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Therapeutic Selective Nerve Root Block in the Nonsurgical Treatment of Traumatically Induced Cervical Spondylotic Radicular Pain

Slipman, Curtis W., MD; Lipetz, Jason S., MD; DePalma, Michael J., MD; Jackson, Howard B., MD

American Journal of Physical Medicine & Rehabilitation: June 2004 - Volume 83 - Issue 6 - p 446-454
Research Articles: Pain
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Slipman CW, Lipetz JS, DePalma MJ, Jackson HB: Therapeutic selective nerve root block in the nonsurgical treatment of traumatically induced cervical spondylotic radicular pain. Am J Phys Med Rehabil 2004;83:446–454.

Objective: To investigate the outcomes resulting from the use of fluoroscopically guided therapeutic selective nerve root block in the nonsurgical treatment of traumatically induced cervical spondylotic radicular pain.

Design: Restrospective study with independent clinical review. A total of 15 patients who met specific physical examination or electrodiagnostic criteria and failed to improve clinically after at least 4 wks of physical therapy were included. Each patient demonstrated a positive response to a fluoroscopically guided cervical selective nerve root block. Therapeutic selective nerve root blocks were administered in conjunction with physical therapy. Outcome measures included visual analog scale pain scores, employment status, medication usage, and patient satisfaction.

Results: Patients' symptom duration before diagnostic injection averaged 13.0 mos. An average of 3.7 therapeutic injections were administered. Follow-up data collection transpired at an average of 20.7 mos after discharge from treatment. An overall good or excellent outcome was observed in three patients (20.0%). Among those treated without surgery, a significant reduction (P = 0.0313) in pain score was observed at the time of follow-up. Six patients (40.0%) proceeded to surgery.

Conclusions: These initial and preliminary findings do not support the use of therapeutic selective nerve root block in the treatment of this challenging patient population with traumatically induced spondylotic radicular pain.

From the Penn Spine Center, Department of Rehabilitation Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania (CWS, MJD); the Division of Musculoskeletal Rehabilitation, Physical Medicine and Rehabilitation Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania (CWS); the Center for Spine Rehabilitation, Department of Rehabilitation Medicine, North Shore-Long Island Jewish Health System, New Hyde Park, New York (JSL); and the Florida Institute, Tampa, Florida (HBJ).

Correspondence:

All correspondence and requests for reprints should be addressed to Curtis W. Slipman, MD, The Penn Spine Center, Ground Floor White Building, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104.

© 2004 Lippincott Williams & Wilkins, Inc.