Is It Radiculopathy or Referred Pain? Buttock Pain in Spinal Stenosis Patients

• Published in: Clinics in orthopedic surgery Vol. 11; no. 1; pp. 89 - 94
• Main Authors: Shim, Dae Moo, Kim, Tae Gyun, Koo, Jun Sung, Kwon, Young Ho, Kim, Chang Su
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Orthopaedic Association 01.03.2019; 대한정형외과학회
• Subjects: Adult; Aged; Aged, 80 and over; Buttocks; Female; Humans; Male; Middle Aged; Nerve Block; Original; Pain Measurement; Pain, Referred - etiology; Pain, Referred - therapy; Prospective Studies; Radiculopathy - etiology; Radiculopathy - therapy; Spinal Nerve Roots; Spinal Stenosis - complications; Treatment Outcome; Zygapophyseal Joint; 정형외과학; Buttocks; Nerve block; Pain; Spinal stenosis
• ISSN: 2005-291X; 2005-4408; 2005-4408
• DOI: 10.4055/cios.2019.11.1.89

Buttock pain is common, and there are no fixed guidelines for its diagnosis and treatment. This study compared a selective nerve root block and a facet joint block for patients with degenerative spinal disease and buttock pain. Patients with degenerative spinal disease who presented with buttock pain, received a selective nerve root block (group A) or a facet joint block (group B) from June 2017 to September 2017, and were able to be followed up for more than 3 months were prospectively enrolled. Clinical results were assessed using a visual analog scale for comparative analysis. One day after the procedure, an excellent response was found in 7% and 6% of groups A and B, respectively; a good response was found in 41% and 13% of groups A and B, respectively. Two weeks later, an excellent response was found in 11% and 4% of groups A and B, respectively; a good response was found in 41% and 20% of groups A and B, respectively. Six weeks later, an excellent response was found in 11% and 7% of groups A and B, respectively, and a good response was found in 41% and 20% of groups A and B, respectively. At the final follow-up, more than 47% and 46% of patients showed a good response in groups A and B, respectively. In group A, the visual analog scale score improved compared to the pre-procedure value of 5.01 to 2.74 on day 1, 2.51 at week 2, 2.38 at week 6, and 2.39 at week 12. In group B, the visual analog scale score improved compared to the preprocedure value of 5.24 to 3.94 on day 1, 3.99 at week 2, 3.24 at week 6, and 2.59 at week 12. On day 1 and at weeks 2 and 6, group A showed a significantly better outcome than group B ( < 0.05). The selective nerve root block showed superior results up to 6 weeks post-procedure. Considering that the selective nerve root block is effective for treating radiculopathy, the primary cause of buttock pain can be thought to be radiculopathy rather than degenerative changes of the facet joint.