Lumbosacral Radiculopathy: Inciting Events and Their Association with Epidural Steroid Injection Outcomes
Lumbosacral Radiculopathy: Inciting Events and Their Association with Epidural Steroid Injection Outcomes
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DOI：
10.1093/pm/pnz097
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发表时间：
2019-12-01
期刊：
影响因子：
3.1
通讯作者：
Cohen, Steven Paul
中科院分区：
文献类型：
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作者：
Engle, Alyson Marie;Chen, Yian;Cohen, Steven Paul
Objective.腰痛是全球残疾的主要原因，腰骶神经根病占这些病例的三分之一以上。关于病因和腰骶神经根病之间的关系的数据有限，具体原因是否能预测治疗结果尚不清楚。设计、设置和主题。本研究探讨了2007年1月至2015年12月期间慢性疼痛诊所中腰骶神经根病的患者报告病因，并检查了这些原因是否影响硬膜外类固醇注射结果。方法.我们回顾了1,242例接受硬膜外类固醇注射的腰骶神经根病患者的病历。煽动事件的记录是根据笔记模板同时完成的。硬膜外类固醇注射后的积极结果定义为类似于持续6周或更长时间的30%疼痛缓解，无需额外干预。通过多变量logistic回归分析硬膜外类固醇注射结局的相关因素。结果50.7%的患者报告了刺激事件，59.9%的患者经历了积极的硬膜外类固醇注射结局。最常报告的原因是福尔斯（13.1%）、机动车碰撞（10.7%）和举重（7.8%）。椎间盘突出患者（56.3%）比狭窄患者（44.7%）或椎间盘退变患者（47.8%，P = 0.012）更容易报告突发原因。激发事件并不能预测治疗结果。与不良治疗结果相关的因素包括阿片类药物消耗（比值比[OR] = 0.61，95%置信区间[CI] = 0.39-0.95，P = 0.027），继发性增益（OR = 0.69，95%CI = 0.50-0.96，P = 0.030），基线疼痛评分（OR = 0.90，95%CI = 0.84-0.97，P = 0.006）。注射节段数与阳性结局相关（OR = 2.72，95%CI = 1.28-6.47，P = 0.008）。结论.报告的刺激事件在腰骶神经根病患者中很常见，但与硬膜外类固醇注射后的结局无关，其发生并不总是与声称的损伤机制一致。
Objective. Low back pain is the leading cause of worldwide disability, with lumbosacral radiculopathy accounting for over one-third of these cases. There are limited data on the relationship between etiologies and lumbosacral radiculopathy, and it is unknown whether specific causes predict treatment outcomes. Design, Setting, and Subjects. This study explores patient-reported etiologies for lumbosacral radiculopathy in a chronic pain clinic between January 2007 and December 2015 and examines whether these causes affected epidural steroid injection outcomes. Methods. We reviewed the medical records of 1,242 patients with lumbosacral radiculopathy who received epidural steroid injections. The recording of an inciting event was done contemporaneously based on note templates. A positive outcome following an epidural steroid injection was defined as similar to 30% pain relief sustained for six or more weeks without additional intervention. Factors associated with epidural steroid injection outcome were analyzed by multi-variable logistic regression. Results. Fifty point seven percent reported an inciting event, and 59.9% of patients experienced a positive epidural steroid injection outcome. The most commonly reported causes were falls (13.1%), motor vehicle collisions (10.7%), and lifting (7.8%). Individuals with a herniated disc (56.3%) were more likely to report a precipitating cause than those with stenosis (44.7%) or degenerative discs (47.8%, P = 0.012). An inciting event did not predict treatment outcome. Factors associated with negative treatment outcome included opioid consumption (odds ratio [OR] = 0.61, 95% confidence interval [CI] = 0.39-0.95, P = 0.027), secondary gain (OR = 0.69, 95% CI = 0.50-0.96, P = 0.030), and baseline pain score (OR = 0.90, 95% CI = 0.84-0.97, P = 0.006). The number of levels injected was associated with a positive outcome (OR = 2.72, 95% CI = 1.28-6.47, P = 0.008). Conclusions. Reported inciting events are common in patients with lumbosacral radiculopathy but are not associated with outcome following epidural steroid injection, and their occurrence is not always consistent with the purported mechanism of injury.