The value of short-term pain relief in predicting the long-term outcome of ‘indirect’ cervical epidural steroid injections View Full Text


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Article Info

DATE

2018-05

AUTHORS

Holger Joswig, Armin Neff, Christina Ruppert, Gerhard Hildebrandt, Martin Nikolaus Stienen

ABSTRACT

BACKGROUND: The predictive value of short-term arm pain relief after 'indirect' cervical epidural steroid injection (ESI) for the 1-month treatment response has been previously demonstrated. It remained to be answered whether the long-term response could be estimated by the early post-interventional pain course as well. METHODS: Prospective observational study, following a cohort of n = 45 patients for a period of 24 months after 'indirect' ESI for radiculopathy secondary to a single-level cervical disk herniation (CDH). Arm and neck pain on the visual analog scale (VAS), health-related quality of life with the Short Form-12 (SF-12), and functional outcome with the Neck Pain and Disability (NPAD) Scale were assessed. Any additional invasive treatment after a single injection (second injection or surgery) defined treatment outcome as 'non-response'. RESULTS: At 24 months, n = 30 (66.7%) patients were responders and n = 15 (33.3%) were non-responders. Non-responders exited the follow-up at 1 month (n = 10), at 3 months (n = 4), and at 6 months (n = 1). No patients were injected again or operated on between the 6- and 24-month follow-up. Patients with favorable treatment response at 24 months had significantly lower VAS arm pain (p < 0.05) than non-responders at days 6, 8-11, and at the 3-month follow-up. The previously defined cut-off of > 50% short term pain reduction was not a reliable predictor of the 24-month responder status. SF-12 and NPAD scores were better among treatment responders in the long term. CONCLUSIONS: Patients who require a second injection or surgery after 'indirect' cervical ESI for a symptomatic CDH do so within the first 6 months. Short-term pain relief cannot reliably predict the long-term outcome. More... »

PAGES

935-943

References to SciGraph publications

  • 2016-03. Correlation of pain, functional impairment, and health-related quality of life with radiological grading scales of lumbar degenerative disc disease in ACTA NEUROCHIRURGICA
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  • 2011-12. CT-guided cervical nerve root injections: comparing the immediate post-injection anesthetic-related effects of the transforaminal injection with a new indirect technique in SKELETAL RADIOLOGY
  • 2017-02. The value of short-term pain relief in predicting the 1-month outcome of ‘indirect’ cervical epidural steroid injections in ACTA NEUROCHIRURGICA
  • 2007-05. Cervical interlaminar epidural steroid injection for neck pain and cervical radiculopathy: effect and prognostic factors in SKELETAL RADIOLOGY
  • 2005-10. Transforaminal steroid injections in the treatment of cervical radiculopathy. A prospective outcome study in ACTA NEUROCHIRURGICA
  • 2014-07. The short- and medium-term effectiveness of CT-guided selective cervical nerve root injection for pain and disability in SKELETAL RADIOLOGY
  • 2009-11. Cervical transforaminal epidural steroid injection for the management of cervical radiculopathy: a comparative study of particulate versus non-particulate steroids in SKELETAL RADIOLOGY
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    http://scigraph.springernature.com/pub.10.1007/s00701-018-3511-2

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    http://dx.doi.org/10.1007/s00701-018-3511-2

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    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/29541886


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    31 schema:description BACKGROUND: The predictive value of short-term arm pain relief after 'indirect' cervical epidural steroid injection (ESI) for the 1-month treatment response has been previously demonstrated. It remained to be answered whether the long-term response could be estimated by the early post-interventional pain course as well. METHODS: Prospective observational study, following a cohort of n = 45 patients for a period of 24 months after 'indirect' ESI for radiculopathy secondary to a single-level cervical disk herniation (CDH). Arm and neck pain on the visual analog scale (VAS), health-related quality of life with the Short Form-12 (SF-12), and functional outcome with the Neck Pain and Disability (NPAD) Scale were assessed. Any additional invasive treatment after a single injection (second injection or surgery) defined treatment outcome as 'non-response'. RESULTS: At 24 months, n = 30 (66.7%) patients were responders and n = 15 (33.3%) were non-responders. Non-responders exited the follow-up at 1 month (n = 10), at 3 months (n = 4), and at 6 months (n = 1). No patients were injected again or operated on between the 6- and 24-month follow-up. Patients with favorable treatment response at 24 months had significantly lower VAS arm pain (p < 0.05) than non-responders at days 6, 8-11, and at the 3-month follow-up. The previously defined cut-off of > 50% short term pain reduction was not a reliable predictor of the 24-month responder status. SF-12 and NPAD scores were better among treatment responders in the long term. CONCLUSIONS: Patients who require a second injection or surgery after 'indirect' cervical ESI for a symptomatic CDH do so within the first 6 months. Short-term pain relief cannot reliably predict the long-term outcome.
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