EFFICACY OF NERVE ROOT BLOCK FOR THE TREATMENT OF LUMBAR SPINAL CANAL STENOSIS IN ADULTS OLDER THAN 80 YRS OF AGE

Background: Patients with advanced lumbar spinal canal stenosis (LCS) often prefer non-operative treatment owing to decreased physiological function and comorbidities. Although the therapeutic value ofselective nerve root block (SNRB) for LCS is confirmed, there are few reports of its effectiveness in theelderly. We investigated the efficacy of SNRB for LCS in patients over 80 years of age. Methods: The subjects were 112 patients aged over 80 years (mean age: 84 years 45 men and 67 women)with medication-resistant LCS without cauda equina syndrome who underwent SNRB. Cases with acute-onset lumbar disc herniation were excluded. We retrospectively investigated and compared the presence orabsence of surgery, effect of SNRB, number of procedures, duration of disease, and magnetic resonanceimaging findings. Patients who could avoid the surgery by SNRB were defined as the effective group. Patientswhose symptoms were not relieved by SNRB and who underwent surgery and those whose symptoms werenot relieved but who continued conservative treatment were defined as the ineffective group. A total of oneto seven SNRBs were performed in both groups, and the same spine surgeon performed the entire procedurefrom SNRB to surgery. Results: There were 86 nonoperative patients (69 effective cases) and 26 operative patients the overall rateof effectiveness was 61% (69/112 patients). The area of the spinal canal at the responsible level was 108.63mm2in the effective group compared with 77.06 mm 2 in the ineffective group. This was significantlynarrower in the ineffective group (p=0.0094). There was no significant difference in the duration of illness,number of blocks, or hernia complication rate between the groups. No patient experienced severe neuralgiathat may have been caused by neuropathy during SNRB. Discussion: Our outcome showed that more than 60% of older patients with LCS showed symptomatic improvement with SNRB. SNRB can be performed relatively safely in the elderly and appears to be afavourable treatment option for older patients with various risks, such as poor general condition. Conclusions: Multiple sessions of SNRB may provide older patients with symptomaticimprovement and maybe an option for treatment.