1. 2022;25;E1027-E1038Clinical Outcomes of Percutaneous Endoscopic Lumbar Discectomy Assisted With Sequential SNRB in Treating Lumbosacral Contiguous Double-Level Disc Herniation
   Retrospective Study
   Changgui Shi, MD, PhD, Xin Gu, MD, PhD, Yanyan Zhou, Rn, Bin Sun, MD, Junqiang Qi, MD, Yanhai Xi, MD, PhD, Hailong He, MD, PhD, and Guohua Xu, MD, PhD.

BACKGROUND: For patients with lumbosacral contiguous double-level disc herniation, there has been no consensus on which level(s) should be treated. Selective nerve root block (SNRB) can identify the pain-generating nerve root; however, its diagnostic accuracy remains controversial due to potential spread of the injectate. Sequential SNRB from S1 to L5 may improve the diagnostic specificity.

OBJECTIVES: To examine the clinical and radiographic outcomes of percutaneous endoscopic lumbar discectomy (PELD) assisted with sequential SNRB from S1 to L5 in patients who had lumbosacral contiguous double-level disc herniation.

STUDY DESIGN: A retrospective design was used.

SETTING: This study was conducted in a university-affiliated tertiary hospital in Shanghai, China.

METHODS: Fifty-eight consecutive patients with lumbosacral contiguous double-level disc herniation were included (January 2018 to January 2021). Sequential SNRB from S1 to L5 was performed to identify the symptomatic level(s), followed by PELD based on the results of sequential SNRB. Clinical outcomes were assessed by the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and modified Macnab criteria. Pre- and post-operation radiologic and clinical parameters were evaluated. Demographics were retrieved from medical records.

RESULTS: Patients were followed-up with an average duration of 18.6 months. Among the 58 patients, 21 received surgical treatment at L4/L5 level, 25 at L5/S1 level, and 12 at both levels based on the results of sequential SNRB from S1 to L5. Compared with preoperative values, mean VAS scores for leg and back pain, as well as the ODI score, improved significantly after the surgery. There were no significant differences in the clinical outcomes between patients receiving surgical treatment at L4/L5, L5/S1, or both levels. According to the Macnab criteria, 49 patients (84.5%) had excellent or good results.

LIMITATIONS: This study used a retrospective design with relatively small sample size and medium follow-up duration.

CONCLUSIONS: Sequential SNRB from S1 to L5 was an effective approach to guide PELD treatment for patients with lumbosacral contiguous double-level disc herniation. Health care providers may consider using this approach to facilitate future clinical practice.

KEY WORDS: Double-level disc herniation, selective nerve root block, percutaneous endoscopic lumbar discectomy, sequential nerve root block