颈椎经椎间孔硬膜外类固醇注射治疗神经根型颈椎病的疗效：一项报告12个月结果的前瞻性队列研究。

The effectiveness of cervical transforaminal epidural steroid injections for the treatment of cervical radicular pain: A prospective cohort study reporting 12-month outcomes.

作者信息

Conger Aaron M, Randall Dustin J, Sperry Beau P, Kuo Keith T, Petersen Russell, Henrie A Michael, Kendall Richard W, Bisson Erica F, Teramoto Masaru, Martin Brook I, Burnham Taylor R, McCormick Zachary L

机构信息

Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA.

Department of Physical Medicine and Rehabilitation, Stanford University, Stanford, CA, USA.

出版信息

Interv Pain Med. 2023 Dec 22;3(1):100379. doi: 10.1016/j.inpm.2023.100379. eCollection 2024 Mar.

DOI:10.1016/j.inpm.2023.100379

PMID:39239498

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11373075/

Abstract

OBJECTIVES

To evaluate the effectiveness of cervical transforaminal epidural steroid injection (CTFESI) for the treatment of unilateral cervical radicular pain.

DESIGN

Single-group prospective cohort study.

METHODS

Outcomes included ≥50% reductions in Numeric Rating Scale (NRS) for arm pain, ≥30% Neck Disability Index (NDI-5) improvement, health-related quality of life (EQ-5D), global improvement (PGIC), personal goal achievement (COMBI), Chronic Pain Sleep Index (CPSI), and healthcare utilization at one, three, six, and 12 months. Data analysis included descriptive statistics with the calculations of 95% confidence intervals (CIs), contingency table analysis, and multilevel logistic regression (LR) analysis, including a worst-case (WC) sensitivity analysis in which missing data were treated as treatment failure. Participants who were treated surgically were considered failures in the categorical analyses.

RESULTS

33 consecutively enrolled participants (63.6% females, 51.2 ± 12.2 years of age, BMI 28.3 ± 4.5 kg/m) were analyzed. Success rates for ≥50% reduction in NRS for arm pain at one, three, six and 12 months were 57.6% (95% CI 40.8-72.8%), 71.9% (95% CI 54.6-84.4%), 64.5% (95% CI 46.9-78.9%), and 64.5% (95% CI 46.9-78.9%). Success rates for ≥30% improvement in NDI-5 were 60.6% (95% CI 43.7-75.3%), 68.8% (95% CI 51.4-82.0%), 61.3% (95% CI 43.8-76.3%), and 71.0% (95% CI 53.4-83.9%). In WC analysis, success rates for ≥50% arm NRS and NDI-5 were 0-4.3% lower between 1 and 12 months. PGIC scores were at least "much improved" or "very much improved," in 48.4-65.6% of participants between 1 and 12 months. 6.1%, 6.1%, and 3.0% had one, two, or three repeat injections, respectively. 18.2% of participants underwent surgery by 12 months. Participants showed significant improvements in arm NRS and NDI-5 after treatment ( < 0.05), multilevel logistic regression models showed no significant decline in improvements across the follow-up time points ( > 0.05).

CONCLUSION

Statistically significant and clinically meaningful improvements in pain and disability were observed after CTFESI for up to 12 months in individuals with unilateral cervical radicular pain.

摘要

目的

评估颈椎椎间孔硬膜外类固醇注射（CTFESI）治疗单侧颈神经根性疼痛的有效性。

设计

单组前瞻性队列研究。

方法

观察指标包括手臂疼痛数字评定量表（NRS）降低≥50%、颈部功能障碍指数（NDI-5）改善≥30%、健康相关生活质量（EQ-5D）、总体改善情况（PGIC）、个人目标达成情况（COMBI）、慢性疼痛睡眠指数（CPSI），以及在1、3、6和12个月时的医疗资源利用情况。数据分析包括描述性统计及95%置信区间（CI）计算、列联表分析和多水平逻辑回归（LR）分析，其中包括将缺失数据视为治疗失败的最坏情况（WC）敏感性分析。在分类分析中，接受手术治疗的参与者被视为治疗失败。

结果

对33例连续入组的参与者（63.6%为女性，年龄51.2±12.2岁，体重指数28.3±4.5kg/m²）进行了分析。在1、3、6和12个月时，手臂疼痛NRS降低≥50%的成功率分别为57.6%（95%CI 40.8 - 72.8%）、71.9%（95%CI 54.6 - 84.4%）、64.5%（95%CI 46.9 - 78.9%）和64.5%（95%CI 46.9 - 78.9%）。NDI-5改善≥30%的成功率分别为60.6%（95%CI 43.7 - 75.3%）、68.8%（95%CI 51.4 - 82.0%）、61.3%（95%CI 43.8 - 76.3%）和71.0%（95%CI 53.4 - 83.9%）。在WC分析中，1至12个月期间，手臂NRS和NDI-5降低≥50%的成功率低0 - 4.3%。在1至12个月期间，48.4% - 65.6%的参与者PGIC评分至少为“改善很多”或“改善非常多”。分别有6.1%、6.1 %和3.0%的参与者接受了1次、2次或3次重复注射。到12个月时，18.2%的参与者接受了手术。治疗后参与者的手臂NRS和NDI-5有显著改善（P<0.05），多水平逻辑回归模型显示在随访时间点上改善情况无显著下降（P>0.05）。