J Korean Orthop Assoc.  2018 Apr;53(2):166-173. 10.4055/jkoa.2018.53.2.166.

The Effectiveness of Ultrasound-Guided Selective Nerve Root Block for the Treatment of Radicular Pain in the Lower Cervical Spine: An Assessment of Sustainability and Side Effects

• Kang HS
• Kim CS
• Kwon YH

• KMID: 2410065
• DOI: http://doi.org/10.4055/jkoa.2018.53.2.166

Abstract

PURPOSE
The purpose of this study was to evaluate the sustainability and adverse effects of ultrasound-guided selective nerve root block in patients who complained of radiculopathy due to lower cervical disc herniation.
MATERIALS AND METHODS
Between February 2014 and February 2016, 39 out of 60 patients who visited Department of Orthopedic Surgery, Kosin University Gospel Hospital with a chief complaint of radiculopathy due to lower cervical disc herniation were treated with an ultrasound-guided selective nerve root block. To evaluate the efficacy and sustainability of this treatment, the degree of pain relief and functional improvement were evaluated before and 3 months after the procedure. Patients were categorized into two groups: The soft disc group and the hard disc group. The safety of the procedure was evaluated by examining the side effects occurring immediately after the procedure and the following day.
RESULTS
Visual analogue scale and Neck Disability Index were improved from 6.00 to 3.02 and from 15.82 to 6.15, respectively (p < 0.05). There were 2 cases of headache and 2 cases of dizziness; however, they were resolved within 1 hour after the procedure. In 32 patients (82.1%), there was improvement in pain, which persisted for more than 3 months in 24 patients. Contrastinly, 7 patients (17.9%) showed no improvement and 6 patients (15.4%) experienced recurrence of pain or symptoms within 1 month after the procedure. In the soft disc group, there was a reduction in pain, from a score of 5.88 before the procedure to 2.64 twelve weeks after the procedure (p < 0.01). In the hard disc group, there was also a reduction in, from a score of 6.09 before the procedure to 3.22 at postoperative 12 weeks (p < 0.01). There was no significant difference between the two groups.
CONCLUSION
In patients with cervical disc herniation, an ultrasound-guided selective nerve root block appears to be an effective treatment option for outpatients due to its low risk of serious complications.

Keyword

herniated disc; nerve block; ultrasonography

MeSH Terms

Dizziness
Headache
Humans
Intervertebral Disc Displacement
Neck
Nerve Block
Orthopedics
Outpatients
Radiculopathy
Recurrence
Spine*
Ultrasonography

Figure

• 

  Figure 1 A 56-year-old man with C6 radiculopathy showed a pain reduction with a visual analogue scale of 6 before the procedure to 2 at 12 weeks after the procedure. (A, B) Anteroposterior and lateral x-rays show C5/C6 degenerative spondylosis. (C) Axial T2-weighted image (C5/6 level): magnetic resonance imaging shows narrowing of the left neural foramen with structure of low signal intensity (hard disc). (D) Ultrasound-guided selective nerve root block (target nerve root was left C6). Arrowheads, point to the needle; A, anterior tubercle of C6 transverse process; P, posterior tubercle of C6 transverse process.

• 

  Figure 2 A 64-year-old woman with C6 radiculopathy showed pain reduction with a visual analogue scale of 8 before the procedure to 3 at postoperative 12 weeks. (A, B) Anteroposterior and lateral x-rays show narrowing of C5/6 disc space. (C) Sagittal T2-weighted image: magnetic resonance imaging shows disc herniation (soft disc). (D) ultrasound-guided selective nerve root block (target nerve root was left C6). Arrowheads, point to the needle; A, anterior tubercle of C6 transverse process; P, posterior tubercle of C6 transverse process.

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