Annals of Rehabilitation Medicine

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"Selective nerve root injection"

Original Articles

The Ultrasound-guided Selective Nerve Root Injections in the Lower Cervical Spines.: Yun, Dong Hwan , Yu, Seung Don , Kim, Dong Hwan , Choi, Seong Hun , Song, Jae Min; J Korean Acad Rehabil Med 2008;32(6):619-623.

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Objective: To introduce the technique of the ultrasound- guided selective nerve root injection in the lower cervical spine and to evaluate its accuracy and distribution patterns of injections. Method: Thirty-one patients with the cervical radiculopathies (C5 to C7) from cervical disc herniation were enrolled in this study. Targeted nerve root image was obtained and the needle was introduced to its dorsal surface under the ultrasound guidance. Then 2 ml of contrast media was injected which was followed by fluoroscopic image. The accurate injection was defined as the contrast media placed over the neural foramen along the targeted nerve root. Results: 24 of 31 (77.4%) procedures were assesed to be accurately placed and there was no significant complication. The accuracy of injection was lower at the C7 nerve root (70.0%) than other nerve roots. In all cases, large amount of back flow to the brachial plexus and spread to the adjacent nerve roots were observed. Conclusion: In the lower cervical spines, ultrasound-guided selective nerve root injections might be considered as a radiation free, safe and available method. (J Korean Acad Rehab Med 2008; 32: 619-623)

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Cervical Radiculopathy: Selective Nerve Root Injection of Steroids.: Sung, Duk Hyun , Lee, Kang Woo , Ra, Yun Ju; J Korean Acad Rehabil Med 2000;24(4):725-732.

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Objective: To determine the therapeutic efficacy of fluoroscopic and electrical stimulation guided perineural selective nerve root injection in cervical radiculopathy patients.

Method: The gold standard of the diagnosis of cervical radiculopathy was based on clinical features, MRI and electrodiagnostic findings. Considering the natural regression of pain in cervical radiculopathy, only patients (n=27, 14 male and 13 female) who had suffered from persisting or aggravating pain for at least 6 weeks or longer duration after the onset of symptoms, were received a selective nerve root injection (SNRI) of steroids to a target nerve root.

Patients were followed up at 2 weeks and 2 months, and interviewed via telephone or re-examined at an average of 37.8 weeks 68 weeks after injection by a independent physician. Criteria for a successful outcome were greater than 50% reduction of pain on visual analogue scale and an ability to return to previous level of function.

Results: High proportion of patients reported a successful outcome at 2 weeks (88.9%, 24 of 27 patients). Twenty-two of twenty-four patients reported the outcome at 2 months and 20 of 22 patients were followed up for an averrge period of 37.3 weeks. Among these 20 patients 19 patients satisfied with the result of SNRI at an average follow up period of 68 weeks. There was no significant difference of the efficacy according to the duration of the symptoms. There were no complications in any of the patients after injections.

Conclusion: Fluoroscopic and electrical stimulation guided selective nerve root injections of corticosteroids were an effective and safe treatment modality in cervical radiculopathy. These could be considered as a first line treatment before a surgical intervention in whom another conservative treatments are not effective.

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Efficacy of Translaminar Epidural Steroid Injection versus Combined Translaminar Epidural Steroid Injection with Selective Nerve Root Injection in Spinal Stenosis.: Nam, Ki Yeon , Ryu, Gi Hyeong , Choi, Jung Min , Choi, Jong Ho , Kwuan, Bum Sun , Park, Jin Woo; J Korean Acad Rehabil Med 2007;31(1):7-13.

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Objective
To compare treatment effects of translaminar epidural steroid injections (TLESIs) only and selective nerve root injections (SNRIs) with TLESIs in lumbosacral spinal stenosis. Method: Thirty-four patients diagnosed with magnetic resonance imaging (MRI), somatosensory evoked potential (SEP) and electromyography (EMG) were included. 16 patients who had somatosensory pathway dysfunction or abnormal spontaneous activity received combined SNRIs with TLESIs and 20 patients received only TLESIs. The visual analogue scale (VAS) and functional rating index (FRI) were measured before injection, 1 week and 3 months after 3 times injection. Results: The mean values of VAS before injection, 1 week and 3 months after 3 times injection were 7.55, 3.22, 3.61 in only TLESIs and 7.37, 2.06, 2.31 in SNRIs with TLESIs. The mean values of FRI before injection, 1 week and 3 months after 3 times injection were 25.16, 16.00, 15.83 in only TLESIs and 22.50, 8.37, 8.31 in SNRIs with TLESIs. In the mean values of VAS and FRI were significantly lower SNRIs with TLESIs than only TLESIs (p＜0.05). Conclusion: Combined SNRIs with TLESIs were more effective treatment for reduction of pain and improvement of function than only TLESIs in lumbosacral spinal stenosis. (J Korean Acad Rehab Med 2007; 31: 7-13)