Department of Physical Medicine and Rehabilitation, University of Rochester Medical Center, Rochester, NY.
Department of Physical Medicine and Rehabilitation, University of Rochester Medical Center, Rochester, NY.
Arch Phys Med Rehabil. 2024 Aug;105(8):1458-1463. doi: 10.1016/j.apmr.2024.02.720. Epub 2024 Feb 29.
To evaluate the therapeutic effect of transforaminal selective nerve root sleeve injections (TFSNRIs) in a specific subset of patients with clinical symptoms and presentation consistent with spinal stenosis.
Retrospective review.
Tertiary academic spine center.
A total of 176 patients with radicular leg pain with or without low back pain as well as ≥3 clinical features of spinal stenosis and corroborative radiographic features of spinal stenosis on lumbar spine magnetic resonance imaging without confounding spinal pathology (N=176).
Fluoroscopically guided transforaminal selective nerve root sleeve injections.
Patient Reported Outcome Measurement Information System (PROMIS) Physical Function (PF) v1.2/v2.0, Pain Interference (PI) v1.1, and PROMIS (D) v1.0 were collected at baseline and post-procedure short term (<3-months) and long-term (6-12 month) follow-up. Statistical analysis comparing baseline and postprocedural PROMIS scores was performed. Differences were compared with previously established minimal clinically important differences in the spine population.
For patients with spinal stenosis treated with TFSNRI, no statistically significant improvement was observed short- and long-term follow-up in PROMIS PF (P=.97, .77) and PROMIS Depression (P=.86, .85) scores. At short-term follow-up, PROMIS PI scores did significantly improve (P=.01) but the average difference of pre- and post-procedure scores did not reach clinical significance. No significant difference in PROMIS PI was noted at long-term follow-up (.75).
Although a statistically significant difference was observed for improvement in pain, in this retrospective study, TFSNRI did not provide clinically significant improvement in patients' function, pain, or depression for lumbar spinal stenosis at short- and long-term follow-up.
评估经椎间孔选择性神经根袖内注射（TFSNRIs）在一组特定的具有与椎管狭窄一致的临床症状和表现的患者中的治疗效果。
回顾性研究。
三级学术脊柱中心。
共 176 名患有神经根性腿痛的患者，无论是否有腰痛，以及≥3 项椎管狭窄的临床特征，并在腰椎磁共振成像上有椎管狭窄的影像学特征，没有混杂的脊柱病理学（N=176）。
在透视引导下进行经椎间孔选择性神经根袖内注射。
患者报告的结局测量信息系统（PROMIS）身体功能（PF）v1.2/v2.0、疼痛干扰（PI）v1.1 和 PROMIS（D）v1.0，分别在基线和术后短期（<3 个月）和长期（6-12 个月）随访时收集。对基线和术后 PROMIS 评分进行统计学分析。将差异与脊柱人群中已建立的最小临床重要差异进行比较。
对于接受 TFSNRI 治疗的椎管狭窄患者，在短期和长期随访中，PROMIS PF（P=.97，.77）和 PROMIS 抑郁（P=.86，.85）评分均未观察到统计学显著改善。在短期随访时，PROMIS PI 评分显著改善（P=.01），但术前和术后评分的平均差异没有达到临床意义。在长期随访时，PROMIS PI 没有显著差异（.75）。
尽管在疼痛改善方面观察到统计学上的显著差异，但在这项回顾性研究中，TFSNRI 并没有在短期和长期随访中为腰椎椎管狭窄患者的功能、疼痛或抑郁提供临床显著的改善。
