Datta Sukdeb, Everett Clifford R, Trescot Andrea M, Schultz David M, Adlaka Rajiv, Abdi Salahadin, Atluri Sairam L, Smith Howard S, Shah Rinoo V
Vanderbilt University School of Medicine, Nashville, TN, USA.
Pain Physician. 2007 Jan;10(1):113-28.
BACKGROUND: Selective nerve root blocks or transforaminal epidural injections are used for diagnosis and treatment of different spinal disorders. A clear consensus on the use of selective nerve root injections as a diagnostic tool does not currently exist. Additionally, the effectiveness of this procedure as a diagnostic tool is not clear. A systematic review of diagnostic utility of selective nerve root blocks was performed and published in January 2005, which concluded that selective nerve root injections may be helpful as a diagnostic tool in evaluating spinal pain with radicular features, but its role needs to be further clarified. OBJECTIVE: To evaluate and update the accuracy of selective nerve root injections in diagnosing spinal disorders. STUDY DESIGN: A systematic review of selective nerve root blocks for the diagnosis of spinal pain. METHODS: A systematic review of the literature for clinical studies was performed to assess the accuracy of selective nerve root injections in diagnosing spinal pain. Methodologic quality evaluation was performed utilizing Agency for Healthcare Research and Quality (AHRQ) and Quality Assessment Studies of Diagnostic Accuracy (QUADAS) criteria. Studies were graded and evidence classified into 5 levels: conclusive, strong, moderate, limited, or indeterminate. An extensive literature search was performed utilizing resources from the library at Vanderbilt University Medical Center, PubMed, EMBASE, BioMed, and Cochrane Reviews. Manual searches of bibliographies of known primary and review articles, and abstracts from scientific meetings within the last 2 years were also reviewed. RESULTS: There is limited evidence on the effectiveness of selective nerve root injections as a diagnostic tool for spinal pain. There is insufficient research for stronger support, but the available literature is supportive of selective nerve root injections as a diagnostic test for equivocal radicular pain. There is moderate evidence for use in the preoperative evaluation of patients with negative or inconclusive imaging studies. The positive predictive value of diagnostic selective nerve root blocks is low, but they have a useful negative predictive value. CONCLUSION: Selective nerve root injections may be helpful as a diagnostic tool in evaluating spinal pain with radicular features. However, their role needs to be further clarified by additional research and consensus.
背景：选择性神经根阻滞或经椎间孔硬膜外注射用于诊断和治疗不同的脊柱疾病。目前对于将选择性神经根注射作为一种诊断工具的使用尚未达成明确共识。此外，该操作作为诊断工具的有效性尚不清楚。2005年1月进行并发表了一项关于选择性神经根阻滞诊断效用的系统评价，其结论是选择性神经根注射在评估具有神经根特征的脊柱疼痛时可能作为一种诊断工具是有帮助的，但其作用需要进一步阐明。 目的：评估并更新选择性神经根注射在诊断脊柱疾病中的准确性。 研究设计：对用于诊断脊柱疼痛的选择性神经根阻滞进行系统评价。 方法：对临床研究文献进行系统评价，以评估选择性神经根注射在诊断脊柱疼痛中的准确性。利用医疗保健研究与质量机构（AHRQ）和诊断准确性质量评估研究（QUADAS）标准进行方法学质量评估。对研究进行分级，证据分为5个级别：确凿、有力、中等、有限或不确定。利用范德比尔特大学医学中心图书馆资源、PubMed、EMBASE、BioMed和Cochrane系统评价进行广泛的文献检索。还查阅了已知的原始文献和综述文章的参考文献以及过去2年科学会议的摘要。 结果：关于选择性神经根注射作为脊柱疼痛诊断工具的有效性证据有限。缺乏足够的研究以获得更强有力的支持，但现有文献支持选择性神经根注射作为对可疑神经根性疼痛的诊断试验。在对影像学检查阴性或不确定的患者进行术前评估方面有中等证据支持。诊断性选择性神经根阻滞的阳性预测值较低，但具有有用的阴性预测值。 结论：选择性神经根注射在评估具有神经根特征的脊柱疼痛时可能作为一种诊断工具是有帮助的。然而，其作用需要通过更多的研究和共识进一步阐明。
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