{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T13:08:27Z","timestamp":1793365707076,"version":"4.5.0"},"reference-count":38,"publisher":"BMJ","issue":"4","funder":[{"name":"NIHR Systematic Review Fellowship"},{"name":"Clinical Lectureship, School of Clinical Medicine, University of Cambridge"},{"name":"National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West"},{"name":"National Institute for Health Research Health Technology Assessment programme grant"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,2,22]]},"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Lumbar radiculopathy (LR) often manifests as pain in the lower back radiating into one leg (sciatica). Unsuccessful back surgery is associated with significant healthcare costs and risks to patients. This review aims to examine the diagnostic accuracy of selective nerve root blocks (SNRBs) to identify patients most likely to benefit from lumbar decompression surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Systematic review of diagnostic test accuracy studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Eligibility criteria<\/jats:title>\n                    <jats:p>Primary research articles using a patient population with low back pain and symptoms in the leg, SNRB administered under radiological guidance as index test, and any reported reference standard for the diagnosis of LR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Information sources<\/jats:title>\n                    <jats:p>MEDLINE (Ovid), MEDLINE In-Process &amp; Other Non-Indexed Citations, EMBASE, Science Citation Index, Biosis, LILACS, Dissertation abstracts and National Technical Information Service from inception to 2018.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Risk of bias and applicability was assessed using the QUADAS-2 tool. We performed random-effects logistic regression to meta-analyse studies grouped by reference standard.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>6 studies (341 patients) were included in this review. All studies were judged at high risk of bias. There was substantial heterogeneity across studies in sensitivity (range 57%\u2013100%) and specificity (10%\u201386%) estimates. Four studies were diagnostic cohort studies that used either intraoperative findings during surgery (pooled sensitivity: 93.5% [95% CI 84.0 to 97.6]; specificity: 50.0% [16.8 to 83.2]) or \u2018outcome following surgery\u2019 as the reference standard (pooled sensitivity: 90.9% [83.1 to 95.3]; specificity 22.0% [7.4 to 49.9]). Two studies had a within-patient case-control study design, but results were not pooled because different types of control injections were used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We found limited evidence which was of low methodological quality indicating that the diagnostic accuracy of SNRB is uncertain and that specificity in particular may be low. SNRB is a safe test with a low risk of clinically significant complications, but it remains unclear whether the additional diagnostic information it provides justifies the cost of the test.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2018-025790","type":"journal-article","created":{"date-parts":[[2019,4,20]],"date-time":"2019-04-20T12:20:13Z","timestamp":1555762813000},"page":"e025790","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":31,"title":["The utility of diagnostic selective nerve root blocks in the management of patients with lumbar radiculopathy: a systematic review"],"prefix":"10.1136","volume":"9","author":[{"given":"Rebecca","family":"Beynon","sequence":"first","affiliation":[{"name":"Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9824-9335","authenticated-orcid":false,"given":"Martha Maria Christine","family":"Elwenspoek","sequence":"additional","affiliation":[{"name":"Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK"},{"name":"The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Athena","family":"Sheppard","sequence":"additional","affiliation":[{"name":"Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK"},{"name":"The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John Nicholas","family":"Higgins","sequence":"additional","affiliation":[{"name":"Radiology, Addenbrooke\u2019s Hospital, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelos G","family":"Kolias","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke\u2019s Hospital & University of Cambridge, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodney J","family":"Laing","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke\u2019s Hospital & University of Cambridge, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Penny","family":"Whiting","sequence":"additional","affiliation":[{"name":"Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK"},{"name":"The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Hollingworth","sequence":"additional","affiliation":[{"name":"Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,4,20]]},"reference":[{"key":"2025121409591527000_9.4.e025790.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0304-3959(99)00187-6"},{"key":"2025121409591527000_9.4.e025790.2","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-010-1603-7"},{"key":"2025121409591527000_9.4.e025790.3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0707136"},{"key":"2025121409591527000_9.4.e025790.4","doi-asserted-by":"publisher","DOI":"10.1001\/jama.296.20.2441"},{"key":"2025121409591527000_9.4.e025790.5","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa064039"},{"key":"2025121409591527000_9.4.e025790.6","doi-asserted-by":"crossref","unstructured":"Peul WC , van den Hout WB , Brand R , et al . 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