Prediction of Therapeutic Response to Cervical Epidural Steroid Injection According to Distribution of Radicular Pain

Shakir A, Ma V, Mehta B: Prediction of therapeutic response to cervical epidural steroid injection according to distribution of radicular pain. Am J Phys Med Rehabil 2011; 90: 917-922. Objective: This study aimed to determine whether the distribution of radicular pain has predictive value in identifying patients who would benefit from transforaminal cervical epidural steroid injections. Design: Retrospective cohort study of subjects with cervical radiculopathy who underwent cervical epidural steroid injections from February 2005 to January 2006. Data from subjects were divided into groups based on pain distribution, imaging-based diagnosis of cervical disk herniation or stenosis, and their response to treatment. chi(2) tests were used to assess the relationships between distribution and benefit. Results: Of the 117 charts reviewed, complete data were available for 94 subjects. Forty-eight subjects had cervical disk herniations and, of these, 52% had pain above the elbow with 60% benefit, and 48% had pain below the elbow with 61% benefit. Forty-six subjects had cervical stenosis and, of these, 57% had pain above the elbow with 62% benefit, and 43% had pain below the elbow with 80% benefit. Benefit was defined as 70% or greater reduction in pain. chi(2) testing demonstrated no statistically significant difference in beneficial response to cervical epidural steroid injections based on pain distributions. Conclusions: The likelihood of subjects to report a positive benefit from cervical epidural steroid injections as a treatment of their cervical radicular pain was independent of the distribution of their pain. Although our results did not show pain distribution to have a predictive value, additional research is needed in identifying predictive factors to improve outcomes and reduce cost.