151. Efficacy of transforaminal steroid injections to prevent surgical treatment for patients with cervical radiculopathy

BACKGROUND CONTEXT The use of epidural spinal injections (ESIs) is a nonoperative method to treat patients dealing with cervical radiculopathy. The efficacy of ESI as a treatment for cervical radiculopathy varies significantly in literature and the possibility of prognostic indicators is controversial. PURPOSE The objective of this study was to determine the efficacy of transforaminal steroid injections in the prevention of surgical treatment for patients with cervical radiculopathy. We also evaluated clinical and demographic factors that may correlate with the success rate of ESI. STUDY DESIGN/SETTING Retrospective study from a single academic center. PATIENT SAMPLE One hundred consecutive patients who received cervical transforaminal epidural steroid injections between February 2009 and March 2014. OUTCOME MEASURES Using clinical and demographic data, we will determine the efficacy of ESIs in the prevention of surgical treatment for patients with cervical radiculopathy. METHODS Clinical and demographic data were collected. Patients were categorized into surgical and nonsurgical treatment groups. Demographic data (gender, BMI, number of injections, number of levels affected, symptom duration, comorbidities) were analyzed in relation to the clinical outcome (surgery or no surgery). The analysis included Chi-square tests for categorical variables and ANOVA tests for continuous variables. RESULTS Study sample, n=100; mean age was 51.5 years (range: 32-82 years), and gender: males=50 and females= 50. The average follow-up was 3.7 years (range: 0-9 years). The average length of time between injection appointments was 3.64 months (range: 0.5-17 months). The average duration of injection treatment for those with multiple appointments was 5.53 months (range: 0.5-34 months). Sixty-three patients (63%) did not require surgery and thirty-seven patients (37%) required surgery following ESIs. The average age was no different between the groups, surgery group (52 years) and nonsurgical group (50 years), p=0.34. The surgery rate was lower in patients with one level of radiculopathy (29%) compared to patients with multilevel radiculopathy (46%), p=0.06. The surgery rate was 57% with patients suffering from acute pain and 34% with patients suffering chronic pain, p=0.08. The average time period between the initial injection and surgery in the surgery group was 5.2 months (1-29 months). No difference was noticed for gender, BMI, comorbidities and the average number of injections between the surgical group and nonsurgical group. CONCLUSIONS The surgery rate was lower in single-level radiculopathy patients who received transforaminal epidural steroid injections. There was a trend toward a higher rate of surgical treatment in patients who had multilevel radiculopathy and were suffering from acute pain. The small study sample and retrospective nature of the study were limitations. FDA DEVICE/DRUG STATUS Epidural spinal injection (Approved for this indication).