Application Of Selective Nerve Root Block In Estimate The "Responsible Segment" Of Lumbar Degenerative Diseases

Objective: To explore the clinical application value of selective nerve root block(SNRB)in judging the "responsible segment" of lumbar degenerative diseases.Methods: From October 2016 to October 2018,a prospective study was conducted.Patients with lumbar degenerative diseases who could not clearly judge the "responsibility segment" after initial positioning by traditional methods(imaging examination + physical examination).The scope of the "responsibility segment" was judged by SNRB.According to the range judged by SNRB,the appropriate method was selected according to the actual condition of the patients.The patients were treated with decompression surgery,and the results of "responsibility segment" and SNRB were recorded.The VAS,JOA and ODI scores were recorded before operation,three months after operation,six months after operation and the last follow-up.The excellent and good rate of operation effect and the decline of VAS score were calculated,and the data were analyzed statistically.According to the analysis results,the clinical value of SNRB in the responsible segment of lumbar degenerative diseases was evaluated.Results: A total of 40 patients,aged 54-78,with an average age of(63 +9.3)years,with a course of 20 days to 10 years,with an average of(5.4 +1.7)years,including 25 males and 15 females,were enrolled in the study.The follow-up period was from 6 months to 19 months,with an average follow-up time of(10.5 +4.7)months.After admission,the total number of "responsibility segment" was 82,with an average of 2.05 per person.According to the results of SNRB,the total number of "responsibility segment" was reduced to 52,with an average of 1.30 per person.Meaning(P < 0.05);no complications occurred in all patients with selective nerve root block;VAS score,JOA score and ODI score were significantly improved in 40 patients at 3 months,6 months and the last follow-up(P < 0.05).The VAS score of 40 patients decreased by 71.93%+12.89% compared with before.The VAS score of all patients decreased by more than 50%(50%-100%).At the last follow-up,the JOA improvement rate of 40 patients was cured(100%)in 5 cases,significant(60%-99%)in 31 cases,effective(25%-59%)in 4 cases,and the total effective rate was 100%.All patients had no residual symptoms caused by incomplete decompression.The preoperative judgment of "responsibility section" covered all the correct "responsibility section".Conclusion: For patients with lumbar degeneration who can not identify the "responsible segment" by imaging + symptoms and signs,the addition of diagnostic SNRB can help some patients to narrow the scope of the "responsible segment".SNRB as a way of judging the "responsible segment" has certain clinical application value.