Lumbar selective nerve root block (SNRB) is a common interventional procedure used for diagnosis and treatment of radiculopathy in degenerative spine conditions. This scoping review systematically maps the types, frequencies, and severities of complications associated with lumbar SNRB, highlighting the need for comprehensive understanding given the procedure's widespread use.
Background
Radiculopathy, a prevalent degenerative spine condition, is expected to increase with aging populations. Conservative management is the initial approach, with SNRB serving as both a therapeutic and diagnostic tool during the subacute phase. SNRB involves image-guided injection of anesthetics and/or corticosteroids near affected nerve roots to reduce inflammation and pain. Despite frequent use, a comprehensive synthesis of complications related to lumbar SNRB has not been previously undertaken.
Data Highlights
The review included peer-reviewed studies reporting complications of lumbar SNRB in adults with degenerative spinal conditions. Complications were categorized using the CTCAE classification into nine groups and graded by severity. Crude and adjusted complication rates were calculated based on both the number of procedures and patients. Data extraction covered study design, sample size, injectate type and volume, imaging modality, and reported complications.
Key Findings
Complications of lumbar SNRB were categorized into nervous system disorders, procedural injuries, musculoskeletal disorders, infections, psychiatric, vascular, endocrine, renal, and other organ system disorders.
Complications were further classified by severity into mild/moderate (CTCAE grades 1-2) and severe (grades 3-5).
Crude and adjusted complication rates were calculated using both procedure-based and patient-based denominators to account for reporting variability.
Imaging guidance and injectate type/volume varied across studies, potentially influencing complication profiles.
Previous literature reviews focused on limited complication types; this review provides a comprehensive mapping of complication types, frequencies, and severities.
Clinical Implications
Clinicians should be aware of the broad spectrum of potential complications associated with lumbar SNRB, including rare but severe adverse events. Careful patient selection, precise imaging guidance, and judicious use of injectates may mitigate risks. Comprehensive complication monitoring and reporting are essential to inform clinical decision-making and improve patient safety.
Conclusion
This scoping review provides a systematic overview of complications related to lumbar SNRB, emphasizing the need for standardized reporting and further research to optimize procedural safety. Understanding the full complication spectrum supports informed clinical use of lumbar SNRB in degenerative spine conditions.
References
Joanna Briggs Institute/PRISMA-ScR/2024 -- Methodology and Reporting Standards for Scoping Reviews
Open Science Framework/2024 -- Registered Protocol for Lumbar SNRB Complication Review
CTCAE/Version 5.0/2017 -- Common Terminology Criteria for Adverse Events
