153. Can cervical transforaminal epidural steroid injections be surgery-sparing?

Abstract

BACKGROUND CONTEXT Cervical radiculopathy can have a significant effect on patient quality of life. Cervical transforaminal epidural steroid injections (TF ESIs) have come under scrutiny due to risk of the procedure and lack of literature demonstrating long-term effect. PURPOSE To determine whether cervical TF ESIs improve patient-reported quality-of-life outcomes, offer therapeutic benefit, and whether TF ESIs decrease the need for cervical spine surgery. STUDY DESIGN/SETTING Hospital-based outpatient medical spine practice. PATIENT SAMPLE A total of 99 consecutive patients who underwent unilateral cervical TF ESI. Of those, 82 patients were available for analysis who underwent cervical injection between 12/11/2013 and 11/8/2017. Average age was 51.3 (SD = 11.5 years) with 51.2% male, 48.8% female. Levels included 45.1% performed at C5-6, 31.7% at C6-7, and 23% at other cervical levels. Median duration of symptoms was seven months. OUTCOME MEASURES We evaluated data using validated outcomes measures – PHQ9, PDQ, and PROMIS-Physical. METHODS Retrospective review of single practitioner's outcomes after all patients undergoing cervical TF ESIs from 2014-2017. RESULTS Of the 99 patients, 25 went on to have cervical surgery; 90.2% patients had diagnostic benefit considered to at least 80% immediate relief 4 hours after injection. Only one patient had a complication: a less than 1 minute seizure with lidocaine test dose. History of spine surgery was the only statistically significant predictor to long-term benefit after cervical TF ESI. Patients who had prior spine surgery had a hazard of postinjection surgery that was 4.2 times larger, compared to patients who did not have prior spine surgery (P = 0.001). None of the other predictors were significantly associated with time from injection to surgery. Patients who had duration of symptoms of 1 year or more had higher postinjection PDQ scores than patients who had duration of symptoms 3 months or less, and patients who had history of spine surgery had higher postinjection PDQ scores. Overall Mean Visual Analog Score (VAS) decreased mean 7.6 to 4.09 at 3 months (n=82), (P CONCLUSIONS Cervical TF ESIs can be done safely with minimal morbidity and significant benefit at 6 months. In more than 2/3 of the patients, surgery was not needed due to diagnostic and therapeutic benefit from cervical TF ESI. FDA DEVsICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.