The Journal of Bone and Joint Surgery 82:1589 (2000)
© 2000 The Journal of Bone and Joint Surgery, Inc.
The Effect of Nerve-Root Injections on the Need for Operative Treatment of Lumbar Radicular Pain
A Prospective, Randomized, Controlled, Double-Blind Study*
K. Daniel Riew, M.D. ,
Yuming Yin, M.D.,
Louis Gilula, M.D.,
Keith H. Bridwell, M.D.,
Lawrence G. Lenke, M.D.,
Carl Lauryssen, M.D. and
Kari Goette, B.S.N.
Investigation performed at the Department of Orthopaedic
Surgery, Washington University School of Medicine, St. Louis, Missouri
*No benefits in any form have been received or will be received
from a commercial party related directly or indirectly to the subject
of this article. Funds were received in total or partial support
of the research or clinical study presented in this article. The
funding sources were the Barnes-Jewish Christian Health System's
Innovations in Health Care Grant and Washington University School
of Medicine.
Department of Orthopaedic Surgery (K. D. R., K. H. B., L. G.
L., and K. G.), Mallinckrodt Institute of Radiology (Y. Y. and L.
G.), and Division of Neurosurgery (C. L.), Washington University School
of Medicine, One Barnes-Jewish Hospital Plaza, St. Louis, Missouri
63110. E-mail address for K. D. Riew: riewd{at}msnotes.wustl.edu
Background: The purpose of the present study
was to determine the effectiveness of selective nerve-root injections in
obviating the need for an operation in patients with lumbar radicular
pain who were otherwise considered to be operative candidates. Although selective
nerve-root injections are used widely, we are not aware of any prospective,
randomized, controlled, double-blind studies demonstrating their
efficacy.
Methods: Fifty-five patients who were referred
to four spine surgeons because of lumbar radicular pain and who
had radiographic confirmation of nerve-root compression were prospectively
randomized into the study. All of the patients had to have requested operative
intervention and had to be considered operative candidates by the
treating surgeon. They then were randomized and referred to a radiologist who
performed a selective nerve-root injection with either bupivacaine
alone or bupivacaine with betamethasone. The treating physicians
and the patients were blinded to the medication. The patients were
allowed to choose to receive as many as four injections. The treatment
was considered to have failed if the patient proceeded to have the
operation, which he or she could opt to do at any point in the study.
Results: Twenty-nine of the fifty-five patients,
all of whom had initially requested operative treatment, decided
not to have the operation during the follow-up period (range, thirteen
to twenty-eight months) after the nerve-root injections. Of the
twenty-seven patients who had received bupivacaine alone, nine elected
not to have the operation. Of the twenty-eight patients who had
received bupivacaine and betamethasone, twenty decided not to have
the operation. The difference in the operative rates between the
two groups was highly significant (p < 0.004).
Conclusions: Our data demonstrate that selective
nerve-root injections of corticosteroids are significantly more effective
than those of bupivacaine alone in obviating the need for a decompression
for up to thirteen to twenty-eight months following the injections
in operative candidates. This finding suggests that patients who
have lumbar radicular pain at one or two levels should be considered
for treatment with selective nerve-root injections of corticosteroids
prior to being considered for operative intervention.
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