Kolstad F, Leivseth G, Nygaard O P
National Centre of Spinal Disorders, Norwegian University of Science and Technology, University Hospital of Trondheim, Trondheim, Norway.
Acta Neurochir (Wien). 2005 Oct;147(10):1065-70; discussion 1070. doi: 10.1007/s00701-005-0542-2. Epub 2005 Jun 9.
The aim of this study was to assess if transforaminal steroid injections applied to cohort of patients waiting for cervical disc surgery, reduce the pain of cervical radiculopathy and hence reduce the need for surgical intervention. Cervical radiculopathy due to cervical disc herniation or spondylosis is a common indication for cervical disc surgery. Surgery is however not always successful, and is not done without risk of complications. Transforaminal injection of steroids has gained popularity due to the rationale that inflammation of the spinal nerve roots causes radicular pain, and therefore steroids placed locally should relieve symptoms.
During a 12-month period, 21 secondary referral patients with unilateral cervical radiculopathy entered the study. Cervical disc herniation or spondylosis affecting the corresponding nerve root was demonstrated by appropriate investigation (MRI or myelography). The patients then received 2 transforaminal steroid injections, at 2 weeks interval, while waiting for operative treatment. The pain intensity (VAS), Odom's criteria and operative indications were registered at 6 weeks and 4 months.
After receiving injection treatment 5 of the 21 patients decided to cancel the operation due to clinical improvement. A statistically significant reduction (0.02) in radicular pain score was simultaneously measured. This corresponds well with the reduction in operative requirements since radicular pain is the main indication for operative treatment. The responders experienced a long-lasting effect. Those responding positively however improved neck pain to the same extent as radicular pain, and patients with cervical spondylosis responded as positively as those with disc herniation.
This prospective cohort study indicates a reduction in the need for operative treatment due to injection treatment. The clinical effect is measurable, and a statistically significant improvement of the radicular pain is registered. Routine transforaminal injection treatment prior to surgery seems rewarding, but the complication risk must be taken into consideration.
本研究的目的是评估对等待颈椎间盘手术的患者队列进行经椎间孔类固醇注射是否能减轻神经根型颈椎病的疼痛，从而减少手术干预的需求。因颈椎间盘突出或颈椎病导致的神经根型颈椎病是颈椎间盘手术的常见适应症。然而，手术并非总是成功的，且存在并发症风险。经椎间孔注射类固醇因基于神经根炎症会引起放射性疼痛，所以局部注射类固醇应能缓解症状这一原理而受到欢迎。
在12个月期间，21例单侧神经根型颈椎病的二级转诊患者进入研究。通过适当检查（磁共振成像或脊髓造影）证实存在影响相应神经根的颈椎间盘突出或颈椎病。患者在等待手术治疗期间，每隔2周接受2次经椎间孔类固醇注射。在6周和4个月时记录疼痛强度（视觉模拟评分法）、奥多姆标准和手术指征。
接受注射治疗后，21例患者中有5例因临床症状改善而决定取消手术。同时测量到神经根性疼痛评分有统计学意义的降低（0.02）。这与手术需求的减少非常吻合，因为神经根性疼痛是手术治疗的主要指征。有反应者经历了持久的效果。然而，反应积极者颈部疼痛的改善程度与神经根性疼痛相同，颈椎病患者的反应与椎间盘突出患者一样积极。
这项前瞻性队列研究表明注射治疗可减少手术治疗的需求。临床效果是可测量的，且神经根性疼痛有统计学意义的改善。术前常规经椎间孔注射治疗似乎是值得的，但必须考虑并发症风险。
