The following article was presented at the American Pain Society in New Orleans in October 1997.

EFFICACY OF SELECTIVE NERVE ROOT BLOCK AND LYSIS OF EPIDURAL ADHESIONS IN TREATMENT OF CHRONIC RADICULOPATHY: PROSPECTIVE RANDOMIZED STUDY 

Y. Eugene Mironer, Carolinas Center for Advanced Management of Pain
Judson Somerville, Laredo Clinic for Pain Management 

Introduction: Chronic Radiculopathy is a common problem that often responds poorly to conservative treatment, as well as to conventional epidural steroid injections. Some of the newer modalities of managing radiculopathy are Selective Nerve Root Block (SNRB) and Lysis of Epidural Adhesions (LEA), that involve more specific intervention on affected level. We conducted a prospective study to assess and compare the efficacy of these methods of treatment. Twenty patients with chronic radiculopathy due to herniated disc or postlaminectomy changes; documented with clinical examination, results of radiological studies or current perception threshold test, were randomly assessed to two equal groups. One group received SNRB with local anesthetic and steroids, the other underwent LEA (Local Anesthetic, Steroid, Hyptertonic Saline and Hyaluronidase). Results were assessed by pain scores using standard VAS (0-10) before the procedures and two months after treatment (mean 59 days) as well as by necessity for any additional invasive procedures, including surgery.

Results: The mean pain score of both groups was significantly reduced from 8.5 to 4.0 after LEA and from 8.6 to 4.8 after SNRB. These changes were not statistically different between the two groups; 6 out of 10 patients in LEA group and 4 out of 10 in the SNRB group improved more than 50%. Three patients in each category had no changes in their status and required additional invasive treatment. Patients after Laminectomy represented 80% of failed cases but only 28% of successes.

Conclusion: We conclude that both LEA and SNRB are equally effective methods for treating chronic radiculopathy with significantly better outcome for patients without previous back surgery.