利用患者报告结局测量信息系统作为结局指标评估透视引导下经椎间孔硬膜外类固醇注射治疗神经根型颈椎病的效果。
Evaluation of fluoroscopically guided transforaminal epidural steroid injections for cervical radiculopathy utilizing patient reported outcome measurement information system as an outcome measure.
作者信息
Stephens Andrew R, El-Hassan Ramzi, Laplante Ben L, Patel Rajeev K
机构信息
University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14623, USA.
出版信息
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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