Maus Timothy P, El-Yahchouchi Christine A, Geske Jennifer R, Carter Rickey E, Kaufmann Timothy J, Wald John T, Diehn Felix E
*Department of Radiology, Mayo Clinic, Rochester, Minnesota
Department of Anesthesiology, Case Western Reserve University, Cleveland, Ohio.
Pain Med. 2016 Dec;17(12):2176-2184. doi: 10.1093/pm/pnw043. Epub 2016 Mar 23.
To examine associations between imaging characteristics of compressive lesions and patient outcomes after lumbar transforaminal epidural steroid injections (TFESIs) stratified by steroid formulation (solution versus suspension).
DESIGN/SUBJECTS: Retrospective observational study, academic radiology practice. A 516-patient sample was selected from 2,634 consecutive patients receiving lumbar TFESI for radicular pain.
The advanced imaging study(s) preceding sampled TFESI were reviewed. Compressive lesions were described by a) nature of the lesion [disc herniation, fixed stenosis, synovial cyst, epidural fibrosis, no lesion] b) degree of neural compression [4 part scale], and c) presence of a tandem lesion. Associations between 2-month categorical outcomes (responder rates for pain, functional recovery) and imaging characteristics, stratified by steroid formulation, were examined with chi-squared tests of categorical outcomes and multivariable logistic regression models.
Disc herniation patients had more responders for functional recovery than patients with fixed lesions (54% versus 38%, P = 0.01). Patients with fixed lesions receiving steroid solution (dexamethasone) had more responders for pain relief, with a similar trend for functional recovery, than patients receiving suspensions (59% versus 40%, P = 0.01). Outcomes for patients with fixed lesions treated with dexamethasone were not statistically different from those for disc herniation patients. Patients with single compressive lesions had more responders than those with tandem lesions (55% versus 41%, P = 0.03).
In the entire sample, outcomes for disc herniations were more favorable than for fixed lesions. However, fixed lesions treated with dexamethasone had outcomes indistinguishable from disc herniations. Single lesions had better outcomes than tandem lesions.
研究腰椎经椎间孔硬膜外类固醇注射（TFESI）后，按类固醇剂型（溶液与混悬液）分层的压迫性病变的影像学特征与患者预后之间的关联。
设计/研究对象：回顾性观察研究，学术性放射科实践。从2634例因神经根性疼痛接受腰椎TFESI的连续患者中选取了516例患者作为样本。
回顾了样本TFESI之前的高级影像学检查。压迫性病变通过以下方面进行描述：a）病变性质[椎间盘突出、固定性狭窄、滑膜囊肿、硬膜外纤维化、无病变]；b）神经受压程度[四分制量表]；c）串联病变的存在情况。通过分类结果的卡方检验和多变量逻辑回归模型，研究按类固醇剂型分层的2个月分类结局（疼痛缓解率、功能恢复率）与影像学特征之间的关联。
椎间盘突出患者功能恢复的缓解者比固定性病变患者更多（54%对38%，P = 0.01）。接受类固醇溶液（地塞米松）的固定性病变患者疼痛缓解的缓解者比接受混悬液的患者更多，功能恢复也有类似趋势（59%对40%，P = 0.01）。用地塞米松治疗的固定性病变患者的结局与椎间盘突出患者的结局无统计学差异。单一压迫性病变患者的缓解者比串联病变患者更多（55%对41%，P = 0.03）。
在整个样本中，椎间盘突出的预后比固定性病变更有利。然而，用地塞米松治疗的固定性病变的结局与椎间盘突出难以区分。单一病变的预后比串联病变更好。
