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Value of diagnostic lumbar selective nerve root block: a prospective controlled study

Cited 19 time in Web of Science Cited 22 time in Scopus
Authors
Yeom, J S; Lee, J W; Park, K-W; Chang, B-S; Lee, C-K; Buchowski, J M; Riew, K D
Issue Date
2008-02-15
Publisher
American Society of Neuroradiology
Citation
AJNR Am J Neuroradiol. 2008;29(5):1017-23
Keywords
AdolescentAdultAgedFemaleHumansLow Back Pain/*diagnosis/*therapyMaleMiddle AgedNerve Block/*methodsProspective StudiesReproducibility of ResultsSensitivity and Specificity
Abstract
BACKGROUND AND PURPOSE: Although diagnostic lumbar selective nerve root blocks are often used to confirm the pain-generating nerve root level, the reported accuracy of these blocks has been variable and their usefulness is controversial. The purpose of this study was to evaluate the accuracy of diagnostic lumbar selective nerve root blocks to analyze potential causes of false results in a prospective, controlled, single-blinded manner. MATERIALS AND METHODS: A total of 105 block anesthetics were performed under fluoroscopic guidance in 47 consecutive patients with pure radiculopathy from a single confirmed level: 47 blocks were performed at the symptomatic level, and 58 were performed at the adjacent asymptomatic "control" level. Contrast and local anesthetics were injected, and spot radiographs were taken in all cases. We calculated the diagnostic value of the block anesthetics using concordance with the injected level. We analyzed the potential causes of false results using spot radiographs. RESULTS: On the basis of a definition of a positive block as 70% pain relief, determined by receiver-operator characteristic (ROC) analysis, diagnostic lumbar selective nerve root block anesthetics had a sensitivity of 57%, a specificity of 86%, an accuracy of 73%, a positive predictive value of 77%, and a negative predictive value of 71%. False-negatives were due to the following causes identifiable on spot radiographs: insufficient infiltration, insufficient passage of the injectate, and intraepineural injections. On the other hand, false-positives resulted from overflow of the injectate from the injected asymptomatic level into either the epidural space or symptomatic level. CONCLUSION: The accuracy of diagnostic lumbar selective nerve root blocks is only moderate. To improve the accuracy, great care should be taken to avoid inadequate blocks and overflow, and to precisely interpret spot radiographs.
ISSN
1936-959X (Electronic)
Language
English
URI
http://www.ajnr.org/cgi/reprint/29/5/1017.pdf

https://hdl.handle.net/10371/67464
DOI
https://doi.org/10.3174/ajnr.A0955
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College of Medicine/School of Medicine (의과대학/대학원)Orthopedic Surgery (정형외과학전공)Journal Papers (저널논문_정형외과학전공)
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