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 Diagnostic Utility of Selective Nerve Root Blocks in the Diagnosis of Lumbosacral Radicular Pain: Systematic Review and Update of Current Evidence

2013 ◽  
Vol 2s;16 (2s;4) ◽  
pp. SE97-SE124
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Lower Extremity ◽  
Diagnostic Tool ◽  
Nerve Root ◽  
Radicular Pain ◽  
Low Back ◽  
Limited Evidence ◽  
Lower Extremity Pain ◽  
Nerve Root Blocks

Background: Lumbosacral selective nerve root blocks and/ or transforaminal epidural injections are used for diagnosis and treatment of different disorders causing low back and lower extremity pain. A clear consensus on the use of selective nerve root injections as a diagnostic tool does not currently exist. Additionally, the validity of this procedure as a diagnostic tool is not clear. Objective: To evaluate and update the accuracy of selective nerve root injections in diagnosing lumbar spinal disorders. Study Design: A systematic review of selective nerve root blocks for the diagnosis of low back and lower extremity pain. Methods: Methodological quality assessment of included studies was performed using the Quality Appraisal of Reliability Studies (QAREL) checklist. Only diagnostic accuracy studies meeting at least 50% of the designated inclusion criteria were utilized for analysis. Studies scoring less than 50% are presented descriptively and analyzed critically. The level of evidence was classified as good, fair, or limited or poor based on the quality of evidence grading scale developed by the United States Preventive Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to September 2012, and manual searches of the bibliographies of known primary and review articles. Outcome Measures: In this review, we evaluated studies in which controlled local anesthetic blocks were performed using at least 50% pain relief as the reference standard. Results: There is limited evidence for the accuracy of selective nerve root injections as a diagnostic tool for lumbosacral disorders. There is limited evidence for their use in the preoperative evaluation of patients with negative or inconclusive imaging studies. Limitations: The limitations of this systematic review include a paucity of literature, variations in technique, and variable criterion standards for the diagnosis of lumbar radicular pain. Conclusions: There is limited evidence for selective nerve root injections as a diagnostic tool in evaluating low back pain with radicular features. However, their role needs to be further clarified by additional research and consensus. Key words: Low back pain, lower extremity pain, selective nerve root block, transforaminal epidural injection, discogenic pain, radiculitis, sciatica radiculopathy, nerve root pain

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.

Tissue plasminogen activator as a novel diagnostic aid in acute pulmonary embolism

VASA ◽  
2014 ◽  
Vol 43 (6) ◽  
pp. 450-458 ◽  
Author(s):  
Julio Flores ◽  
Ángel García-Avello ◽  
Esther Alonso ◽  
Antonio Ruíz ◽  
Olga Navarrete ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Negative Predictive Value ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Predictive Value ◽  
Acute Pulmonary Embolism ◽  
Enzyme Linked Immunosorbent Assay ◽  
Diagnostic Utility ◽  
Tissue Plasminogen ◽  
D Dimer

Background: We evaluated the diagnostic efficacy of tissue plasminogen activator (tPA), using an enzyme-linked immunosorbent assay (ELISA) and compared it with an ELISA D-dimer (VIDAS D-dimer) in acute pulmonary embolism (PE). Patients and methods: We studied 127 consecutive outpatients with clinically suspected PE. The diagnosis of PE was based on a clinical probability pretest for PE and a strict protocol of imaging studies. A plasma sample to measure the levels of tPA and D-dimer was obtained at enrollment. Diagnostic accuracy for tPA and D-dimer was determined by the area under the receiver operating characteristic (ROC) curve. Sensitivity, specificity, predictive values, and the diagnostic utility of tPA with a cutoff of 8.5 ng/mL and D-dimer with a cutoff of 500 ng/mL, were calculated for PE diagnosis. Results: PE was confirmed in 41 patients (32 %). Areas under ROC curves were 0.86 for D-dimer and 0.71 for tPA. The sensitivity/negative predictive value for D-dimer using a cutoff of 500 ng/mL, and tPA using a cutoff of 8.5 ng/mL, were 95 % (95 % CI, 88–100 %)/95 % (95 % CI, 88–100 %) and 95 % (95 % CI, 88–100 %)/94 %), respectively. The diagnostic utility to exclude PE was 28.3 % (95 % CI, 21–37 %) for D-dimer and 24.4 % (95 % CI, 17–33 %) for tPA. Conclusions: The tPA with a cutoff of 8.5 ng/mL has a high sensitivity and negative predictive value for exclusion of PE, similar to those observed for the VIDAS D-dimer with a cutoff of 500 ng/mL, although the diagnostic utility was slightly higher for the D-dimer.

Diagnostic Selective Nerve Root Blocks

1998 ◽  
Vol 10 (2) ◽  
pp. 123-146 ◽  
Author(s):  
Curtis W. Slipman ◽  
Randal A. Palmitier
Keyword(s):  
Nerve Root ◽  
Nerve Root Blocks
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