Results of cervical epidural steroid injections based on the physician referral source

Abstract

BackgroundMany patients who receive cervical epidural steroid injections (ESIs) are referred for the injection from a physician who does not perform the procedure. PurposeTo compare success rates of fluoroscopically-guided cervical ESIs in patients who had a clinical evaluation and recommendation for the injection by a fellowship-trained spine specialist who routinely performs ESIs (Group A), vs those who had a clinical evaluation by a fellowship-trained spine specialist who referred the patient for the procedure to be done by a different physician (Group B). Study design/settingRetrospective, observational, in vivo study of consecutive patients. Patient Sample. Patients undergoing cervical transforaminal (TF) or interlaminar (IL) ESIs at a single outpatient academic spine center. Outcome measuresNumeric Rating Scale (NRS) pain score improvement. MethodsCurrent procedural terminology (CPT) codes were used to search all consecutive patients who received a cervical TF or IL ESI between January 2010 and October 2018. All patients with pre and post-injection NRS pain scores within 60 days of the injection were included in the analysis. ResultsA total of 363 ESIs were analyzed (178 ​TF and 185 IL). 275 patients were evaluated and referred for the injection by a spine specialist who performs these procedures (Group A), and 88 were evaluated and referred by a spine specialist who does not perform these procedures (Group B). Success was defined as > 50% improvement in the NRS pain score. 52% [95% CI: 47–57%] of all patients who received a cervical ESI achieved a successful outcome. There were better results in Group A with a 57% [95% CI: 51–63%] success rate compared to a 38% [95% CI: 28–48%] success rate in Group B. Group A also had a higher proportion of patients who achieved at least 80% pain relief (31% [95% CI: 26–36%]) compared to Group B (17% [95% CI: 9–25%]). ConclusionThis retrospective study demonstrated better results from cervical ESIs when patients were referred for the injection by a physician who performs ESIs. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.