Patient-Reported Outcomes and Satisfaction after Cervical Epidural Steroid Injection for Cervical Radiculopathy

Authors

  • Ali Hosseinpoor Non-Communicable Disease Research Center, Fasa University of Medical Sciences, Fasa, Fars, Iran
  • Masoud Hashemi Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Payman Dadkhah Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Mehrdad Taheri Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Mahshid Ghasemi Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Mojtaba Farjam Non-Communicable Disease Research Center, Fasa University of Medical Sciences, Fasa, Fars, Iran

DOI:

https://doi.org/10.31661/gmj.v8i.1478

Keywords:

Radiculopathy, Neck Pain, Steroids, Injection, Epidural, Pain Management

Abstract

Background: Cervical radiculopathy caused by disc herniation is a frequent public health issue with economical and socio-professional impacts. The objective of the present study is to evaluate the patient-reported outcomes and satisfaction from cervical epidural steroid injection during a 2-year follow-up. Materials and Methods: Results based on patients’ reports from a previously performed intervention of cervical epidural steroid injection on patients with cervical radiculopathy due to cervical disc herniation are prospectively collected. Outcome measures are Neck Disability Index (NDI), numerical rating scale (NRS) for pain assessment, and 5-scale patient satisfaction questionnaire (PSQ) plus opioid medication for pain relief, additional injections, and progression to surgery. Results: Of total 37 cases, 34 were available for follow-up after 2-year postoperatively. The mean preoperative NDI was 21.17 and improved to 17.38, and the mean NRS was 7.7 and improved to 5.00; both were statistically significant. Mean patient satisfaction after 2 years was 3.17 out of 5. 11 cases needed additional injections, and 4 of patients proceeded to surgery. Conclusion: We showed that transforaminal cervical epidural steroid injection for cervical radiculopathy is an effective non-surgical treatment option, providing significant pain relief and functional improvement during 2-years follow-up along with higher-than-average patient satisfaction in most of our patients. [GMJ.2019;8:e1478] 

