Lumbar epidural steroid injections for lumbosacral radicular pain in patients with normal imaging: A propensity-matched study

Steven P. Cohen , Ariz A. Keshwani , Dost Khan , Milan P. Stojanovic
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Abstract

Background

Epidural steroid injections are indicated for radicular pain, with a pre-injection MRI not mandated in guidelines. There is conflicting evidence that MRI findings correlate with outcomes.

Methods

Fourteen patients with near-normal imaging (i.e., no evidence of nerve root compression and minor degenerative changes if present) who underwent ESI for lumbosacral radicular pain and were followed for up to 12 weeks were propensity matched against 14 patients with radicular pain secondary to concordant MRI pathology. The primary outcome measure was mean reduction in average leg pain relief at 4 and 12 weeks. Secondary outcome measures included average back pain, function, analgesic reduction, satisfaction, and a categorical measure of success predesignated as a ≥2-point decrease in average leg pain score coupled with a positive global perceived effect and not requiring any additional intervening interventions.

Results

For mean reduction in average leg pain at 4 weeks, there were no significant differences between those with near-normal MRIs and those with abnormal imaging (2.36 (SD 2.55) vs. 2.61 (SD 2.15); P = 0.72). For average back pain reduction at the same time point, the mean reduction was 0.75 (1.73) among cases vs. 1.07 (2.01) in control patients (P = 0.57). There were also no differences observed in pain reduction outcomes at 12 weeks. The average reduction in Oswestry Disability Index at 12 weeks favored the near-normal imaging group (8.64 % (SD 11.36) vs. 0 % (7.69); P = 0.047). A trend was noted wherein more patients with abnormal imaging experienced a positive outcome at 4 weeks (50 % vs. 28.57 %; P = 0.22) but not 12 weeks (28.57 % in both groups).

Conclusions

There were no significant differences in pain outcomes compared to control patients, though patients with near-normal imaging fared worse than historical controls and the larger cohort from which propensity-matched patients were selected. The possibility of poorer outcomes should be considered when selecting patients with normal imaging and radiculopathy for ESI.
腰椎硬膜外类固醇注射治疗影像学正常患者腰骶神经根痛:倾向匹配研究
背景:硬膜外类固醇注射适用于神经根性疼痛,注射前MRI检查在指南中没有强制要求。有相互矛盾的证据表明MRI结果与结果相关。方法14例影像学接近正常(即无神经根压迫和轻微退行性改变的证据)的腰骶神经根痛患者接受ESI治疗,随访长达12周,与14例继发于MRI病理一致的神经根痛患者倾向匹配。主要结局指标是4周和12周时平均腿部疼痛缓解的平均减少。次要结果测量包括平均背痛、功能、镇痛减少、满意度和成功的分类测量,预先指定为平均腿痛评分降低≥2分,并伴有积极的整体感知效果,不需要任何额外的干预措施。结果对于4周时平均腿部疼痛的减少,mri接近正常的患者和mri异常的患者之间没有显著差异(2.36 (SD 2.55) vs. 2.61 (SD 2.15);p = 0.72)。对于同一时间点的平均背部疼痛减轻,病例平均减轻0.75(1.73),对照组平均减轻1.07 (2.01)(P = 0.57)。在12周时疼痛减轻的结果也没有观察到差异。12周时Oswestry残疾指数的平均下降有利于接近正常影像学组(8.64% (SD 11.36) vs. 0% (7.69);p = 0.047)。有一种趋势被注意到,更多的异常影像学患者在4周时出现了阳性结果(50% vs. 28.57%;P = 0.22),但12周时无差异(两组均为28.57%)。结论:与对照患者相比,疼痛结果没有显著差异,尽管影像学接近正常的患者的表现比历史对照组和从倾向匹配的患者中选择的更大队列更差。在选择影像学正常且神经根病变的患者进行ESI时,应考虑预后较差的可能性。
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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