Repetitive transforaminal steroid injections in cervical radiculopathy: a prospective outcome study including 140 patients

摘要

>Study design: Prospective case series.>Objective: To evaluate the effect of three repetitive transforaminal steroid injections in a large series of selected patients with cervical radiculopathy caused by spondylosis.>Methods: Consecutively, 140 patients with long-lasting medical history, clinical findings, and MRI indicating a cervical nerve root origin based on degenerative disease and a positive selective transforaminal diagnostic nerve root blocks with local anesthetics resulting in at least 50% temporary arm pain reduction were included.Before treatment started, patients underwent a clinical examination by a neurosurgeon. All patients were followed-up and evaluated by one physiotherapist at the neurosurgery outpatient clinic. A designed outcome questionnaire including Neck Disability Index (NDI), Symptoms Frequency Index, and Visual Analog Scale for pain intensity were used.A series of three transforaminal steroid injections, with 3 weeks in between, were performed by a neuroradiologist using image intensifier guidance in an x-ray suite. At 12–14 weeks after the first injection, follow-up was performed. Criteria for positive response to the treatment was >50% radicular arm pain reduction. Except for occasional painkillers, no other treatment was given to the patients.>Results: Positive response to the treatment was achieved in 49% (n = 69) with a significant difference in NDI and pain intensity between responders and nonresponders.>Conclusions: Repetitive transforaminal steroid injections may reduce symptoms (frequency, intensity, and fewer limitations of daily living activities) of radiculopathy in patients with degenerative disease in the cervical spine at a short time follow-up. rules="all" class="rendered small default_table">>Final class of evidence-treatment> valign="top" align="left" rowspan="1" colspan="1">Study design valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1"> RCT valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1"> Cohort valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1"> Case control valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1"> Case series valign="top" align="center" rowspan="1" colspan="1">•> valign="top" align="left" rowspan="1" colspan="1">Methods valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1"> Concealed allocation (RCT) valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1"> Intention to treat (RCT) valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1"> Blinded/independent evaluation of primary outcome valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1"> F/U ≥85% valign="top" align="center" rowspan="1" colspan="1">•> valign="top" align="left" rowspan="1" colspan="1"> Adequate sample size valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1"> Control for confounding valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1">>Overall class of evidence valign="top" align="center" rowspan="1" colspan="1">>IV> valign="top" align="left" colspan="2" rowspan="1">The definiton of the different classes of evidence is available on page 63. class="head no_bottom_margin" id="__sec2title">Study Rationale and ContextTreatment strategies for cervical radiculopathy caused by disc degeneration and spondylosis include ergonomic adjustments, analgesic medications including opioid and nonsteroidal antiinflammatories, physiotherapy, temporary immobilization with a collar, and, in case of failure of conservative treatments, eventually surgery.^, Transforaminal steroid injections have sporadically been reported in the literature as an alternative for treatment of cervical radiculopathy.^,,,,,,, The use of such injections is controversial and no studies with strong evidence for their effectiveness have been published. However, severe complications have been reported in a small number of patients following transforaminal steroid injections.^,, We have previously reported on favorable results using transforaminal steroid injections for many years as an alternative treatment to surgery in select patients. We have also noted that patients often needed repetitive injections to achieve satisfactory results. The need for repetitive injections has been reported in the literature.