Costandi Shrif J, Azer Gerges, Eshraghi Yashar, Zeyed Yosaf, Atalla Jasmyn E, Looka Michael E, Mekhail Nagy A
From the *Pain Management Department, †Evidence-Based Pain Medicine Research, and ‡Outcomes Research Department, Cleveland Clinic, Cleveland; and §Ohio State University, Columbus, OH; and ∥Oakland University, Rochester, MI.
Reg Anesth Pain Med. 2015 Nov-Dec;40(6):674-80. doi: 10.1097/AAP.0000000000000323.
Cervical transforaminal epidural steroid injections (CTFESIs) may help decrease pain and restore function in patients with cervical radiculopathy. Evidence of the injections' effectiveness, however, remains controversial, and multiple case reports have identified potential complications. Such reports have led to diminished interest in including the procedure in patient care algorithms.
Our retrospective analysis aims to evaluate the CTFESI-associated pain relief and possible decreased need for spine surgery, along with its potential predictive role in determining cervical surgical outcomes. Finally, our study intends to estimate associated complications.
A pain management database registry was used to identify patients who were referred by spine surgeons for diagnostic CTFESIs in preparation for possible surgery between January 2001 and December 2009. Outcomes were defined as the incidence of cervical surgery after diagnostic injection and the associated pain relief. A Poisson distribution was used to obtain a 95% confidence interval for the incidence of complications.
Sixty-four patients met the inclusion and exclusion criteria. After diagnostic CTFESIs, 45 (70.3%) of the observed 64 patients did not require cervical spine surgery whereas 19 (29.7%) still did. The mean pain reduction was 4.4 units on the numeric rating scale, with no observed complications.
This retrospective analysis further demonstrates the safety, diagnostic value, and possible therapeutic role of CTFESIs. A larger, controlled, randomized study is needed to assess definitively the procedure's efficacy and safety.
颈椎经椎间孔硬膜外类固醇注射（CTFESI）可能有助于减轻颈椎神经根病患者的疼痛并恢复其功能。然而，关于该注射有效性的证据仍存在争议，并且多个病例报告已确定了潜在并发症。此类报告导致人们对将该手术纳入患者护理方案的兴趣降低。
我们的回顾性分析旨在评估CTFESI相关的疼痛缓解情况以及脊柱手术需求可能的减少情况，及其在确定颈椎手术结果方面的潜在预测作用。最后，我们的研究旨在估计相关并发症。
使用疼痛管理数据库登记系统来识别2001年1月至2009年12月期间被脊柱外科医生转诊以进行诊断性CTFESI为可能的手术做准备的患者。结果定义为诊断性注射后颈椎手术的发生率以及相关的疼痛缓解情况。采用泊松分布来获得并发症发生率的95%置信区间。
64例患者符合纳入和排除标准。在诊断性CTFESI后，64例观察患者中有45例（70.3%）不需要进行颈椎手术，而19例（29.7%）仍需要手术。数字评分量表上的平均疼痛减轻为4.4个单位，未观察到并发症。
这项回顾性分析进一步证明了CTFESI的安全性、诊断价值和可能的治疗作用。需要进行一项更大规模的、对照的、随机研究来明确评估该手术的疗效和安全性。
