Long Term Outcomes from CT-guided Indirect Cervical Nerve Root Blocks and their relationship to the MRI findings- A prospective Study

被引:22
作者
Bensler, Susanne [1 ,2 ]
Sutter, Reto [1 ,2 ]
Pfirrmann, Christian W. A. [1 ,2 ]
Peterson, Cynthia K. [1 ,2 ]
机构
[1] Orthoped Univ Hosp Balgrist, Dept Radiol, CH-8008 Zurich, Switzerland
[2] Univ Zurich, Fac Med, CH-8091 Zurich, Switzerland
关键词
Long term outcome; Cervical nerve root block; CT guided; Indirect; MRI; SPINAL ARTERY SYNDROME; TRANSFORAMINAL INJECTION; STEROID INJECTIONS; PAIN; RADICULOPATHY; ROPIVACAINE; MECHANISM; BACK;
D O I
10.1007/s00330-015-3758-4
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
To investigate long-term pain reduction and 'improvement' in patients with indirect cervical nerve-root-blocks in comparison to MRI findings. One hundred and twelve patients with MRI confirmed cervical radiculopathy and an indirect cervical nerve-root-block were included. Two radiologists independently evaluated the MRI examinations. 12 different MRI abnormalities at the level and side of infiltration were compared to pain relief and 'improvement' at 1-month, 3-months and 1-year post injection. The proportion of patients reporting clinically relevant 'improvement' was 36.7 % at 1-month, 53.9 % at 3-months and 68.1 % at 1-year. At 1-month post injection, a statistically significantly lower percentage of patients eventually requiring surgery reported improvement and lower NRS change scores compared to those who did not undergo surgery (p = 0.001). Patients with extrusion of the disc were around 4-times more likely to have surgery. At 1-year post-injection the presence of nerve-root compromise was significantly linked to treatment outcome (p = 0.011). Patients with nerve root compression were more likely to report improvement at 1 year. Patients with disc extrusions have less pain relief and are 4 times more likely to go to surgery than patients with disc protrusions. aEuro cent Good long term outcomes after indirect nerve root infiltrations with non-particulate steroids. aEuro cent The presence of nerve root compression was a predictive finding of 'improvement'. aEuro cent Significantly less patients subsequently having surgery had lower NRS scores 1-month post injection. aEuro cent There is less pain relief in patients with disc extrusions. aEuro cent There are less improvement in patients with modic type I changes.
引用
收藏
页码:3405 / 3413
页数:9
相关论文
共 29 条
[1]   Cervical transforaminal injection of corticosteroids into a radicular artery: a possible mechanism for spinal cord injury [J].
Baker, R ;
Dreyfuss, P ;
Mercer, S ;
Bogduk, N .
PAIN, 2003, 103 (1-2) :211-215
[2]   A cervical anterior spinal artery syndrome after diagnostic blockade of the right C6-nerve root [J].
Brouwers, PJAM ;
Kottink, EJBL ;
Simon, MAM ;
Prevo, RL .
PAIN, 2001, 91 (03) :397-399
[3]  
Bush K, 1996, Eur Spine J, V5, P319, DOI 10.1007/BF00304347
[4]   MOLECULAR MECHANISMS OF LOCAL-ANESTHESIA - A REVIEW [J].
BUTTERWORTH, JF ;
STRICHARTZ, GR .
ANESTHESIOLOGY, 1990, 72 (04) :711-734
[5]   The short- and medium-term effectiveness of CT-guided selective cervical nerve root injection for pain and disability [J].
Desai, Amidevi ;
Saha, Shouvik ;
Sharma, Naveen ;
Huckerby, Lauren ;
Houghton, Russell .
SKELETAL RADIOLOGY, 2014, 43 (07) :973-978
[6]   Comparative effectiveness of cervical transforaminal injections with particulate and nonparticulate corticosteroid preparations for cervical radicular pain [J].
Dreyfuss, P ;
Baker, R ;
Bogduk, N .
PAIN MEDICINE, 2006, 7 (03) :237-242
[7]   Incidence of intravascular penetration in transforaminal cervical epidural steroid injections [J].
Furman, MB ;
Giovanniello, MT ;
O'Brien, EM .
SPINE, 2003, 28 (01) :21-25
[8]   Must we discontinue selective cervical nerve root blocks? Report of two cases and review of the literature [J].
Hodler, Juerg ;
Boos, Norbert ;
Schubert, Martin .
EUROPEAN SPINE JOURNAL, 2013, 22 :S466-S470
[9]   Anatomy of the cervical intervertebral foramina: vulnerable arteries and ischemic neurologic injuries after transforaminal epidural injections [J].
Huntoon, MA .
PAIN, 2005, 117 (1-2) :104-111
[10]   Temporary neurologic deficit after cervical transforaminal injection of local anesthetic [J].
Karasek, M ;
Bogduk, N .
PAIN MEDICINE, 2004, 5 (02) :202-205