基于医生转诊来源的腰椎经椎间孔硬膜外类固醇注射结果。
Results of lumbar transforaminal epidural steroid injections based on the physician referral source.
作者信息
Levin Josh, Li Wei-Xian, Gall Nolan, Chan John, Caragea Marc, Huynh Lisa, Koltsov Jayme, Smuck Matt
机构信息
Department of Orthopaedic Surgery, Stanford University, 450 Broadway St., Pavilion C, 4th Floor, MC 6342, Redwood City, CA, 94063, USA.
Department of Neurosurgery, Stanford University, 450 Broadway St., Pavilion C, 4th Floor, MC 6342, Redwood City, CA, 94063, USA.
出版信息
Interv Pain Med. 2022 Jul 31;1(3):100114. doi: 10.1016/j.inpm.2022.100114. eCollection 2022 Sep.
BACKGROUND
Many patients who receive lumbosacral transforaminal epidural steroid injections (TFESIs) are referred for the injection from a physician who does not perform the procedure.
PURPOSE
To compare success rates of fluoroscopically guided lumbosacral TFESIs in patients who had a clinical evaluation and recommendation for the injection by a fellowship-trained spine specialist who routinely performs ESIs (Group A), vs those who had a clinical evaluation by a fellowship-trained spine specialist who referred the patient for the procedure to be done by a different physician (Group B).
STUDY DESIGN/SETTING: Retrospective, observational, in vivo study of consecutive patients. Patient.
SAMPLE
Patients undergoing lumbosacral TFESIs at a single outpatient academic spine center. Outcome.
MEASURES
Numeric Rating Scale (NRS) pain score improvement.
METHODS
Current procedural terminology (CPT) codes were used to search all consecutive patients who received a lumbosacral TFESI between September 2019 and September 2020. All patients with pre- and post-injection NRS pain scores within 60 days of the injection were included in the analysis.
RESULTS
A total of 230 TFESIs were analyzed, 151 in Group A, and 79 in Group B. The primary outcome was defined as > 50% improvement in the NRS pain score. 39% [95% CI: 33, 45%] of all patients who received a lumbosacral TFESI achieved a successful outcome. There were better results in Group A with a 47% [95% CI: 39, 55%] success rate compared to a 23% [95% CI: 14, 32%] success rate in Group B. Group A also had a higher proportion of patients who achieved at least 80% pain relief (26% [95% CI: 19, 33%]) compared to Group B (10% [95% CI: 3, 17%]). History of prior surgery did not significantly affect outcomes.
CONCLUSION
This retrospective study demonstrated a higher success rate from lumbosacral TFESIs when patients were referred for the injection by a physician who performs ESIs.
背景
许多接受腰骶部经椎间孔硬膜外类固醇注射（TFESI）的患者是由不进行该操作的医生转诊来接受注射的。
目的
比较在接受了临床评估并由常规进行硬膜外注射的脊柱专科 fellowship 培训医生推荐进行注射的患者（A 组）与接受了临床评估但由脊柱专科 fellowship 培训医生转诊给另一位医生进行该操作的患者（B 组）中，透视引导下腰骶部 TFESI 的成功率。
研究设计/设置：对连续患者进行的回顾性、观察性体内研究。患者。
样本
在一个门诊学术脊柱中心接受腰骶部 TFESI 的患者。结果。
测量指标
数字评分量表（NRS）疼痛评分改善情况。
方法
使用当前程序术语（CPT）代码搜索 2019 年 9 月至 2020 年 9 月期间所有接受腰骶部 TFESI 的连续患者。所有在注射后 60 天内有注射前和注射后 NRS 疼痛评分的患者都纳入分析。
结果
共分析了 230 次 TFESI，A 组 151 次，B 组 79 次。主要结局定义为 NRS 疼痛评分改善>50%。所有接受腰骶部 TFESI 的患者中有 39%[95%CI：33，45%]取得了成功结局。A 组结果更好，成功率为 47%[95%CI：39，55%]，而 B 组成功率为 23%[95%CI：14，32%]。A 组中至少实现 80%疼痛缓解的患者比例也高于 B 组（26%[95%CI：19，33%]对比 B 组的 10%[95%CI：3，17%]）。既往手术史对结局无显著影响。
结论
这项回顾性研究表明，当患者由进行硬膜外注射的医生转诊进行注射时，腰骶部 TFESI 的成功率更高。
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