scholarly journals The diagnostic utility and cost-effectiveness of selective nerve root blocks in patients considered for lumbar decompression surgery: a systematic review and economic model

2013 ◽  
Vol 17 (19) ◽  
Author(s):  
R Beynon ◽  
J Hawkins ◽  
R Laing ◽  
N Higgins ◽  
P Whiting ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cost Effectiveness ◽  
Nerve Root ◽  
Economic Model ◽  
Decompression Surgery ◽  
Diagnostic Utility ◽  
Lumbar Decompression ◽  
Nerve Root Blocks ◽  
Lumbar Decompression Surgery

scholarly journals Nerve root herniation with entrapment in the facet joint gap after lumbar decompression surgery: a case presentation

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Branko Popadic ◽  
Florian Scheichel ◽  
Melanie Themesl ◽  
Ingo Decristoforo ◽  
Camillo Sherif ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Nerve Root ◽  
Facet Joint ◽  
Surgical Complication ◽  
Decompression Surgery ◽  
Case Presentation ◽  
Lumbar Decompression ◽  
Postoperative Mri ◽  
Joint Gap ◽  
Lumbar Decompression Surgery

Abstract Background An incidental dural tear is a well-known complication during spine surgery. A rare consequence is a postoperative nerve root herniation. The purpose of this report is to describe a case of such a herniation with entrapment in the facet gap joint and to present the first MR images of this rare surgical complication. Case presentation We report a case of a patient who underwent lumbar decompression surgery and afterwards suffered a sudden intractable sciatica. Postoperative MRI showed a new facet joint gap effusion. During revision surgery an entrapped nerve root was found in the facet joint gap. In retrospective, the herniated nerve root is visible on postoperative MRI. Conclusion This case report highlights a rare complication during spine surgery. This finding is important as signs suggestive for nerve root herniation can easily be overlooked on MRI. Furthermore, this represents the first MRI documentation of this complication.

scholarly journals The utility of diagnostic selective nerve root blocks in the management of patients with lumbar radiculopathy: a systematic review

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e025790 ◽  
Author(s):  
Rebecca Beynon ◽  
Martha Maria Christine Elwenspoek ◽  
Athena Sheppard ◽  
John Nicholas Higgins ◽  
Angelos G Kolias ◽  
...  
Keyword(s):  
Systematic Review ◽  
Diagnostic Accuracy ◽  
Nerve Root ◽  
Risk Of Bias ◽  
Decompression Surgery ◽  
Test Accuracy ◽  
Index Test ◽  
Lumbar Radiculopathy ◽  
Reference Standard ◽  
Nerve Root Blocks

ObjectiveLumbar radiculopathy (LR) often manifests as pain in the lower back radiating into one leg (sciatica). Unsuccessful back surgery is associated with significant healthcare costs and risks to patients. This review aims to examine the diagnostic accuracy of selective nerve root blocks (SNRBs) to identify patients most likely to benefit from lumbar decompression surgery.DesignSystematic review of diagnostic test accuracy studies.Eligibility criteriaPrimary research articles using a patient population with low back pain and symptoms in the leg, SNRB administered under radiological guidance as index test, and any reported reference standard for the diagnosis of LR.Information sourcesMEDLINE (Ovid), MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, Science Citation Index, Biosis, LILACS, Dissertation abstracts and National Technical Information Service from inception to 2018.MethodsRisk of bias and applicability was assessed using the QUADAS-2 tool. We performed random-effects logistic regression to meta-analyse studies grouped by reference standard.Results6 studies (341 patients) were included in this review. All studies were judged at high risk of bias. There was substantial heterogeneity across studies in sensitivity (range 57%–100%) and specificity (10%–86%) estimates. Four studies were diagnostic cohort studies that used either intraoperative findings during surgery (pooled sensitivity: 93.5% [95% CI 84.0 to 97.6]; specificity: 50.0% [16.8 to 83.2]) or ‘outcome following surgery’ as the reference standard (pooled sensitivity: 90.9% [83.1 to 95.3]; specificity 22.0% [7.4 to 49.9]). Two studies had a within-patient case-control study design, but results were not pooled because different types of control injections were used.ConclusionsWe found limited evidence which was of low methodological quality indicating that the diagnostic accuracy of SNRB is uncertain and that specificity in particular may be low. SNRB is a safe test with a low risk of clinically significant complications, but it remains unclear whether the additional diagnostic information it provides justifies the cost of the test.

scholarly journals An Updated Systematic Review of the Diagnostic Utility of Selective Nerve Root Blocks

