Defining the Threshold Response of Lumbar Selective Nerve Root Block in Predicting Good Outcome Following Lumbar Foraminotomy
试验速览
- 阶段
- 4 期
- 状态
- 终止
- 入组人数
- 11
- 试验地点
- 1
- 主要终点
- Visual Analog Scale (VAS) Leg Pain Score
研究概览
简要总结
SNRB, as measured by the change in pain and objective functional ability, can solicit crucial information regarding a patient's clinical picture and can predict a patient's outcome post-surgery. By using the walk test as an objective functional assessment, the aim is to better standardize the threshold for a positive response to SNRB.
In summary, SNRB, despite utilized frequently in the diagnostic work-up with patients with lumbar radiculopathy, vary widely in their sensitivity and specificity. The reasons, as outlined above, are multifactorial. The proposed study aims to minimize the known limitations of these injections and prospectively define their positive and negative predictive value in a homogenous group of patients undergoing surgery for lumbar foraminal stenosis and radiculopathy. The design will define a threshold of response utilizing both subjective and objective measures and more accurately predict excellent results following surgery.
详细描述
The proposed study will identify the threshold response level that quantifies the predictive value of diagnostic SNRBs in patients who present with lumbar foraminal stenosis and radiculopathy. Specifically, the proposed study will address the question of whether there is a degree or length of response to SNRB, which predicts an excellent surgical outcome. The hypothesis is that diagnostic SNRBs, when performed correctly, are useful in localizing the level of involvement in LSS and improve the accuracy and efficacy of surgical intervention. Use of diagnostic SNRBs will thus be used to clarify the clinical picture, giving the surgeon the information to make the right decision to operate or not, and, in the case of operation, predicting the optimal level(s) for surgical intervention. In addition, the investigators plan to identify and fully characterize a standard threshold level and time of nerve block response that will optimize the accuracy, specificity, and sensitivity of SNRB in predicting surgical outcomes.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Diagnostic
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 80 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Ages 18-80
- •Diagnosis of unilateral lower extremity radiculopathy due to degenerative foraminal stenosis
- •Patients scheduled for an associated lumbar foraminotomy procedure
- •Diagnosis of radiculopathy with imaging and/or clinical history or physical exam that does not demonstrate a clear neurogenic source of their pain
- •Subjects must be available for the entire study duration (12 months)
排除标准
- •Patients will be excluded if there is a clear correlation between imaging and radiculopathy
- •Radiculopathy associated with trauma, tumor or infection. Non-radicular lower extremity pain will also be excluded
- •Patients who cannot tolerate the SNRB without IV sedation
- •Surgery requiring multi-level decompression and/or fusion
- •Surgical indication for malignancy, injection or acute or emergency trauma
- •History of major surgery within 3 months prior to enrollment
- •Pregnant females
- •Presence of severe acute, chronic medical or psychiatric condition
研究组 & 干预措施
Selective Nerve Root Block
Patient will receive a Selective Nerve Root Block injection at the target level prior to surgical intervention.
干预措施: Selective Nerve Root Block (Drug)
结局指标
主要结局
Visual Analog Scale (VAS) Leg Pain Score
时间窗: 12-months
Aim: 0-2 point improvement The Visual Analogue Scale (VAS) consists of a straight line with the endpoints defining extreme limits such as 'no pain at all' (0) and 'pain as bad as it could be' (10). The patient is asked to mark their pain level on the line between the two endpoints. The distance and change between '0' and the mark then defines the subject's pain. This will be measured at each subject visit.
次要结局
- Oswestry Disability Index Questionnaire (ODI)(12-Months)
- Pain Disability Questionnaire (PDQ)(12-months)
- EQ-5D Questionnaire(12-Months)
研究者
Michael Steinmetz, MD
Principal Investigator
The Cleveland Clinic