Ten-Day Response to CT-Guided Spinal Infiltration Therapy in More Than 1,000 Patients

Abstract

Aims: Infiltration therapy (IT) for degenerative spine disease is considered a valuable nonsurgical treatment option in the absence of severe neurological deficits. The aim of this study was to evaluate the 10-day response to CT-guided IT in various spinal disorders and to identify parameters that are positively or negatively associated with short-term outcome. Methods: Prospective study on n = 1,327 consecutive patients that received CT-guided IT between February 2007 and June 2013. Different steroids (betamethasone, dexamethasone, triamcinolone) with or without bupivacaine were applied using different CT-guided techniques. The primary end point was the patients' response 10 days after IT, which was graded as being better, same, or worse by a handout questionnaire. The chi-square test was used for subgroup comparisons. Results: A total of 1,002 patients provided 10-day follow-up. Clinically meaningful pain relief was achieved in 65/107 patients treated for cervical disc herniation (60.8%), 27/60 for cervical foraminal stenosis (45%), 295/412 for lumbar disc herniation (71.6%), 134/199 for lumbar spinal stenosis (67.3%), 35/61 for cervical facet joint pain (57.4%), 87/128 for lumbar facet joint pain (68%), and 25/35 for sacroiliac joint syndrome (71.4%). For CDH and CFS, both direct and indirect infiltration techniques were equally effective. Patients with “soft compression” (CDH) had better pain outcomes than those with “hard compression” (CFS; p = 0.034). For LDH, the response tended to be better in patients receiving combined transforaminal (TF) and interlaminar (IL) IT as compared with single TF or IL IT (p = 0.089). For LSS, any infiltration technique (TF, IL, or combined) resulted in equal responses (p = 0.767). There was no difference with regard to the type or dose of cortisone administered on 10-day response for any spinal disorder. An age-dependent difference was shown for elderly patients with LSS and SIJS responding better to IT. Repeated infiltrations were equally effective in alleviating pain as compared with the first infiltration. Conclusions: CT-guided IT for various spinal disorders has an overall positive response rate of 66.7% after 10 days. Various infiltration techniques, types, and doses of cortisone were equally effective as were repeated infiltrations compared with first-time treatments.