Selective Dual Nerve Root Block Through Extreme Lateral Transforaminal Approach

Kim, Eun Sang

Abstract

BACKGROUND: Selective nerve root block(SNRB) is often helpful for radiculopathy in geriatric patients when surgery is contraindicated and/or patients are poor candidate for surgery. However, multiple injections are often necessary with conventional SNRB for each pathologic level of polyradiculopathy. On the other hand, caudal or interlaminar epidural block cannot reach the pathologic area directly. We reviewed our experience with SNRB for both exiting and traversing nerve roots simultaneously by injecting directly to the ventral epidural pathologic area through extreme lateral transforaminal approach.
METHODS
From March 2003 to June 2005, we performed extreme lateral transforaminal epidural injection with mixture of corticosteroid and local anesthetic in 25 patients. Both exiting and traversing nerve roots and ventral epidural area were identified with radio-opaque contrast media under C-arm fluoroscope. The outcome of treatment was measured using visual analog scale(VAS) score and Oswestry disability index(ODI) score.
RESULTS
The mean age of 25 patients was 53.4 years and 17 of them were women. All of them complained low back pain and polyradiculopathy. After selective dual nerve root block, the average VAS score dropped from 8.5 to 4.3 for leg pain and 7.8 to 5 for low back pain. The ODI score dropped from 38 to 22. Symptom relief was maintained during 8-12 weeks. There was no complication in this procedure.
CONCLUSION
With extreme lateral, transforaminal approach, we can block simultaneously both exiting and traversing nerve roots with single injection of corticosteroid and local anesthetic agent. Sinuvertebral nerve at the pathologic ventral epidural area can also be blocked. In patients with multi-level nerve abnormalities or complex postoperative back pain, this approach was effective therapeutic procedure that can block dual pathologic lesions directly with single injection