Impact of advanced practitioner-led fluoroscopic nerve root blocks on lumbosacral radiculopathy outcomes

Background: Selective nerve root block is a key intervention for managing lumbosacral radiculopathy, often caused by intervertebral disc herniation. While traditionally performed by consultant medical practitioners, advanced practitioners are increasingly involved in this role. Aims: This service evaluation compared the outcomes of selective nerve root blocks performed by an advanced practitioner and three consultant radiologists. It evaluated whether including an advanced practitioner in a consultant-led team could maintain patient outcomes without compromising treatment effectiveness, and whether experience or technique were critical for successful treatment. Methods: The investigation reviewed 524 fluoroscopically guided selective nerve root blocks, with 131 procedures performed by each practitioner. Treatment outcomes were categorised as significant, partial, or no symptomatic relief achieved. Additionally, 31 sacral (S1) selective nerve root block procedures per practitioner using a standardised approach were analysed to examine any impact of technique variations. Results: There was a strong correlation ( r =0.96) in treatment outcomes between lumbar and sacral selective nerve root blocks across all practitioners. All practitioners exceeded the target success rate of 82%, with the advanced practitioner achieving the highest success rate (99%) and superior results in terms of significant symptomatic relief (92%) compared to the consultant radiologists (52%–71%). The advanced practitioner had a notably lower failure rate (1% vs. 8%–15%). Conclusions: Advanced practitioners, with proper training and governance, can effectively perform selective nerve root blocks and enhance patient outcomes without compromising care quality. Implications for practice: These findings indicate that experienced advanced practitioners can safely and effectively undertake selective nerve root block procedures without compromising care quality or therapeutic outcome. This supports the strategic expansion of advanced practice roles within interventional radiology services, which may improve service capacity, reduce procedural bottlenecks and enhance continuity of care.