Wednesday, September 26, 2018 1:00 PM – 2:00 PM Interventional Pain Management: 31. Epidural perineural injection of autologous conditioned serum is better than methylprednisolone in unilateral cervical radiculopathy at longer duration: a prospective randomized comparative study

Abstract

BACKGROUND CONTEXT Cytokine molecules like IL-1 and prostaglandins are considered sensitizers of nerve root at chemical level in the pathogenesis of pain in cervical radiculopathy. Autologous conditioned xerum which contains interleukin-1 receptor antagonist (IL-1Ra) in high concentration may be a promising, new treatment option for patients with unilateral cervical radicular compression. It can be given by translaminar or transforaminal routes to the affected roots but the rationale for using a transforaminal route of injection rather than an inter-laminar route is that the injectate is delivered directly onto the target nerve root. PURPOSE To compare the efficacy of epidural perineural injection of autologous conditioned serum (ACS) with methylprednisolone (MPS) in treating unilateral cervical radiculopathy and to evaluate the treatment safety of ACS. STUDY DESIGN/SETTING A prospective randomized comparative study. PATIENT SAMPLE Two groups, ACS group (50 patients), MPS group (50 patients). Randomized with computer generated charts. OUTCOME MEASURES VAS scores for pain at 3 weeks (first follow up, 3 months (second follow-up), 6 months (third follow-up). METHODS Male or female patient aged between 30 years and 60 years with complaints of neck pain (moderate to severe as determined by VAS) and unilateral upper limb radiculopathy with radiological criteria: abnormal disc degeneration correlating with clinical findings were included and randomly divided into two groups. ACS group received autologous conditioned serum and the other group received methylprednisolone (MPS group) by transforaminal route under fluoroscopic guidance. ACS preparation -ACS was prepared by withdrawing 50 ml of blood from the patient under aseptic precautions and transferred to a centrifuge tube containing medical grade glass beads for incubation at 37°C, with 5% CO2 for 24 hours. After incubation, ACS was retrieved by centrifugation and stored at –20°C. RESULTS The ACS group had a decrease in pain by 50.70% (VAS score) at first follow-up (3 weeks), by 66.19% at second follow-up (3 months) and by 73.24% at third follow-up (6 months) compared to baseline. Group MPS had a decrease in pain by 68.12% at first follow-up, by 63.04% at second follow-up and by 58.45% at third follow-up compared to baseline. The difference between the two groups was statistically significant at first follow-up (p=.000) in favor of MPS group, but at third follow-up it was significant (P=.027) in favor of ACS. CONCLUSIONS Steroids (MPS) are effective in pain control in cervical radiculopathy for short duration but ACS improves disability and general health in long duration and is safe. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.