2007 ◽  
Vol 1;10 (1;1) ◽  
pp. 113-128
Author(s):  
Sukdeb Datta
Keyword(s):  
Systematic Review ◽  
Diagnostic Tool ◽  
Nerve Root ◽  
Predictive Value ◽  
Spinal Pain ◽  
Diagnostic Utility ◽  
Extensive Literature ◽  
Spinal Disorders ◽  
Cochrane Reviews ◽  
Nerve Root Blocks

Background: Selective nerve root blocks or transforaminal epidural injections are used for diagnosis and treatment of different spinal disorders. A clear consensus on the use of selective nerve root injections as a diagnostic tool does not currently exist. Additionally, the effectiveness of this procedure as a diagnostic tool is not clear. A systematic review of diagnostic utility of selective nerve root blocks was performed and published in January 2005, which concluded that selective nerve root injections may be helpful as a diagnostic tool in evaluating spinal pain with radicular features, but its role needs to be further clarified. Objective: To evaluate and update the accuracy of selective nerve root injections in diagnosing spinal disorders. Study Design: A systematic review of selective nerve root blocks for the diagnosis of spinal pain. Methods: A systematic review of the literature for clinical studies was performed to assess the accuracy of selective nerve root injections in diagnosing spinal pain. Methodologic quality evaluation was performed utilizing Agency for Healthcare Research and Quality (AHRQ) and Quality Assessment Studies of Diagnostic Accuracy (QUADAS) criteria. Studies were graded and evidence classified into 5 levels: conclusive, strong, moderate, limited, or indeterminate. An extensive literature search was performed utilizing resources from the library at Vanderbilt University Medical Center, PubMed, EMBASE, BioMed, and Cochrane Reviews. Manual searches of bibliographies of known primary and review articles, and abstracts from scientific meetings within the last 2 years were also reviewed. Results: There is limited evidence on the effectiveness of selective nerve root injections as a diagnostic tool for spinal pain. There is insufficient research for stronger support, but the available literature is supportive of selective nerve root injections as a diagnostic test for equivocal radicular pain. There is moderate evidence for use in the preoperative evaluation of patients with negative or inconclusive imaging studies. The positive predictive value of diagnostic selective nerve root blocks is low, but they have a useful negative predictive value. Conclusion: Selective nerve root injections may be helpful as a diagnostic tool in evaluating spinal pain with radicular features. However, their role needs to be further clarified by additional research and consensus. Keywords: Selective nerve root block, transforaminal epidural injection, spinal pain, discogenic pain, radiculopathy, nerve root pain

scholarly journals Preservation and Tissue Handling Technique on Iatrogenic Dural Tear with Herniated Nerve Root at Cauda Equina Level

2016 ◽  
Vol 2016 ◽  
pp. 1-6
Author(s):  
Ahmad Jabir Rahyussalim ◽  
Yoshi Pratama Djaja ◽  
Ifran Saleh ◽  
Ahmad Yanuar Safri ◽  
Tri Kurniawati
Keyword(s):  
Nerve Root ◽  
Cauda Equina ◽  
Relative Size ◽  
Decompression Surgery ◽  
Dural Tear ◽  
Lumbar Decompression ◽  
Tissue Handling ◽  
Long Term Result ◽  
Lumbar Decompression Surgery ◽  
Incidental Durotomy

Iatrogenic or incidental dural tear is a relatively common complication in lumbar decompression surgery. Although mostly there are no changes that occurred in long-term result following an incidental durotomy, the sequelae are not always benign especially when the herniated nerve root is involved. Preservation and tissue handling is paramount in order to prevent further injury. Two cases of dural tear with herniated nerve root complicating the lumbar decompression surgery are presented. Direct watertight repair was performed using the preservation and tissue handling concept. Assessing the relative size between the dural tear and the root mass is the key in determining whether enlargement of tear is needed. Whenever feasible, the tear will not be enlarged. Opening the vent by using a suture anchor and manually repositioning the nerve root with a fine instrument is the key for an atraumatic handling of the herniated nerve root. Clinical and neurophysiology examination was performed postoperatively and no further neurologic deficit occurred despite the iatrogenic injury. Although some debate on a few intraoperative and postoperative details still persists, tissue handling and preservation concept should be applied in all cases.

Routine Postoperative Imaging Early After Lumbar Decompression Surgery

Spine ◽  
2013 ◽  
Vol 38 (20) ◽  
pp. E1263-E1268 ◽  
Author(s):  
Gerrit Alexander Schubert ◽  
Michaels Diepers ◽  
Aldemar Andres Hegewald ◽  
Marcel Seiz ◽  
Claudius Thomé
Keyword(s):  
Decompression Surgery ◽  
Postoperative Imaging ◽  
Lumbar Decompression ◽  
Lumbar Decompression Surgery
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