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The Incidence of Double Nerve Root Contribution to Lumbar Radiculopathy in Patients Treated by Image Guidance 2007

Interventional Spine

Melissa Kang, MD
Walter S Bartynski, MD, ASSR Member
William E Rothfus, MD, ASSR Member

Scientific Paper

Purpose

To assess the frequency of dual nerve root contribution to radiating leg pain identified during image guided treatment.

Methods & Materials

Eighty five patients in whom selective lumbar nerve root block and steroid administration were performed under CT or fluoroscopic guidance were retrospectively reviewed.
In 33 patients (39%), the presenting pattern of radiculopathy was nonspecific and/or suggested that 2 roots may be contributing to the patient's pain. Accompanying imaging suggested more than one possible site of root compression or irritation and 2 adjacent nerve root blocks were performed in these patients.
The clinical and imaging features of these 33 patients were retrospectively reviewed along with the immediate outcome of nerve root block.

Results

In 24 of 33 patients (73%) both treated roots significantly contributed to the patient's leg pain. Imaging in these patients typically demonstrated disc protrusion with both paracentral/foraminal components or post-operative changes at one level with concomitant degenerative changes at the second root site. This represented 24 of 85 (28%) of the overall population.
In 9 of 33 (27%), only 1 of 2 roots contributed to the patient's radiculopathy, often in spite of imaging features of root compression, post-operative change or disc protrusion.

Conclusion

Multiple nerve root contribution to a patient's lumbar radiculopathy is not uncommon in an image guided pain management practice. If clinical symptoms suggest radiculopathy but the exact root distribution is unclear, and in particular if accompanying imaging suggests multi-level root abnormality, treatment of both suspect roots should be strongly considered.