Selective Nerve Root Blocks: An Analysis of Efficacy and Outcomes in Surgery Prevention

Introduction: Selective nerve root block (SNRB) is an effective conservative treatment for radicular leg pain. In cases where radiculopathy fails to respond to conservative measures, surgical intervention may be necessary, often with significant costs and associated risks. This study seeks to evaluate the effectiveness of SNRB in preventing or delaying surgery in patients with radicular leg pain and to compare its outcomes in individuals with disc prolapse versus those with lumbar canal stenosis.

Methods: This study included adults who received Selective Nerve Root Blocks (SNRB) for radicular pain between October 2017 and May 2024. Demographic data for all patients were retrospectively gathered from the hospital's electronic database. Outcome measures included changes in pain scores, assessed using the Visual Analog Scale (VAS) pre- and post-procedure, as well as the number of patients who subsequently underwent spinal surgery.

Results: 60 patients met the inclusion criteria for this study, including 30 males (50%). The average age was 53.53 ± 16.35 years, with a mean follow-up period of 13.67 months (range: 4 to 82 months). Pain relief was observed in 42 patients (70%) following SNRB, with the average VAS score improving from 8.26 ± 0.76 pre-procedure to 3.33 ± 2.92 post-procedure. 51 patients (85%) were able to avoid surgery throughout the follow-up period. 34(56.67%) patients had disc prolapse, 21(35%) had canal stenosis, and the remaining had other causes. In the disc prolapse group, 67.75% of patients reported significant pain relief, with the mean VAS score improving from 8.33 to 3.76. In the canal stenosis group, 61.9% reported similar pain reduction, with the VAS score decreasing from 8.1 to 2.95. Furthermore, 82.35% of disc prolapse patients were able to avoid surgery, compared to 90.48% in the canal stenosis group.

Conclusion : SNRB is an effective non-surgical intervention that can help prevent/delay the need for surgery in patients with radicular pain.