经硬膜外导管靶向注射类固醇与标准经椎间孔硬膜外注射治疗单侧颈神经根性疼痛的随机对照试验：六个月结果

A Randomized Comparative Trial of Targeted Steroid Injection via Epidural Catheter vs Standard Transforaminal Epidural Injection for the Treatment of Unilateral Cervical Radicular Pain: Six-Month Results.

作者信息

McCormick Zachary L, Conger Aaron, Sperry Beau P, Teramoto Masaru, Petersen Russell, Salazar Fabio, Cunningham Shellie, Michael Henrie A, Bisson Erica, Kendall Richard

机构信息

Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah.

Alabama College of Osteopathic Medicine, Dothan, Alabama.

出版信息

Pain Med. 2020 Oct 1;21(10):2077-2089. doi: 10.1093/pm/pnaa242.

DOI:10.1093/pm/pnaa242

PMID:32797232

Abstract

OBJECTIVES

Compare the effectiveness of catheter-directed cervical interlaminar epidural steroid injection (C-CIESI) with triamcinolone to cervical transforaminal steroid injection (CTFESI) with dexamethasone for the treatment of refractory unilateral radicular pain.

DESIGN

Prospective, randomized, comparative trial.

METHODS

Primary outcome: proportion of participants with ≥50% numeric rating scale pain score reduction from baseline "dominant pain" (the greater of arm vs neck) at one month postinjection. Secondary outcomes: ≥30% Neck Disability Index (NDI-5) reduction and Patient Global Impression of Change (PGIC) response indicating "much improved" or "very much improved."

RESULTS

One hundred twenty participants (55.6% females, 52.3 ± 12.5 years of age, BMI 28.2 ± 6.5 kg/m2), were enrolled. The proportions of participants who experienced ≥50% pain reduction at one, three, and six months were 68.5% (95% CI = 54.9-79.5%), 59.3% (95% CI = 45.7-71.6%), and 60.8% (95% CI = 46.7-73.2%), respectively, in the C-CIESI group compared with 49.1% (95% CI = 36.4-62.0%), 46.4% (95% CI = 33.8-59.6%), and 51.9% (95% CI = 38.4-65.2%), respectively, in the CTFESI group. The between-group difference at one month was significant (P = 0.038). The proportions of participants who experienced a ≥30% NDI-5 score improvement were 64.0% (95% CI = 49.8-76.1%) and 54.9% (95% CI = 41.1-68.0%) in the C-CIESI and CTFESI groups (P = 0.352). Participants reported similar PGIC improvement in both groups: At six months, 53.2% (95% CI 38.9-67.1%) and 54.5% (95% CI = 39.7-68.7%) of the C-CIESI and CTFESI groups reported being "much improved" or "very much improved," respectively (P = 0.897).

CONCLUSIONS

Both C-CIESI with triamcinolone and CTFESI with dexamethasone are effective in reducing pain and disability associated with refractory unilateral cervical radiculopathy in a substantial proportion of participants for at least six months.

摘要

目的

比较使用曲安奈德的导管引导下颈椎椎间孔硬膜外类固醇注射（C-CIESI）与使用地塞米松的颈椎经椎间孔类固醇注射（CTFESI）治疗难治性单侧神经根性疼痛的效果。

设计

前瞻性、随机、对照试验。

方法

主要结局指标：注射后1个月时，“主要疼痛”（手臂与颈部疼痛程度较重者）的数字评分量表疼痛评分较基线降低≥50%的参与者比例。次要结局指标：颈部功能障碍指数（NDI-5）降低≥30%，以及患者整体改善印象（PGIC）显示“明显改善”或“非常明显改善”。

结果

共纳入120名参与者（55.6%为女性，年龄52.3±12.5岁，体重指数28.2±6.5kg/m²）。C-CIESI组在注射后1个月、3个月和6个月时疼痛降低≥50%的参与者比例分别为68.5%（95%置信区间=54.9-79.5%）、59.3%（95%置信区间=45.7-71.6%）和60.8%（95%置信区间=46.7-73.2%），而CTFESI组分别为49.1%（95%置信区间=36.4-62.0%）、46.4%（95%置信区间=33.8-59.6%）和51.9%（95%置信区间=38.4-65.2%）。1个月时两组间差异具有统计学意义（P=0.038）。C-CIESI组和CTFESI组中NDI-5评分改善≥30%的参与者比例分别为64.0%（95%置信区间=49.8-76.1%）和54.9%（95%置信区间=41.1-68.0%）（P=0.352）。两组参与者报告的PGIC改善情况相似：在6个月时，C-CIESI组和CTFESI组分别有53.2%（95%置信区间38.9-67.1%）和54.5%（95%置信区间=39.7-68.7%）的参与者报告“明显改善”或“非常明显改善”（P=0.897）。