颈神经根性疼痛行椎板间硬膜外类固醇注射后与治疗成功相关的因素

Factors Associated with Treatment Success After Interlaminar Epidural Steroid Injection for Cervical Radicular Pain.

作者信息

Celenlioglu Alp Eren, Solmaz Ilker, Eksert Sami, Simsek Fatih, Ilkbahar Serkan, Sir Ender

机构信息

University of Health Sciences Gulhane Training and Research Hospital, Department of Pain Medicine, Ankara, Turkey.

出版信息

Turk Neurosurg. 2023;33(2):326-333. doi: 10.5137/1019-5149.JTN.42539-22.2.

DOI:10.5137/1019-5149.JTN.42539-22.2

PMID:36799281

Abstract

AIM

To investigate the demographic, clinical and radiological findings associated with treatment success after interlaminar epidural steroid injection (ILESI) in radicular pain induced by cervical disc herniation.

MATERIAL AND METHODS

In this retrospective study, the data of patients who received cervical ILESI between January 2017 and June 2021 were screened. Of 223 patients, 92 with unilateral radicular neck pain due to cervical disc herniation were included. Demographic data, symptom duration, and numerical rating scale scores at baseline, at three weeks, three months, and six months after treatment were collected from the medical records of the patients. Disc herniation level, cervical axis, disc height, presence and degree of spinal canal and neural foraminal stenosis, vertebral endplate signal change, and definitive presence of uncovertebral and facet osteoarthritis were evaluated using cervical spine magnetic resonance imaging. Treatment success was determined as ?50% reduction in pain scores at six months compared to baseline.

RESULTS

Data of 92 patients (27 men, 65 women) were included. The mean age was 50.82 ± 10.22 years, and the median symptom duration was 12 (4.25 to 20) months. At six months after ILESI, treatment was successful in 58 (58.7%) patients and unsuccessful in 34 (41.3%) patients. Multivariable logistic regression analysis was performed to identify the factors associated with treatment success at six months post-injection. In the final model, neural foraminal stenosis (non-severe vs. severe) and spinal canal stenosis (non-severe vs. severe) were significantly associated with the treatment success (OR=3.02, 95% CI=1.40?10.95, p=0.009; OR=5.31, 95% CI=1.77?15.85, p=0.003).

CONCLUSION

Treatment success of cervical ILESI at six months is favorable. However, the presence of severe neural foraminal and spinal canal stenosis is associated with a reduced likelihood of treatment success.

摘要

目的

探讨颈椎间盘突出症所致神经根性疼痛患者行椎板间硬膜外类固醇注射（ILESI）后与治疗成功相关的人口统计学、临床及影像学表现。

材料与方法

在这项回顾性研究中，筛选了2017年1月至2021年6月期间接受颈椎ILESI治疗的患者数据。在223例患者中，纳入了92例因颈椎间盘突出症导致单侧颈部神经根性疼痛的患者。从患者病历中收集人口统计学数据、症状持续时间以及治疗前、治疗后3周（译者注：原文为at three weeks，此处根据上下文推测可能是治疗后3周）、3个月和6个月时的数字评分量表得分。使用颈椎磁共振成像评估椎间盘突出水平、颈椎曲度、椎间盘高度、椎管及神经根管狭窄的存在情况及程度、椎体终板信号改变以及钩椎关节和小关节骨关节炎的明确存在情况。治疗成功的判定标准为与基线相比在6个月时疼痛评分降低50%。

结果

纳入了92例患者的数据（27例男性，65例女性）。平均年龄为50.82±10.22岁，症状持续时间中位数为12（4.25至20）个月。ILESI治疗6个月后，58例（58.7%）患者治疗成功，34例（41.3%）患者治疗失败。进行多变量逻辑回归分析以确定注射后6个月时与治疗成功相关的因素。在最终模型中，神经根管狭窄（非严重与严重）和椎管狭窄（非严重与严重）与治疗成功显著相关（比值比=3.02，95%置信区间=1.40至10.95，p=0.009；比值比=5.31，95%置信区间=1.77至15.85，p=0.003）。