Abstract
Introduction: There is still controversy regarding the treatment of acute Lumbar Radicular pain. Most authorities recommend bed rest, anti-inflammatory medication and physical therapy (Riew et al JBJS 1982 and Tulder ET AL Spine 22–1997) Comparing the outcome of operative and conservative treatment in selected patients many authors (Weber et al, Hakelius et al) did not find any significant difference after first year and no difference after 4 years. However many patients treated conservatively complains of persistent pain and seek further intervention.
Aim: We did a prospective study to determine the effectiveness of selective nerve root injection in relieving pain in patients with Lumbar radicular pain.
Material and Methods: We included 27 consecutive patients in our study, who had selective nerve root block. Inclusion criteria were Degenerative Lumbar Radicular pain or spinal stenosis, MRI correlating with Lumbar radiculopathy and no benefit from 6 weeks Anti-inflammatory medication, Rest, Physical treatment and activity modification. Informed consent taken from all patients for this study. Each patient was given Low Back Pain outcome score questionnaire of Greenough and Fraser and Oswestry Disability index of Fairbank, to be filled pre and post injection in day ward and at regular intervals up to 3 months post-injection. Adcortyl 20mg with 1 ml of 1% Lignocaine were injected under image in theatre after confirming the site with radioculogram and pain replication.
Results: From the total of 27 patients, 25 (92%) showed improvement in their symptoms in first week. Out of these 25 patients, 18(66%) had long-term improvement and 7(26%) showed short-term relief. Statistically significant improvement at every stage of assessment was observed.
Conclusion: The selective nerve root block combined with careful history, physical examination and quality radiolographic studies, is an important tool in the diagnosis and treatment of patients with predominant Lumbar radicular symptoms. It gives acceptable results in form of pain relief in 3 months. It has a role in lumbar Radicular pain largely in patients where surgery is not appropriate for whatever reasons.
The abstracts were prepared by Raymond Moran. Correspondence should be addressed to him at the Irish Orthopaedic Assocation, c/o Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland.
