Radiculopathy

A study 1 compared different treatment efficacies in two groups of patients with degenerative spinal disease-related buttock pain and found that the group receiving a selective nerve root block had clinically-significant improvement outcomes at post-procedure through 6-weeks, compared to the group that were treated with a facet joint block. This suggests that the cause of spinal-related buttocks pain is most likely radiculopathy, rather than facet joint degeneration.

What’s at Stake?

Many patients with spinal stenosis complain of back pain, buttock pain, or pain radiating from the buttock to the lower legs. As it is assumed that nerve root inflammation can contribute to lumbar and lower leg pain radiating from the spine, a common and frequently effective treatment may involve steroid or procaine injections. Selective nerve root block is used effectively in the treatment of degenerative scoliosis and has been demonstrated to be a successful form of short-and-long-term treatment for the pain. Similarly, a facet joint block has been used as an effective treatment for buttock pain, post-procedural lumbar pain, and morning stiffness associated with spinal degeneration.

Though various treatments have proven effective in alleviating or reducing pain in a percentage of the spinal patients receiving injections and blocks, the exact etiology of spinal-related buttock pain and radiating pain remains unclear. Because of this, uniform diagnostic and treatment guidelines for buttock pain—especially without concurrent radiating lower leg involvement—have been difficult to establish. This study links positive treatment outcomes with a more definitive diagnostic cause of buttock pain and seeks to contribute to the diagnostic and treatment criteria of buttock pain discussion.

The Study

Researchers treated 146 male and female patients presenting with spinal-related buttock pain without lower leg radiation by one of two methods—a) selective nerve root block (76 patients), or b) facet joint block (70 patients). The mean age of patients in both groups was 65 years. Both groups shared similar demographics when it came to age, sex, and health. Each of the patients was evaluated prior to their procedure and on day one, week 2, week 6, and at 12 weeks post-procedure. Their evaluation results were compared by their group injection method, and the results were then analyzed.

Results

On the DAY 1 post-procedure analysis, 7 percent of the patients in the nerve block group (GROUP A) were shown to have experienced an “excellent” response, and 6 percent of those in the facet joint block group (GROUP B) had an “excellent” response. In GROUP A, 46 percent of the patients treated showed a “good” response to the treatment, while only 13 percent of the patients in GROUP B had a “good” response.

At the two-week post-procedure follow up, 11 percent of the GROUP A patients demonstrated an “excellent” response, with only 4 percent of the patients from GROUP B had an “excellent” response. Similarly, 41 percent of the GROUP A patients were classified as having experienced a “good” response, compared with only 20 percent of those in GROUP B.

At the six-week post-procedural follow up, 11 percent of the GROUP A patients were classified in the “excellent” response group, while only 7 percent from GROUP B had this distinction. Forty-one percent of the patients from GROUP A demonstrated a “good” response, and only 20 percent of the GROUP B patients had a “good” response.

At 12-weeks, 47 percent of the GROUP A patients were classified in the “good” response category, and 46 percent of those in GROUP B experienced a “good” response to the treatment.

Conclusion

Researchers in this study sought to identify the cause of buttock pain associated with spinal stenosis. Specifically, they used a retrograde methodology to discover if the buttock pain was radiating pain or caused by facet joint degeneration. They treated two groups of patients using either selective nerve root block or facet joint block, and the data collected and analyzed indicates that the selected nerve root block was more effective through post-treatment follow ups through 6 weeks. The implication of this data suggests that spinal-related buttock pain is most likely caused by radiculopathy, rather than facet joint degeneration.

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