• J Devulder, P Deene, M De Laat, M Van Bastelaere, G Brusselmans, and G Rolly.
• Department of Anesthesia, University Hospital of Gent, Belgium.
• Clin J Pain. 1999 Jun 1; 15 (2): 132-5.

ObjectiveTo evaluate outcome in patients with failed back surgery syndrome treated with nerve root sleeve injections.Design And PatientsAn open, nonblinded, randomized study on 60 patients with documented fibrosis in fewer than three nerve roots.InterventionsAfter random selection, 20 patients were injected with 1 ml bupivacaine 0.5% combined with 1500 units hyaluronidase and 1 ml saline per nerve root sleeve (group A), another 20 were treated with 1 ml bupivacaine 0.5% combined with 40 mg methylprednisolone solution (Depo Medrol) per nerve root (group B), and a third group was treated with bupivacaine 0.5% combined with 1500 units hyaluronidase and 40 mg methylprednisolone solution (group C). The volume of each injection was 2 ml. The injections were given twice at an interval of 1 week.Outcome MeasuresThe patients were evaluated on a verbal pain rating scale 1, 3, and 6 months after the second injection. The Kruskal-Wallis test was used to detect statistically significant differences among the three groups, and the analysis was refined with the Friedman test.Results And ConclusionsOverall, although injections induced analgesia at 1 month, these effects were reduced at 3- and 6-month follow-ups. No statistical differences were found between the three treatment groups (after 1 month, p = 0.71; after 3 months, p = 0.69; after 6 months, p = 0.66. The Friedman test showed a significant decrease in treatment score as a function of time in groups B and C (p = 0.015) but not in group A (p = 0.074). Corticosteroids seem responsible for the last phenomenon.

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