COMPRESSION OF L5 AND S1 ROOTS WITH ATYPICAL SYMPTOMS- THE DIAGNOSTIC VALUE OF NERVE ROOT INJECTIONS.

Abstract

Decision to operate for lumbar nerve root compression is usually based on the clinical findings and MRI scan evidence of nerve root compression. Decision-making is difficult in the small subset of patients with atypical pain, pain in the groin, buttock or thigh with L5 and S1 nerve root compression, as evident on the MRI scan. We retrospectively studied 125- diagnostic nerve root injections; of which there were 12 patients who had pain in the groin, thigh or buttock and their MRI scans were reported as nerve root (11 L5 & 1 S1) compression by the radiologist independently. All these 12 patients were subjected to injection of the affected nerve root with bupivacaine and methylprednisolone under the guidance of image intensifier. Of these 5 (42%) of them had temporary relief of the symptoms; and all of them underwent surgical decompression of the affected nerve root. They were followed for an average of 12 months with satisfactory results. This demonstrates the importance of nerve root injections as a diagnostic tool in patients with atypical symptoms with nerve root compression as seen on the MRI scan.