• Changgui Shi, Ning Xu, Bin Sun, Rui Chen, Hailong He, Guohua Xu, Xiaojian Ye, and Xin Gu.
• Department of Orthopedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.
• Pain Physician. 2021 Jul 1; 24 (4): E483-E492.

BackgroundSelective nerve root block (SNRB) has been used to facilitate the diagnostic process when radiologic abnormalities are not correlated with clinical symptomatology in patients with cervical radiculopathy. Meanwhile, minimally invasive posterior percutaneous endoscopic cervical foraminotomy and discectomy (PPECFD) has been widely used to treat cervical radiculopathy because of its advantages. However, combination of these 2 procedures in the treatment of cervical radiculopathy with diagnostic uncertainty has not been reported.ObjectivesTo examine the clinical outcomes of PPECFD assisted with SNRB in patients who had cervical radiculopathy with diagnostic uncertainty.Study DesignA retrospective design was used.SettingThis study was conducted in a university-affiliated tertiary hospital in Shanghai, China.MethodsThirty consecutive patients with cervical radicular pain who had diagnostic uncertainty were included (January 2018 to January 2019). Diagnostic SNRB was performed to identify the responsible nerve root(s). PPECFD was selected as the treatment when the SNRB result was positive. Clinical outcomes were assessed by the Visual Analog Scale (VAS), Neck Disability Index (NDI), and modified Macnab criteria. Pre- and post-operative radiologic and clinical parameters were evaluated. Other information was retrieved from the electronic records.ResultsAll patients had successful SNRB procedures. Four were excluded from the analysis because of the negative results of the SNRB. Among the remaining 26 patients who underwent the subsequent PPECFD surgery, the mean follow-up was 14 months. Compared with preoperative values, the mean VAS scores for radicular arm pain and neck pain, as well as the NDI score, improved significantly. According to the Macnab criteria, 22 patients (84.6%) had excellent or good results. No major peri- and postoperative complications were observed.LimitationsThis study used a retrospective design with relatively small sample size and medium follow-up duration.ConclusionsDiagnostic SNRB may be a helpful tool to identify the origin of cervical radicular pain for patients with diagnostic uncertainty. With the guidance of SNRB, PPECFD is likely to be an effective and safe option for the treatment of cervical radiculopathy with diagnostic uncertainty.

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