Levin Josh, Gall Nolan, Chan John, Huynh Lisa, Koltsov Jayme, Kennedy D J, Smuck Matt
Department of Orthopaedic Surgery, Stanford University, 450 Broadway St., Pavilion C, 4th Floor, MC 6342, Redwood City, CA, 94063, United States.
Department of Neurosurgery, Stanford University, United States.
Interv Pain Med. 2021 Dec 6;1(1):100001. doi: 10.1016/j.inpm.2021.100001. eCollection 2022 Mar.
Many patients who receive cervical epidural steroid injections (ESIs) are referred for the injection from a physician who does not perform the procedure.
To compare success rates of fluoroscopically-guided cervical ESIs 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 cervical transforaminal (TF) or interlaminar (IL) ESIs at a single outpatient academic spine center.
Numeric Rating Scale (NRS) pain score improvement.
Current procedural terminology (CPT) codes were used to search all consecutive patients who received a cervical TF or IL ESI between January 2010 and October 2018. All patients with pre and post-injection NRS pain scores within 60 days of the injection were included in the analysis.
A total of 363 ESIs were analyzed (178 TF and 185 IL). 275 patients were evaluated and referred for the injection by a spine specialist who performs these procedures (Group A), and 88 were evaluated and referred by a spine specialist who does not perform these procedures (Group B). Success was defined as > 50% improvement in the NRS pain score. 52% [95% CI: 47-57%] of all patients who received a cervical ESI achieved a successful outcome. There were better results in Group A with a 57% [95% CI: 51-63%] success rate compared to a 38% [95% CI: 28-48%] success rate in Group B. Group A also had a higher proportion of patients who achieved at least 80% pain relief (31% [95% CI: 26-36%]) compared to Group B (17% [95% CI: 9-25%]).
This retrospective study demonstrated better results from cervical ESIs when patients were referred for the injection by a physician who performs ESIs. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
许多接受颈椎硬膜外类固醇注射（ESI）的患者是由不进行该操作的医生转诊来接受注射的。
比较在接受临床评估并由常规进行ESI的脊柱专科 fellowship 培训医生推荐注射的患者（A组）与接受临床评估并由将患者转诊给其他医生进行该操作的脊柱专科 fellowship 培训医生评估的患者（B组）中，透视引导下颈椎ESI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颈椎经椎间孔（TF）或椎板间（IL）ESI的患者。
数字评分量表（NRS）疼痛评分改善情况。
使用当前程序术语（CPT）代码搜索2010年1月至2018年10月期间所有接受颈椎TF或IL ESI的连续患者。分析所有在注射后60天内有注射前和注射后NRS疼痛评分的患者。
共分析了363次ESI（178次TF和185次IL）。275名患者由进行这些操作的脊柱专科医生评估并转诊接受注射（A组），88名患者由不进行这些操作的脊柱专科医生评估并转诊（B组）。成功定义为NRS疼痛评分改善>50%。所有接受颈椎ESI的患者中有52%[95%CI：47 - 57%]取得了成功结果。A组结果更好，成功率为57%[95%CI：51 - 63%]，而B组成功率为38%[95%CI：28 - 48%]。A组中至少实现80%疼痛缓解的患者比例也高于B组（31%[95%CI：26 - 36%]对比B组的17%[95%CI：9 - 25%]）。
这项回顾性研究表明，当患者由进行ESI的医生转诊接受注射时，颈椎ESI的效果更好。本研究未接受公共、商业或非营利部门资助机构的任何特定资助。
