (SNRB) when used in the cervical spine in patients with radiculopathy was evaluated in two prospective studies including 20 patients with mono segmental disc disease and 30 patients with two segmental disc disease. In another prospective study including nine patients, the contrast spread from three different volumes injected into the foraminal area was evaluated with multi-slice computed tomography. Furthermore, 40 patients were prospectively randomized for treatment with a transforaminal injection of saline and local anaesthetics or steroids and local anaesthetics in treatment of radicular pain. The patients were followed up after three weeks.



In the mono-segmental study it was shown that positive response to a selective nerve root block predicted good/excellent surgical outcome in 100% of the patients. In the two segmental degenerated patients it was shown that diagnostic SNRB provided information not given by the MRI and/or clinical examination. The correlation between SNRB and MRI was 60 %, and between SNRB and clinical examination, 28 %. The positive response to the SNRB predicted good/excellent outcome in 82 % of the treated patients.



Distribution from transforaminal SNRB was influenced by the injected volume and the foraminal area. Injection into a large foramen created a spread into the spinal canal distant from the injected site with possibility to reach nearby nerve roots. Injection into a narrow foramen created a spread along the vertebral artery with possible spread to other nerve roots. The nerve root above the injected level was more often at risk than the nerve root below and a volume of 0.5 of local anaesthetics is more reliable than 1.5 for diagnostic blocks.



No difference was seen when comparing saline/local anaesthetics with steroids/local anaesthetics for the treatment of radiculopathy. Further studies have to be performed to evaluate the need for steroids in such treatment as the steroid component can produce serious complications when injected into spinal blood vessels. (Less)
Abstract (Swedish)
Popular Abstract in Swedish

Symtomgivande nervrots påverkan i halsryggen diagnostiseras via sjukhistoria, klinisk undersökning och magnetkamera undersökning av halsryggen (MRI). Hos flera av patienterna som genomgår denna utredning infinner sig svårigheter att identifiera den/de nervrötter som är ansvariga för patientens smärta. Detta beror på att den kliniska undersökningen och undersökningen med MRI inte ger tillräcklig information.



Utvärdering av nyttan av information från selektiva diagnostiska nervrots blockader (SNRB) med lokalanestesi hos patienter med nervrotspåverkan i halsryggen är utförd i två prospektiva studier innefattande 20 patienter med disksjukdom på en nivå och på 30 patienter med två... (More)
Popular Abstract in Swedish

Symtomgivande nervrots påverkan i halsryggen diagnostiseras via sjukhistoria, klinisk undersökning och magnetkamera undersökning av halsryggen (MRI). Hos flera av patienterna som genomgår denna utredning infinner sig svårigheter att identifiera den/de nervrötter som är ansvariga för patientens smärta. Detta beror på att den kliniska undersökningen och undersökningen med MRI inte ger tillräcklig information.



Utvärdering av nyttan av information från selektiva diagnostiska nervrots blockader (SNRB) med lokalanestesi hos patienter med nervrotspåverkan i halsryggen är utförd i två prospektiva studier innefattande 20 patienter med disksjukdom på en nivå och på 30 patienter med två nivåers disksjukdom. I en annan prospektiv studie innehållande nio patienter studeras kontrastspridningen från tre olika volymer injicerade i halsryggen med samma teknik som används vid SNRB. Effekten av kortison på nervrotssmärta i halsryggen utvärderas i en prospektiv och randomiserad studie innefattande 40 patienter. Som kontroll användes koksaltlösning. Effekten utvärderas efter 3 veckor.



I en nivå studien framkom god korrelation mellan MRI fynd och SNRB. I två nivåer studien framkom information från SNRB som klinisk undersökning och MRI fynd inte kunde ge. Korrelationen mellan SNRB och MRI var 60 % och mellan SNRB och klinisk undersökning 28 %. Positiv effekt av SNRB korrelerade till good/excellent outcome efter behandling i 82 % av patienterna. Kontrast spridning från transforaminala SNRB påverkas av storleken på den injicerade volymen samt arean på rotkanalen som injiceras. Användandet av 0.5 ml vid diagnostiska SNRB är mera selektiv än 1.5 ml. Den nervrot som ligger ovanför den injicerade rotkanalen förefaller vara den som mest riskerar att bli påverkad av oönskad spridning.



