Diagnostic selective nerve root block in degenerative lumbar spine radiculopathy: a systematic review and meta-analysis.

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.