Journal of neurosurgery. Spine · 2026
Diagnostic selective nerve root block in degenerative lumbar spine radiculopathy: a systematic review and meta-analysis.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Kocemba David, Ørskov Søren, Carlsen Jakob Gram, Schulz Mette Katrine, Uhrbrand Bent, Dinesen Hanne, Mikkelsen Ronni, Thygesen Mathias Møller, Rasmussen Mikkel Mylius
Аннотация
OBJECTIVE: The aim of this study was to estimate the diagnostic accuracy of selective nerve root blocks (SNRBs) in patients with lumbar radiculopathy undergoing surgery.
METHODS: The authors searched major medical databases (PubMed, Embase, CINAHL [Cumulative Index to Nursing and Allied Health Literature], Cochrane Library, Web of Science, Google Scholar, and Scopus) and trial registries (ClinicalTrials.gov, ICTRP [International Clinical Trials Registry Program], CENTRAL [Cochrane Central Register of Controlled Trials]). They included studies that 1) investigated foraminal or transforaminal SNRB in adults with degenerative lumbar conditions and radiculopathy; 2) utilized local anesthetics, steroids, or both; 3) performed SNRB under fluoroscopic or CT guidance; and 4) reported SNRB response and postoperative outcomes. Two independent reviewers screened the studies, assessed the risk of bias using QUADAS (Quality Assessment of Diagnostic Accuracy Studies)-2, and evaluated the certainty of evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation). Diagnostic accuracy was evaluated using a random-effects model to calculate summary estimates for sensitivity and specificity.
RESULTS: The authors identified 11,723 studies, of which 134 were selected for full-text review. Of these, 25 met the inclusion criteria for the systematic review and 7 for the meta-analysis. Summary estimates for sensitivity of 0.88 (95% CI 0.80-0.92) and specificity of 0.57 (95% CI 0.27-0.83), I2 = 24.7%, were obtained. The certainty of evidence was rated moderate for sensitivity and very low for specificity.
CONCLUSIONS: This is the first meta-analysis to evaluate the sensitivity, specificity, and certainty of evidence for SNRB. The diagnostic utility depends highly on the pretest probability of a favorable surgical outcome. Clinicians should interpret SNRB findings within the context of clinical and imaging findings.
METHODS: The authors searched major medical databases (PubMed, Embase, CINAHL [Cumulative Index to Nursing and Allied Health Literature], Cochrane Library, Web of Science, Google Scholar, and Scopus) and trial registries (ClinicalTrials.gov, ICTRP [International Clinical Trials Registry Program], CENTRAL [Cochrane Central Register of Controlled Trials]). They included studies that 1) investigated foraminal or transforaminal SNRB in adults with degenerative lumbar conditions and radiculopathy; 2) utilized local anesthetics, steroids, or both; 3) performed SNRB under fluoroscopic or CT guidance; and 4) reported SNRB response and postoperative outcomes. Two independent reviewers screened the studies, assessed the risk of bias using QUADAS (Quality Assessment of Diagnostic Accuracy Studies)-2, and evaluated the certainty of evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation). Diagnostic accuracy was evaluated using a random-effects model to calculate summary estimates for sensitivity and specificity.
RESULTS: The authors identified 11,723 studies, of which 134 were selected for full-text review. Of these, 25 met the inclusion criteria for the systematic review and 7 for the meta-analysis. Summary estimates for sensitivity of 0.88 (95% CI 0.80-0.92) and specificity of 0.57 (95% CI 0.27-0.83), I2 = 24.7%, were obtained. The certainty of evidence was rated moderate for sensitivity and very low for specificity.
CONCLUSIONS: This is the first meta-analysis to evaluate the sensitivity, specificity, and certainty of evidence for SNRB. The diagnostic utility depends highly on the pretest probability of a favorable surgical outcome. Clinicians should interpret SNRB findings within the context of clinical and imaging findings.