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Critical Reviews™ in Physical and Rehabilitation Medicine
SJR: 0.121 SNIP: 0.228 CiteScore™: 0.17

ISSN Print: 0896-2960
ISSN Online: 2162-6553

Critical Reviews™ in Physical and Rehabilitation Medicine

DOI: 10.1615/CritRevPhysRehabilMed.v10.i2.20
pages 123-146

Diagnostic Selective Nerve Root Blocks

Curtis W. Slipman
Penn Spine Center, Department of Rehabilitation Medicine, Hospital of the University of Pennsylvania, Philadelphia
Randal A. Palmitier
University of Pennsylvania Medical Center, Department of Rehabilitation Medicine, 3400 Spruce Street, Philadelphia, PA 19104

ABSTRACT

The precise identification of pain generators continues to challenge the multiple disciplines treating patients with spine related disorders. The intricate relationship between skeletal and neural tissue allows for both radicular pain and more complex scleratomal pain referral. Visual anatomic studies are capable of identifying abnormal morphology, but a large body of literature supports an inflammatory etiology of pain that can occur in the absence of mechanical compromise. Magnetic resonance imaging has demonstrated a high sensitivity for anatomic disorders of the spine, but there are significant concerns regarding its clinical specificity. The role of electrophysiologic studies in the assessment of pain is also limited. Electromyography and somatosensory evoked potential assess the physiologic integrity of motor and sensory nerves, but observed abnormalities do not confirm a lesion as the source of pain. Diagnostic selective nerve root blocks (SNRB) arm the interventional physiatrist with a unique functional and anatomically specific test which can correlate patient symptoms with other morphologic and physiologic abnormalities. A review of the literature suggests a high specificity for SNRBs and a high sensitivity when other diagnostic tests prove inconclusive. Injection techniques and the pertinent lumbosacral, thoracic, and cervical anatomy are discussed. The clinician must adhere to recommended techniques to avoid both complications and pitfalls in interpretation.


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