20. Long-term results of cervical transforaminal epidural steroid injections for cervical radiculopathy

Abstract

<h3>BACKGROUND CONTEXT</h3> Cervical radiculopathy can have significant effects on patient's pain and quality of life. Cervical transforaminal epidural steroid injections (TF ESIs) are thought to be high-risk procedures with limited longer-term effectiveness. <h3>PURPOSE</h3> To determine whether cervical TF ESIs improve patient reported quality of life outcomes, offer therapeutic benefit, and whether TF ESIs decrease the need to undergo cervical spine surgery. <h3>STUDY DESIGN/SETTING</h3> Academic hospital medical spine practice. <h3>PATIENT SAMPLE</h3> A total of 223 consecutive patients who underwent unilateral cervical TF ESI between 12/11/2013 and 12/23/2020. Average age was 51.8 (SD = 11.2 years) with 49.8% male, 50.2% female. Of the total, 3.8% were performed at C3-4, 9.5% at C4-5, 41.4% at C5-6, 38.0% at C6-7, and 7.2% at C7-T1. Median duration of symptoms was 9 months; 18.7% had previous cervical spine surgery; 19.8% had a repeat injection at the same level; 86.3% had IV sedation (Versed [midazolam]). Pathology 38.9% had disc herniation, 59.9 had bony foraminal stenosis, 1.1% had psedoarthrosis. Ninety-five percent had physicial therapy prior to cervical TF ESI. 35.5% had CT cervical spine and 40.8% had upper extremity EMG prior to cervical TF ESI. <h3>OUTCOME MEASURES</h3> We evaluated data using validated patient-reported outcomes measures – PHQ9, and PROMIS-GH Physical, and PROMIS-GH Mental. <h3>METHODS</h3> Retrospective review of single practitioner's outcomes after all patient undergoing cervical TF ESI from 2014-2020. <h3>RESULTS</h3> Of the 223 patients, 60 patients went on to have cervical surgery, 26.9%. Of the total patients, 92.8% had diagnostic benefit considered to be at least 80% immediate relief 4 hours after injection. 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 post-injection surgery that was 2.03 times larger, compared to patients who did not have prior spine surgery (P = 0.012). Mean PHQ-9 change of -1.53 at 3 months (p=0.016, n=91), -2.14 at 6 months (p= 0.006, n=53), -1.40 at 12 months (p= 0.056, n=61), -2.22 at 24 months (p=0.017, n=34). Mean PROMIS-GH physical change of +2.12 at 3 months (p=0.002, n=80), +2.22 at 6 months (p=0.005, n=55), +3.10 at 12 months (p=0.001, n=65), +3.23 at 24 months (p=0.001, n=38). History of cervical surgery was associated with worse PHQ-9 scores. <h3>CONCLUSIONS</h3> Cervical TF ESI can be done safely with minimal morbidity and significant benefit at 24 months. In more than 2/3 of the patients, surgery was not needed due to diagnostic and therapeutic benefit from cervical TF ESI. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.