Stephens Andrew R, El-Hassan Ramzi, Laplante Ben L, Patel Rajeev K
University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14623, USA.
Interv Pain Med. 2025 Mar 1;4(1):100556. doi: 10.1016/j.inpm.2025.100556. eCollection 2025 Mar.
BACKGROUND: Cervical radiculopathy is a common cause of pain. For patients who fail conservative management, a transforaminal epidural steroid injection (TFESI) is an accepted intervention and alternative to decompression surgery. OBJECTIVE: The purpose of this study was to evaluate the therapeutic effect of TFESIs for patients with cervical radiculopathy. METHODS: Adult patients treated at a multidisciplinary, tertiary academic spine center with cervical radicular pain and MRI evidence of corroborative cervical spondylotic foraminal stenosis and who had failed at least 6 weeks of conservative management consisting of medication and physical rehabilitation were included in this study. Patient Reported Outcome Measurement Information System (PROMIS) domains of Physical Function (PF) v1.2/v2.0 and Pain Interference (PI) v1.1 were collected at baseline and at 3-, 6-, and 12-month follow-up visits. Statistical analysis comparing baseline score with follow-up post-procedural PROMIS scores was performed. The percentage of patients who reported improvement exceeding the minimal clinically important difference was calculated for survey responders and for the worst case scenario. RESULTS: 87 patients met inclusion criteria. PROMIS PI at 3-, 6-, and 12-months follow-up statistically improved by 2.2 (95 % confidence interval [CI] 2.1-2.4, p = 0.02), 2.3 (95 % CI 2.1-2.5, p = 0.03), and 2.7 (95 % CI 2.5-3.0, p = 0.03) points, respectively. Follow-up PROMIS PF score did not significantly differ from baseline scores. The percentage of patients that exceeded MCID thresholds of clinical significance was 59 % (95 % CI 47%-70 %) at 3-months, 52 % (95 % CI 41%-63 %) at 6-months, and 60 % (95 % CI 50%-72 %) at 12-months. Worst case scenario analysis demonstrated that 51 % (95 % CI 39%-62 %) of patients exceeded the MCID thresholds at 3-months, 32 % (95 % CI 22%-43 %) at 6-months, and 23 % (95 % CI 13%-33 %) at 12-months. CONCLUSIONS: Our study demonstrated that TFESI leads to a long-term improvement up to a year in pain for patients with cervical radiculopathy.
背景：神经根型颈椎病是疼痛的常见原因。对于保守治疗失败的患者，经椎间孔硬膜外类固醇注射（TFESI）是一种被认可的干预措施，也是减压手术的替代方法。 目的：本研究旨在评估TFESI对神经根型颈椎病患者的治疗效果。 方法：本研究纳入了在多学科三级学术脊柱中心接受治疗的成年患者，这些患者有颈神经根性疼痛且MRI显示有确凿的颈椎病性椎间孔狭窄，并且至少6周的药物和物理康复保守治疗失败。在基线以及3个月、6个月和12个月随访时收集患者报告结局测量信息系统（PROMIS）的身体功能（PF）v1.2/v2.0和疼痛干扰（PI）v1.1领域的数据。对基线评分与术后随访PROMIS评分进行统计分析比较。计算报告改善超过最小临床重要差异的患者百分比，包括调查应答者和最坏情况。 结果：87例患者符合纳入标准。在3个月、6个月和12个月随访时，PROMIS PI分别在统计学上改善了2.2分（95%置信区间[CI] 2.1 - 2.4，p = 0.02）、2.3分（95% CI 2.1 - 2.5，p = 0.03）和2.7分（95% CI 2.5 - 3.0，p = 0.03）。随访时PROMIS PF评分与基线评分无显著差异。超过临床意义MCID阈值的患者百分比在3个月时为59%（95% CI 47% - 70%），6个月时为52%（95% CI 41% - 63%），12个月时为60%（95% CI 50% - 72%）。最坏情况分析表明，3个月时51%（95% CI 39% - 62%）的患者超过MCID阈值，6个月时为32%（95% CI 22% - 43%），12个月时为23%（95% CI 13% - 33%）。 结论：我们的研究表明，TFESI可使神经根型颈椎病患者的疼痛在长达一年的时间内得到长期改善。
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