The effect of nerve-root injections on the need for operative treatment oflumbar radicular pain - A prospective, randomized, controlled, double-blind study

Background: The purpose of the present study was to determine the effective ness of selective nerve-root injections in obviating the need for an operat ion in patients with lumbar radicular pain who were otherwise considered to be operative candidates. Although selective nerve-root injections are used widely,ve 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 becau se of lumbar radicular pain and who had radiographic confirmation of nerve- root compression were prospectively randomized into the study. All of the p atients had to have requested operative intervention and had to be consider ed operative candidates by the treating surgeon. They then were randomized and referred to a radiologist who performed a selective nerve-root injectio n with either bupivacaine alone or bupivacaine with betamethasone. The trea ting physicians and the patients were blinded to the medication. The patien ts were allowed to choose to receive as many as four injections. The treatm ent was considered to have failed if the patient proceeded to have the oper ation, which he or she could opt to do at any paint 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 group s was highly significant (p < 0.004). Conclusions Our data demonstrate that selective nerve-root injections of co rticosteroids are significantly more effective than those of bupivacaine al one 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.