Background: In a previous prospective, randomized, controlled,
double-blinded study on the effect of nerve root blocks on the need for
operative treatment of lumbar radicular pain, we found that injections of
corticosteroids were more effective than bupivacaine for up to thirteen to
twenty-eight months. We performed a minimum five-year followup of those
patients who had avoided surgery.
Methods: All of the patients were considered to be operative
candidates by the treating surgeon, and all had initially requested operative
intervention. They had then been randomized to be treated with a selective
nerve-root block with either bupivacaine or bupivacaine and betamethasone.
Both the treating physician and the patient were blinded to the type of
medication. Of fifty-five randomized patients, twenty-nine avoided an
operation in the original study. Twenty-one of those twenty-nine patients were
reevaluated with a follow-up questionnaire at a minimum of five years after
the initial block.
Results: Seventeen of the twenty-one patients still had not had
operative intervention. There was no difference between the group treated with
bupivacaine alone and the group treated with bupivacaine and betamethasone
with regard to the avoidance of surgery for five years. At the five-year
follow-up evaluation, all of the patients who had avoided operative treatment
had significant decreases in neurological symptoms and back pain compared with
the baseline values.
Conclusions: The majority of patients with lumbar radicular pain who
avoid an operation for at least one year after receiving a nerve root
injection with bupivacaine alone or in combination with betamethasone will
continue to avoid operative intervention for a minimum of five years.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.