Presented at the 2012 AAPM Annual Meeting « Back

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

Vincent Y. Ma, BA, vincent.ma@case.edu¹, Ali Shakir, MD², Bina Mehta, MD², (1) Case Western Reserve University School of Medicine, Cleveland, Ohio, (2) Western Reserve Spine & Pain Institute, Kent, Ohio

Introduction/Statement of the Problem: This study was performed in order to determine whether the distribution of radicular pain has predictive value in identifying patients who would benefit from transforaminal cervical epidural steroid injections (CESI). Materials and Methods: This retrospective cohort study examines subjects with cervical radiculopathy who underwent CESI from February 2005 to January 2006. Data from subjects was divided into groups based on pain distribution, imaging based diagnosis of cervical disc herniation, or stenosis and their response to treatment. Chi-square tests were utilized to assess relationships between distribution and benefit. This study was conducted with IRB approval. Results: Complete data were available for 94 subjects of 117 charts reviewed. Forty-eight subjects had cervical disc 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-square testing demonstrated no statistically significant difference in beneficial response to CESI based on pain distributions. Conclusions: The likelihood of subjects to report a positive benefit from CESI as a treatment for 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 in order to improve outcomes and reduce cost.

Funding: None