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  • Therapeutic outcomes following CT-guided transforaminal selective nerve root block for cervical radicular pain amenable to surgical decompression: a prospective study

    Final Number:

    Moujahed Labidi MD; Mathieu Laflamme; Jerome Paquet; Alexandre Denault MD, FRCSC; David Mercier MD, MSc

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: The role of selective nerve root block (SNRB) in cervical radiculopathy is not well defined. Controversy persists as to whether there is a substantial and durable pain relief following SNRB.

    Methods: Methods: In this prospective study, patients with compressive cervical radiculopathy that failed conservative management were offered a transforaminal SNRB under CT guidance while awaiting surgery. Neck and arm pain were assessed with the visual analog scale (VAS) and function evaluated with the neck disability index and the short-form 36 at baseline and at 48 hours, 2, 4 and 8 weeks following the SNRB.

    Results: Overall, 21 patients had a SNRB, but 2 patients were lost to follow-up. Mean age was 46 years and average symptom duration was 6.9 months. There was no complication associated with the SNRB. Mean maximal reduction of arm pain after the block was 2.92 on the VAS (95%CI 1.86 – 3.98, p < 0.0001). Mean arm pain reduction was 1.95 at 4 weeks (95%CI 0.94 – 2.96, p = 0.0004) and 1.79 at 8 weeks (95%CI 0.13 – 2.08, p = 0.025). There were a mean reduction of 1.84 (95%CI -6.95 – 3.27, p>0.1) on the NDI and a mean increase of 2.79 (95%CI -1.37 – 6.95, p>0.1) on the SF-36 at 8 weeks. By 8 weeks, 78.9% of patients had reduced their medication intake and 47.4% had stopped or cut back on opiates. However, 5 patients (26.3%) presented a significant reduction in their arm pain (=3.5 reduction on the VAS) that was sustained at 8 weeks and in only 2 patients (9.5%) was the pain relief significant or durable enough to avoid surgery.

    Conclusions: SNRB may alleviate radicular symptoms in compressive cervical radiculopathy amenable to surgery. However, the pain relief is either insufficient or too short-lived to avoid surgery for most patients.

    Patient Care: This poster presentation allows the participants to learn about selective nerve root block and its potential benefits for patients affected by cervical radiculopathy refractory to medical therapy.

    Learning Objectives: Following this poster presentation, participants should be able to: 1) Describe selective nerve root block and 2) Discuss its effectiveness in cervical radiculopathy


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