The value of short-term pain relief in predicting the 1-month outcome of 'indirect' cervical epidural steroid injections.

Abstract

Clinical management after epidural steroid injections (ESI) of patients with radiculopathy secondary to a cervical disc herniation (CDH) is uncertain. This study aims to determine whether short-term arm pain alleviation following computed tomography-guided 'indirect' cervical ESI can predict the 1-month outcome. We conducted a prospective observation of 45 consecutive patients at a tertiary radiological department. Study components were visual analog scale arm and neck pain at baseline, 15, 30, and 45min, 1, 2, and 4h, on days 1-14, 1month, and at 1year. Health-related quality of life and functional impairment were assessed using the short form-12 and Neck Pain and Disability Scale. Patients who reported ≥80% persisting arm pain, as well as patients who underwent a second injection or an operation within 1month were defined as 'non-responders'. Logistic regression was used to analyze the effect size of the relationship between >50% pain relief at any given study visit and responder status. Patients experiencing a >50% pain reduction 4h after the injection were four times as likely to be responders as those experiencing ≤50% pain reduction (OR 4.04, 95% CI 1.10-14.87). The effect was strongest on days 5-6 (OR 18.37, 95% CI 3.39-99.64) and remained significant until day 14. The results of this study can guide physicians in managing patients with CDH: a ≤50% arm pain relief within 1week after an 'indirect' cervical ESI predicts an unfavorable 1-month outcome and suggests that other treatment options may be considered at an earlier point in time.