Department of Anesthesiology, Nara Medical University, Nara 634-8522, Japan.
Department of Orthopaedics, Nara Medical University, Nara 634-8522, Japan.
Pain Res Manag. 2023 Oct 14;2023:4298436. doi: 10.1155/2023/4298436. eCollection 2023.
Transforaminal epidural steroid injection (TFESI) is widely used to manage lumbar radiculopathy. In clinical settings, patients often undergo repeated transforaminal epidural injections with or without steroid administration.
To examine whether a positive response to TFESI at the first month, can in clinical settings, identify patients with radiculopathy who can avoid surgery for two years. . This prospective observational study was conducted at an academic medical center.
Individuals aged ≥20 years who had been referred to our pain center by spine surgeons were enrolled. All patients were assessed using the Numerical Rating Scale (NRS) at baseline and 1 month after the first TFESI. Patients were divided into two groups according to the NRS decrement: the positive response (PR) group achieved a ≥2.0 decrease on the NRS 1 month after the first TFESI compared to baseline and the no response (NR) group achieved a <2.0 decrease on the NRS. The incidence rates of surgery over two years were compared between the two groups. In addition, we calculated the hazard ratio of the PR group to the NR group regarding the incidence of surgery over two years using the Cox proportional hazard model, adjusting for baseline NRS.
Seventy-six patients completed the two-year follow-up. In total, 8 and 68 patients had bilateral and unilateral radiculopathy, respectively. The PR and NR groups included 35 and 41 patients, respectively. The rate of surgery avoidance was 85.7% and 73.2% in the PR and NR groups, respectively. This difference was not statistically significant (=0.26). After adjusting for baseline NRS, the hazard ratio of the PR group to the NR group regarding the incidence of surgery within two years was 0.35 (95% confidence interval: 0.11-1.11, =0.08).
A positive response to TFESI may not identify patients who can avoid surgery for two years.
经椎间孔硬膜外类固醇注射（TFESI）被广泛用于治疗腰椎神经根病。在临床环境中，患者通常接受多次经椎间孔硬膜外注射，无论是否给予类固醇。
在临床环境中，首次 TFESI 后出现阳性反应是否能确定神经根病患者在两年内可以避免手术。本前瞻性观察研究在一家学术医疗中心进行。
招募了由脊柱外科医生转诊到我们疼痛中心的年龄≥20 岁的个体。所有患者在基线和首次 TFESI 后 1 个月均使用数字评分量表（NRS）进行评估。根据 NRS 下降幅度，患者分为两组：阳性反应（PR）组在首次 TFESI 后 1 个月 NRS 下降幅度≥2.0，无反应（NR）组 NRS 下降幅度<2.0。比较两组两年内手术的发生率。此外，我们使用 Cox 比例风险模型，调整基线 NRS，计算 PR 组与 NR 组两年内手术发生率的风险比。
76 例患者完成了两年的随访。共有 8 例和 68 例患者分别为双侧和单侧神经根病。PR 组和 NR 组分别包括 35 例和 41 例患者。PR 组和 NR 组的手术避免率分别为 85.7%和 73.2%，差异无统计学意义（=0.26）。调整基线 NRS 后，PR 组与 NR 组两年内手术发生率的风险比为 0.35（95%置信区间：0.11-1.11，=0.08）。
TFESI 后的阳性反应可能无法确定两年内可避免手术的患者。
