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Clinical Outcomes of Cervical Radiculopathy Following Epidural Steroid Injection: A Prospective Study With Follow-up for More Than 2 Years

Lee, Sang-Hun MD*; Kim, Ki-Tack MD*; Kim, Dong-Hwan MD; Lee, Bong-Jae MD; Son, Eun-Seok MD§; Kwack, Yoon-Ho MD*

doi: 10.1097/BRS.0b013e31823b4d1f
Cervical Spine

Study Design. A prospective clinical outcome study.

Objective. To analyze clinical outcome and prognostic factors of the epidural steroid injection (ESI) for cervical radiculopathy (CR) patients who were considered surgical candidates.

Summary of Background Data. The clinical outcomes and prognostic factors of ESI for CR have not been consistently reported, and there has been no prospective study with long-term follow-up.

Methods. ESI was administered in 98 patients (mean age = 50.1 yr, follow-up = 40.4 mo) with CR without major neurological deficit. A total of 3 or fewer ESIs were administered, using either the interlaminar or transforaminal technique. The patients were divided into 2 groups: those who did not have surgery and those who underwent surgery at the last follow-up. We analyzed statistical difference of relevant clinical (sex, age, duration of symptom, previous episode of CR, visual analogue scale [VAS] of arm pain, etc.), radiological factors (soft disc vs. hard disc, central disc vs. foraminal disc, single segment involvement vs. multiple segment involvement, degree of neural compression and degeneration, etc.) and clinical outcomes (VAS of arm pain, Odom's criteria, and neck disability index) between the 2 groups.

Results. The patients received mean 1.8 ESI treatments. At the final follow-up, 79 of the patients (80.6%) did not undergo surgery, whereas the other 19 patients (19.4%) underwent surgery. Of the clinical factors, recurred CR (15.2% vs. 42.1%, P = 0.022) and mean VAS score of arm pain before (6.1 vs. 8.2, P = 0.000) and after ESI (2.8 vs. 6.9, P = 0.000) were significantly different between both groups. Radiological factors and outcome parameters showed no significant difference.

Conclusion. In more than 80% of patients with CR who were surgical candidates, surgery was avoided using ESI. The significant factors predisposing failure of ESI were intensity of symptom and a previous episode of CR. ESI is therefore considered a safe and effective treatment to choose before undergoing surgery.

In more than 80% of cervical radiculopathy (CR) patients, surgery was avoided using epidural steroid injection (ESI). The significant factors predisposing failure of ESI were intensity of symptom and a previous episode of CR. Radiological factors and outcome parameters showed no significant difference. ESI is therefore considered a safe and effective treatment to choose before undergoing surgery.

*Department of Orthopedic Surgery;

Physical Medicine and Rehabilitation;

Anesthesiology and Pain Medicine, Kyung Hee University Hospital at Gangdong, Seoul;

§Department of Orthopedic Surgery, Kei Myung University, College of Medicine, Daegu, Korea.

Address correspondence and reprint requests to Sang-Hun Lee, MD, Department of Orthopaedic Surgery, Spine Center, Kyung Hee University Hospital at Gangdong, #149, Sangil-dong, Kangdong-gu, Seoul 134-727, Korea; E-mail: shl6@khu.ac.kr

Acknowledgment date: May 25, 2011. First revision date: August 10, 2011. Acceptance date: September 30, 2011.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

© 2012 Lippincott Williams & Wilkins, Inc.