Published 4 issues per year
ISSN Print: 0896-2960
ISSN Online: 2162-6553
Indexed in
Diagnostic Selective Nerve Root Blocks
ABSTRACT
The precise identification of pain generators continues to challenge the multiple disciplines treating patients with spine related disorders. The intricate relationship between skeletal and neural tissue allows for both radicular pain and more complex scleratomal pain referral. Visual anatomic studies are capable of identifying abnormal morphology, but a large body of literature supports an inflammatory etiology of pain that can occur in the absence of mechanical compromise. Magnetic resonance imaging has demonstrated a high sensitivity for anatomic disorders of the spine, but there are significant concerns regarding its clinical specificity. The role of electrophysiologic studies in the assessment of pain is also limited. Electromyography and somatosensory evoked potential assess the physiologic integrity of motor and sensory nerves, but observed abnormalities do not confirm a lesion as the source of pain. Diagnostic selective nerve root blocks (SNRB) arm the interventional physiatrist with a unique functional and anatomically specific test which can correlate patient symptoms with other morphologic and physiologic abnormalities. A review of the literature suggests a high specificity for SNRBs and a high sensitivity when other diagnostic tests prove inconclusive. Injection techniques and the pertinent lumbosacral, thoracic, and cervical anatomy are discussed. The clinician must adhere to recommended techniques to avoid both complications and pitfalls in interpretation.
-
Slipman Curtis W., Lipetz Jason S., Herzog Richard J., Vresilovic Edward J., Nonsurgical treatment for radicular of pain of zygoapophyseal joint cyst origin: Therapeutic selective nerve root block, Archives of Physical Medicine and Rehabilitation, 81, 8, 2000. Crossref
-
Slipman Curtis W., Lipetz Jason S., Jackson Howard B., Vresilovic Edward J., Deep venous thrombosis and pulmonary embolism as a complication of bed rest for low back pain, Archives of Physical Medicine and Rehabilitation, 81, 1, 2000. Crossref
-
Slipman Curtis W., Rogers Denis P., Lipetz Jason S., Herzog Richard, Versilovic Edward J., Jackson Howard B., An unusual extraspinal cause of bilateral leg pain, Archives of Physical Medicine and Rehabilitation, 80, 6, 1999. Crossref
-
Slipman Curtis W., Lipetz Jason S., Wakeshima Yusuke, Jackson Howard B., Nonsurgical treatment of zygapophyseal joint cyst–induced radicular pain, Archives of Physical Medicine and Rehabilitation, 81, 7, 2000. Crossref
-
DePalma Michael J., Slipman Curtis W., An Algorithmic Methodology, in Interventional Spine, 2008. Crossref