References

Iyer S, Kim HJ. Cervical radiculopathy. Curr Rev Musculoskelet Med. 2016;9(3):272-80. https://doi.org/10.1007/s12178-016-9349-4PMid:27250042 PMCid:PMC4958381 Caridi JM, Pumberger M, Hughes AP. Cervical radiculopathy: a review. HSS J. 2011;7(3):265-72. https://doi.org/10.1007/s11420-011-9218-zPMid:23024624 PMCid:PMC3192889 Cohen SP, editor Epidemiology, diagnosis, and treatment of neck pain. Mayo Clin Proc; 2015: Elsevier. https://doi.org/10.1016/j.mayocp.2014.09.008PMid:25659245 Hashemi SM, Dadkhah P, Taheri M, Abootorabi SMHS. Effects of Percutaneous Laser Disc Decompression (PLDD) on Clinical Outcome of Teared Vs Intact Protruded Intervertebral Discs: A Prospective Cohort Study. Orthopaedic Surgery and Traumatology. 2018;2(1):279-85. Woods BI, Hilibrand AS. Cervical radiculopathy. J Spinal Disord Tech. 2015;28(5):E251-E9. https://doi.org/10.1097/BSD.0000000000000284PMid:25985461 Wainner RS, Gill H. Diagnosis and nonoperative management of cervical radiculopathy. J Orthop Sports Phys Ther. 2000;30(12):728-44. https://doi.org/10.2519/jospt.2000.30.12.728PMid:11153552 Moghtadaei M, Yeganeh A, Boddouhi B, Alaee A, Farahini H, Otoukesh B. Effect of high tibial osteotomy on hip biomechanics in patients with genu varum: a prospective cohort study. Interv Med Appl Sci. 2017;9(2):94-9. https://doi.org/10.1556/1646.9.2017.20PMid:28932503 PMCid:PMC5598133 Manchikanti L, Kaye AD, Manchikanti K, Boswell M, Pampati V, Hirsch J. Efficacy of Epidural Injections in the Treatment of Lumbar Central Spinal Stenosis: A Systematic Review. Anesthe Pain Med. 2015;5(1):e23139. https://doi.org/10.5812/aapm.23139PMid:25789241 PMCid:PMC4350165 Manchikanti L, Pampati V, Benyamin RM, Boswell MV. Analysis of Efficacy Differences between Caudal and Lumbar Interlaminar Epidural Injections in Chronic Lumbar Axial Discogenic Pain: Local Anesthetic Alone vs. Local Combined with Steroids. Int J Med Sci. 2015;12(3):214-22. https://doi.org/10.7150/ijms.10870PMid:25678838 PMCid:PMC4323359 Pandey RA. Efficacy of Epidural Steroid Injection in Management of Lumbar Prolapsed Intervertebral Disc: A Comparison of Caudal, Transforaminal and Interlaminar Routes. Journal of Clinical and Diagnostic Research : JCDR. 2016;10(7):RC05-RC11. https://doi.org/10.7860/JCDR/2016/18208.8127PMid:27630917 PMCid:PMC5020256 Park EJ, Park SY, Lee SJ, Kim NS, Koh DY. Clinical outcomes of epidural neuroplasty for cervical disc herniation. J Korean Med Sci. 2013;28(3):461-5. https://doi.org/10.3346/jkms.2013.28.3.461PMid:23487574 PMCid:PMC3594612 Veihelmann A, Devens C, Trouillier H, Birkenmaier C, Gerdesmeyer L, Refior H. Epidural neuroplasty versus physiotherapy to relieve pain in patients with sciatica: a prospective randomized blinded clinical trial. J Orthop Sci. 2006;11(4):365-9. https://doi.org/10.1007/s00776-006-1032-yPMid:16897200 Buenaventura RM, Datta S, Abdi S, Smith HS. Systematic review of therapeutic lumbar transforaminal epidural steroid injections. Pain Physician. 2009;12(1):233-51. Haefeli M, Elfering A. Pain assessment. Eur Spine J. 2006;15(1):S17-S24. https://doi.org/10.1007/s00586-005-1044-xPMid:16320034 PMCid:PMC3454549 Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther. 1991;14(7):409-15. https://doi.org/10.1037/t35122-000 Thayaparan AJ, Mahdi EJ. The Patient Satisfaction Questionnaire Short Form (PSQ-18) as an adaptable, reliable, and validated tool for use in various settings. Med Educ Online. 2013;18. https://doi.org/10.3402/meo.v18i0.21747PMid:23883565 PMCid:PMC3722414 Babita Ghai M, Dipika Bansal D, Jonan Puni Kay M, Kaivalya Sadashiv Vadaje M. Transforaminal versus parasagittal interlaminar epidural steroid injection in low back pain with radicular pain: a randomized, double-blind, active-control trial. Pain Physician. 2014;17:277-90. Beyaz SG. Comparison of transforaminal and interlaminar epidural steroid injections for the treatment of chronic lumbar pain. Brazilian Journal of Anesthesiology (English Edition). 2017;67(1):21-7. https://doi.org/10.1016/j.bjane.2015.06.003PMid:28017166 Botwin KP, Gruber RD, Bouchlas CG, Torres-Ramos FM, Sanelli JT, Freeman ED, et al. Fluoroscopically Guided Lumbar Transformational Epidural Steroid Injections in Degenerative Lumbar Stenosis: An Outcome Study. Am J Phys Med Rehabil. 2002;81(12):898-905. https://doi.org/10.1097/00002060-200212000-00003PMid:12447088 Jeong HS, Lee JW, Kim SH, Myung JS, Kim JH, Kang HS. Effectiveness of transforaminal epidural steroid injection by using a preganglionic approach: a prospective randomized controlled study. Radiology. 