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

Abstract

Introduction: Sciatica is the classical indication for decompression of the lumbar nerve roots. However there is a small group of patients who have atypical proximal pain i.e. pain in the groin, buttock and thigh pain without radiation below the knee, and have nerve root compression on the MRI scans. We investigated these patients with nerve root injection (NRI).

Methodology: We retrospectively studied 125-diagnostic NRIs, of these there were 12 patients (7 female & 5 male) with pain in the groin(5), thigh (4), buttock(6) & lower back(9) but no radiating pain below the knee. The MRI scans were reported independently as nerve root compression (11 L5 & 1 S1) by the radiologist. All these 12 patients were offered nerve root injection. The nerve root injection was carried out as described by Herron, under the guidance of image intensifier with bupivacaine and methylprednisolone.

Results: Of these 5 (42%) of them had temporary relief of the symptoms with nerve root injection; all of them underwent flavectomy & facetectomy of the affected nerve root. They were followed for an average duration of 39 months. Three patients were delighted with the result, 1 patient had a pain free period for 3 years then the symptoms recurred and the last patient did not benefit with the surgery.

Conclusion: We conclude that nerve root injection can be an important diagnostic tool in making a surgical decision regarding patients with such atypical symptoms.