小关节突关节与经椎间孔硬膜外类固醇注射治疗因椎间孔狭窄引起的颈神经根痛：一项回顾性对比研究。
Facet Joint Versus Transforaminal Epidural Steroid Injections in Patients With Cervical Radicular Pain due to Foraminal Stenosis: A Retrospective Comparative Study.
机构信息
Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Seoul, Korea.
Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Ewha Womans University Mokdong Hospital, Seoul, Korea.
出版信息
J Korean Med Sci. 2022 Jun 27;37(25):e208. doi: 10.3346/jkms.2022.37.e208.
BACKGROUND
A cervical transforaminal epidural (TFE) steroid injection is a useful treatment option for cervical radicular pain, but it carries a small risk of catastrophic complications. Several studies have reported that cervical facet joint (FJ) steroid injection can reduce cervical radicular pain through an indirect epidural spread. The aim of this retrospective comparative study was to evaluate the pain scores and functional disability in subjects receiving cervical FJ or TFE steroid injection for the treatment of cervical radicular pain due to foraminal stenosis (FS).
METHODS
We selected 278 patients 18 years of age and older who underwent cervical FJ (n = 130) or TFE (n= 148) steroid injection for cervical radicular pain. The primary outcomes included pain scores and functional disability during hospital visits one, three, and six months after the initial injection. Secondary outcomes were the proportion of responders and Medication Quantification Scale (MQS) scores. Adverse events and variables correlating with effectiveness one month after the initial injection were also evaluated.
RESULTS
The Numeric Rating Scale and Neck Disability Index scores showed a significant improvement one, three, and six months after the initial injection in both groups, with no significant differences between the groups. No significant differences were observed in the success rates of the procedure one, three, and six months after the initial injection for either group. There were no significant differences in MQS between the groups during the follow-up period. Univariate and multivariate logistic regression analyses revealed that the injection method, age, sex, number of injections, FS severity, MQS, pain duration, and the presence of cervical disc herniation were not independent predictors of treatment success.
CONCLUSION
The efficacy of FJ steroid injection may not be inferior to that of TFE steroid injection in patients with cervical radicular pain due to FS.
背景
颈椎椎间孔硬膜外（TFE）类固醇注射是治疗颈椎神经根痛的有效选择，但存在发生灾难性并发症的小风险。几项研究报告称，颈椎关节突关节（FJ）类固醇注射可通过间接硬膜外扩散减轻颈椎神经根痛。本回顾性对照研究的目的是评估因椎间孔狭窄（FS）导致的颈椎神经根痛患者接受颈椎 FJ 或 TFE 类固醇注射治疗后的疼痛评分和功能障碍。
方法
我们选择了 278 名年龄在 18 岁及以上的患者，他们接受了颈椎 FJ（n=130）或 TFE（n=148）类固醇注射治疗颈椎神经根痛。主要结果包括初始注射后 1、3 和 6 个月时的疼痛评分和功能障碍。次要结果是应答者的比例和药物量化量表（MQS）评分。还评估了初始注射后一个月的不良事件和与疗效相关的变量。
结果
两组患者的数字评分量表和颈部残疾指数评分在初始注射后 1、3 和 6 个月均有显著改善，两组间无显著差异。两组初始注射后 1、3 和 6 个月的手术成功率无显著差异。两组在随访期间的 MQS 无显著差异。单因素和多因素逻辑回归分析显示，注射方法、年龄、性别、注射次数、FS 严重程度、MQS、疼痛持续时间和颈椎间盘突出的存在不是治疗成功的独立预测因素。
结论
对于因 FS 引起的颈椎神经根痛患者，FJ 类固醇注射的疗效可能不劣于 TFE 类固醇注射。
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