2007;245(2):584-90. https://doi.org/10.1148/radiol.2452062007PMid:17940309 Benoist M, Boulu P, Hayem G. Epidural steroid injections in the management of low-back pain with radiculopathy: an update of their efficacy and safety. Eur Spine J. 2012;21(2):204-13. https://doi.org/10.1007/s00586-011-2007-zPMid:21922288 PMCid:PMC3265586 Sung MS. Epidural Steroid Injection for Lumbosacral Radiculopathy. Korean J Radiol. 2006;7(2):77-9. https://doi.org/10.3348/kjr.2006.7.2.77PMid:16799267 PMCid:PMC2667591 Abram SE. Treatment of lumbosacral radiculopathy with epidural steroids. Anesthesiology: The Journal of the American Society of Anesthesiologists. 1999;91(6):1937-. https://doi.org/10.1097/00000542-199912000-00047PMid:10598637 Lee JH, Lee S-H. Comparison of Clinical Efficacy Between Interlaminar and Transforaminal Epidural Injection in Patients With Axial Pain due to Cervical Disc Herniation. Medicine. 2016;95(4):e2568-e. https://doi.org/10.1097/MD.0000000000002568PMid:26825899 PMCid:PMC5291569 Manchikanti L, Cash KA, Pampati V, Malla Y. Two-year follow-up results of fluoroscopic cervical epidural injections in chronic axial or discogenic neck pain: a randomized, double-blind, controlled trial. Int J Med Sci. 2014;11(4):309-20. https://doi.org/10.7150/ijms.8069PMid:24578607 PMCid:PMC3936024 Benditz A, Brunner M, Zeman F, Greimel F, Florian V, Boluki D, et al. Effectiveness of a multimodal pain management concept for patients with cervical radiculopathy with focus on cervical epidural injections. Sci Rep. 2017;7(1):7866-. https://doi.org/10.1038/s41598-017-08350-xPMid:28801567 PMCid:PMC5554143 Bush K, Hillier S. Outcome of cervical radiculopathy treated with periradicular/epidural corticosteroid injections: a prospective study with independent clinical review. Eur Spine J. 1996;5(5):319-25. https://doi.org/10.1007/BF00304347PMid:8915637 Kolstad F, Leivseth G, Nygaard O. Transforaminal steroid injections in the treatment of cervical radiculopathy. A prospective outcome study. Acta Neurochir (Wien). 2005;147(10):1065-70. https://doi.org/10.1007/s00701-005-0542-2PMid:15924210 Persson L, Anderberg L. Repetitive transforaminal steroid injections in cervical radiculopathy: a prospective outcome study including 140 patients. Evid Based Spine Care J. 2012;3(3):13-20. https://doi.org/10.1055/s-0032-1327805PMid:23531493 PMCid:PMC3592766 Anderberg L, Annertz M, Persson L, Brandt L, Säveland H. Transforaminal steroid injections for the treatment of cervical radiculopathy: a prospective and randomised study. Eur Spine J, 2007;16(3):321-8. https://doi.org/10.1007/s00586-006-0142-8PMid:16835737 PMCid:PMC2200696 Zarghooni K, Rashidi A, Siewe J, Röllinghoff M, Bredow J, Eysel P, et al. Single-Shot Epidural Injections in the Management of Radicular Pain. Orthop Rev (Pavia). 2015;7(4):5985-. https://doi.org/10.4081/or.2015.5985PMid:26793292 PMCid:PMC4703910 Delaney TJ, Rowlingson JC, Carron H, Butler A. Epidural steroid effects on nerves and meninges. Anesth Analg. 1980;59(8):610-4. https://doi.org/10.1213/00000539-198008000-00006PMid:7190796 Rowlingson JC. Epidural steroids: Do they have a place in pain management? APS Journal. 1994;3(1):20-7. https://doi.org/10.1016/S1058-9139(05)80231-1 Rowlingson JC, Kirschenbaum LP. Epidural analgesic techniques in the management of cervical pain. Anesth Analg. 1986;65(9):938-42. https://doi.org/10.1213/00000539-198609000-00005 Rathmell JP, Aprill C, Bogduk N. Cervical transforaminal injection of steroids. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2004;100(6):1595-600. https://doi.org/10.1097/00000542-200406000-00035PMid:15166582 Castagnera L, Maurette P, Pointillart V, Vital J, Erny P, Senegas J. Long-term results of cervical epidural steroid injection with and without morphine in chronic cervical radicular pain. Pain. 1994;58(2):239-43. https://doi.org/10.1016/0304-3959(94)90204-6 Sehgal N, Paidin M, Rasmussen D, Tariq A, Hetzel S. Is there a decrease in opioid use after a single epidural steroid injection in LBP: a pilot study. The Journal of Pain. 2013;14(4):S85. https://doi.org/10.1016/j.jpain.2013.01.676 Friedly J, Nishio I, Bishop MJ, Maynard C. The relationship between repeated epidural steroid injections and subsequent opioid use and lumbar surgery. Arch Phys Med Rehabil. 2008;89(6):1011-5. https://doi.org/10.1016/j.apmr.2007.10.037PMid:18503793

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Published

2019-11-03

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Vol. 8 (2019): 2019

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Original Article

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