FUNCTIONAL OUTCOME OF SELECTIVE NERVE ROOT BLOCK FOR LUMBAR RADICULOPATHY IN INTERVERTEBRAL DISC PROLAPSE

Abstract

Background: A leading cause of physical disability is radiculopathy accompanied by back discomfort in the lower back, which can be caused by prolapsed intervertebral discs (PIVD). Acupuncture, analgesics, oral steroids and bed rest are some of the conservative methods for treating lumbar radiculopathy (LR). An identified perturbed nerve root might be targeted to diagnose and treat LR using a local injection technique called a Selective Nerve Root Block (SNRB). Aim and Objective: By assessing functional outcomes using the Oswestry Disability Index (ODI), straight leg raise test (SLRT) and Numerical rating scale (NRS) in pre-injection and post-injection scores on days zero, thirty and ninety. The objective of this study is to ascertain whether SNRB intervention improves the outcome of PIVD with LR. Methodology: The prospective observational study was conducted among 35 consecutive patients of PIVD with LR who presented to the orthopaedics department of the R L Jalappa Hospital, Kolar, during the period between 1st September 2022 and 31st December 2023. As per the proforma, the patient's comprehensive medical history, clinical examination and radiological evaluation were documented. Page 3 Everyone was evaluated using the SLRT, ODI and NRS both before and after the procedure. A combination of 3ml drug [long-acting steroid (1ml) + local anaesthetic agent (2ml)] was instilled into each afflicted nerve root. All patients underwent an assessment on post-procedure day zero, followed by follow-up appointments at 30 and 90 days. Results: The mean age of enrolled patients was 39.63 ± 9.7 years. Among the enrolled patients, the most common side of radiating pain was the left side (57.1%) followed by the right side (42.9%). L4 - L5 was the most common level (45.7%) of PIVD, and the second most common level was L3-L4 (28.6%). The most common level at which SNRB injection was given in the present study was L4 (45.7%). All the patients tested SLRT positive before SNRB injection. After SNRB injection at day 0, all the patients tested SLRT negative, and it remained negative even at 30 days. At 90 days after SNRB injection only 4 patients were tested SLRT positive, and it was statistically significant by Fisher's exact test (P value 0.0001). The pain score decreased immediately after SNRB injection at day 0 of intervention (3.29). But this pain score increased at 30 days (4.14) but not more than the pre-procedure pain and later it decreased at 90 days after intervention (3.14). According to the paired t-test, this decline in the mean NRS score was regarded as significant. The disability assessment score decreased immediately after SNRB injection at day 0 of intervention Page 4 (7.83). However, this disability score remained the same at 30 days (7.86) and later it decreased at 90 days after intervention (6.86). A paired t-test revealed that this drop in the mean ODI score was deemed significant. Inference: SNRB injections have been shown to alleviate pain and disability in patients with LR in PIVD, the benefits of these injections have been observed to persist for up to three months post-administration, potentially improving their quality of life and functional status over an extended period.