Does a Positive Response to Transforaminal Epidural Steroid Injection Identify Patients Who Can Avoid Surgery for Two Years?

IF 2.5 3区医学 Q2 CLINICAL NEUROLOGY Pain Research & Management Pub Date : 2023-10-14 eCollection Date: 2023-01-01 DOI:10.1155/2023/4298436

Aki Fujiwara, Keisuke Watanabe, Hideki Shigematsu, Katsuhiro Kimoto, Mitsuru Ida, Yasuhito Tanaka, Masahiko Kawaguchi

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Abstract

Background: Transforaminal epidural steroid injection (TFESI) is widely used to manage lumbar radiculopathy. In clinical settings, patients often undergo repeated transforaminal epidural injections with or without steroid administration.

Objectives: To examine whether a positive response to TFESI at the first month, can in clinical settings, identify patients with radiculopathy who can avoid surgery for two years. Study Design/Setting. This prospective observational study was conducted at an academic medical center.

Methods: Individuals aged ≥20 years who had been referred to our pain center by spine surgeons were enrolled. All patients were assessed using the Numerical Rating Scale (NRS) at baseline and 1 month after the first TFESI. Patients were divided into two groups according to the NRS decrement: the positive response (PR) group achieved a ≥2.0 decrease on the NRS 1 month after the first TFESI compared to baseline and the no response (NR) group achieved a <2.0 decrease on the NRS. The incidence rates of surgery over two years were compared between the two groups. In addition, we calculated the hazard ratio of the PR group to the NR group regarding the incidence of surgery over two years using the Cox proportional hazard model, adjusting for baseline NRS.

Results: Seventy-six patients completed the two-year follow-up. In total, 8 and 68 patients had bilateral and unilateral radiculopathy, respectively. The PR and NR groups included 35 and 41 patients, respectively. The rate of surgery avoidance was 85.7% and 73.2% in the PR and NR groups, respectively. This difference was not statistically significant (p=0.26). After adjusting for baseline NRS, the hazard ratio of the PR group to the NR group regarding the incidence of surgery within two years was 0.35 (95% confidence interval: 0.11-1.11, p=0.08).

Conclusion: A positive response to TFESI may not identify patients who can avoid surgery for two years.

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经孔硬膜外类固醇注射的阳性反应是否能识别出两年内可以避免手术的患者？

背景：经椎间孔硬膜外类固醇注射（TFESI）被广泛用于治疗腰神经根病。在临床环境中，患者经常在服用或不服用类固醇的情况下接受反复的经孔硬膜外注射。目的：研究在第一个月对TFESI的阳性反应是否可以在临床环境中确定可以避免手术两年的神经根病患者。研究设计/设置。这项前瞻性观察研究是在一家学术医学中心进行的。方法：年龄≥20岁的个体我们招募了几年来被脊椎外科医生转诊到我们疼痛中心的患者。所有患者在基线和1 第一次TFESI后一个月。根据NRS的减少将患者分为两组：阳性反应（PR）组NRS1的减少≥2.0 与基线相比，第一次TFESI后一个月，无反应（NR）组获得了a结果：76名患者完成了为期两年的随访。总共有8名和68名患者分别患有双侧和单侧神经根病。PR组和NR组分别包括35名和41名患者。PR组和NR组的手术回避率分别为85.7%和73.2%。这一差异没有统计学意义（p=0.26）。在调整基线NRS后，PR组与NR组关于两年内手术发生率的风险比为0.35（95%置信区间：0.11-1.11，p=0.08）。结论：对TFESI的阳性反应可能无法确定可以避免两年手术的患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pain Research & Management CLINICAL NEUROLOGY-

CiteScore

5.30

自引率

0.00%

发文量

109

审稿时长

>12 weeks

期刊介绍： Pain Research and Management is a peer-reviewed, Open Access journal that publishes original research articles, review articles, and clinical studies in all areas of pain management. The most recent Impact Factor for Pain Research and Management is 1.685 according to the 2015 Journal Citation Reports released by Thomson Reuters in 2016.