Ingen skillnad i terapeutisk effekt noterades vid jämförelse av kortison och koksaltlösning vid behandling av nervrotssmärta från halsryggen. Ytterliggare studier krävs för att utvärdera nyttan av kortison tillblandning vid lokal behandling av nervrotssmärta från halsryggen. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • Docent Lind, Bengt, Göteborgs Universitet
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Surgery, orthopaedics, Contrast distribution, Nerve root block, Cervical radiculopathy, Kirurgi, traumatology, Treatment, ortopedi, traumatologi
pages
104 pages
publisher
Department of Neurosurgery, Lund University
defense location
Föreläsningssalen plan 4 EA-blocket, Neuroakademien, Universitetssjukhuset i Lund
defense date
2005-11-26 09:15:00
ISBN
91-85481-05-X
language
English
LU publication?
yes
additional info
L Anderberg, M Annertz, L Brandt and H Säveland. 2004. Selective diagnostic cervical nerve root block - correlation with clinical symptoms and MRI-pathology. Acta Neurochir, vol 146 pp 559-565.
L Anderberg, M Annertz, U Rydholm, L Brandt and H Säveland. 2005. Selective diagnostic nerve root block for the evaluation of radicular pain in the multilevel degenerated cervical spine. Eur Spine J, vol Epub ahead of print
L Anderberg, M Annertz, L Persson, L Brandt and H Säveland. . Transforaminal injections of steroids for the treatment of cervical radiculopathy. A randomised study in 40 patients. Eur Spine J., (submitted)
L Anderberg, H Säveland and M Annertz. . Distribution patterns of transforaminal injections in the cervical spine evaluated by Multi-slice Computed Tomography. Eur Spine J., (accepted)
id
481cc88c-c12d-4c2b-8925-343002d7fdf7 (old id 545752)
date added to LUP
2016-04-04 09:55:52
date last changed
2018-11-21 20:55:43
@phdthesis{481cc88c-c12d-4c2b-8925-343002d7fdf7,
  abstract     = {{Cervical radiculopathy is diagnosed by history, clinical examination of the patient and magnetic resonance imaging (MRI) of the cervical spine. In many of the patients undergoing this diagnostic strategy, the nerve root/roots responsible for the radicular pain is difficult to define as clinical examination and MRI investigation does not provide information enough. The information from transforaminal selective diagnostic nerve root blocks with local anaesthetics (SNRB) when used in the cervical spine in patients with radiculopathy was evaluated in two prospective studies including 20 patients with mono segmental disc disease and 30 patients with two segmental disc disease. In another prospective study including nine patients, the contrast spread from three different volumes injected into the foraminal area was evaluated with multi-slice computed tomography. Furthermore, 40 patients were prospectively randomized for treatment with a transforaminal injection of saline and local anaesthetics or steroids and local anaesthetics in treatment of radicular pain. The patients were followed up after three weeks.<br/><br>
<br/><br>
In the mono-segmental study it was shown that positive response to a selective nerve root block predicted good/excellent surgical outcome in 100% of the patients. In the two segmental degenerated patients it was shown that diagnostic SNRB provided information not given by the MRI and/or clinical examination. The correlation between SNRB and MRI was 60 %, and between SNRB and clinical examination, 28 %. The positive response to the SNRB predicted good/excellent outcome in 82 % of the treated patients.<br/><br>
<br/><br>
Distribution from transforaminal SNRB was influenced by the injected volume and the foraminal area. Injection into a large foramen created a spread into the spinal canal distant from the injected site with possibility to reach nearby nerve roots. Injection into a narrow foramen created a spread along the vertebral artery with possible spread to other nerve roots. The nerve root above the injected level was more often at risk than the nerve root below and a volume of 0.5 of local anaesthetics is more reliable than 1.5 for diagnostic blocks.<br/><br>
<br/><br>
No difference was seen when comparing saline/local anaesthetics with steroids/local anaesthetics for the treatment of radiculopathy. Further studies have to be performed to evaluate the need for steroids in such treatment as the steroid component can produce serious complications when injected into spinal blood vessels.}},
  author       = {{Anderberg, Leif}},
  isbn         = {{91-85481-05-X}},
  keywords     = {{Surgery; orthopaedics; Contrast distribution; Nerve root block; Cervical radiculopathy; Kirurgi; traumatology; Treatment; ortopedi; traumatologi}},
  language     = {{eng}},
  publisher    = {{Department of Neurosurgery, Lund University}},
  school       = {{Lund University}},
  title        = {{Cervical Radiculopathy: A Study With Selective Nerve Root Blocks}},
  year         = {{2005}},
}