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Value of diagnostic lumbar selective nerve root block: a prospective controlled study
1Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
AJNR. American Journal of Neuroradiology
|February 15, 2008
Summary
Diagnostic lumbar selective nerve root blocks show moderate accuracy for identifying pain-generating nerve roots. Careful technique and radiograph interpretation are crucial to minimize false results in radiculopathy diagnosis.
Area of Science:
- Pain Medicine
- Neurology
- Radiology
Background:
- Lumbar selective nerve root blocks are utilized for diagnosing pain-generating nerve roots.
- The accuracy and clinical utility of these blocks remain subjects of debate due to variable reported outcomes.
Purpose of the Study:
- To prospectively evaluate the accuracy of diagnostic lumbar selective nerve root blocks.
- To identify factors contributing to false-positive and false-negative results.
Main Methods:
- 105 blocks were performed under fluoroscopic guidance in 47 patients with single-level radiculopathy.
- Blocks were administered at the symptomatic level and adjacent asymptomatic control levels.
- Radiographs were used to assess injectate spread and analyze causes of inaccurate blocks.
Main Results:
- The overall accuracy was 73%, with sensitivity of 57% and specificity of 86%.
- False-negatives were linked to insufficient injection volume, poor spread, or intraepineural placement.
- False-positives occurred due to injectate overflow into adjacent levels or the epidural space.
Conclusions:
- Diagnostic lumbar selective nerve root blocks offer only moderate accuracy.
- Precise technique, avoiding inadequate blocks and overflow, is essential.
- Accurate interpretation of spot radiographs is critical for reliable diagnosis.
