Prognostic factors of selective nerve root block under fluoroscopic guidance for the treatment of young patients with lumbar disc herniation and its role in preventing surgery.

BACKGROUND

As a transitional treatment between conservative treatment and surgical treatment for lumbar disc herniation (LDH), selec tive nerve root block (SNRB) has attracted increasing attention recently. The objective of this study was to evaluate the efficacy and prognostic factors of SNRB in young patients with LDH.

METHODS

A prospective observational cohort study was employed. A total of 134 patients with LDH who received SNRB treatment in our hospital from January 2023 to August 2023 were selected and divided into a recurrence group and a nonrecurrence group according to whether they experienced recurrence after SNRB. The demographic characteristics, clinical and imaging data and SNRB-related information were compared between the two groups. Multivariate logistic regression was used to analyze the factors influencing symptom recurrence after SNRB surgery.

RESULTS

Surgery was avoided in 95.522%, 86.567%, 78.358% and 64.925% of the patients at 2 weeks, 3 months, 6 months and 12 months after SNRB treatment, respectively. Multivariate logistic regression analysis revealed that a disease course of ≥ 3 months (OR = 6.031, 95% CI: 2.592-14.035, P = 0.001) was an independent risk factor for postoperative recurrence of SNRB, and extreme lateral protrusion (OR = 0.273, 95% CI: 0.078-0.956, P = 0.042) and the HIZ sign (OR = 0.200, 95% CI: 0.057-0.702, P = 0.012) were protective factors against postoperative recurrence of SNRB.

CONCLUSIONS

The curative effect of SNRB in the treatment of young patients with LDH is significant. A disease course of ≤ 3 months, far-lateral protrusion and the HIZ sign are predictors of good outcomes. In addition, SNRB combined with medication and physical therapy is recommended as an alternative to surgery for patients who do not have acute surgical indications.