Published in:
01-11-2015 | Musculoskeletal
Long Term Outcomes from CT-guided Indirect Cervical Nerve Root Blocks and their relationship to the MRI findings- A prospective Study
Published in: European Radiology | Issue 11/2015
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Purpose
To investigate long-term pain reduction and ‘improvement’ in patients with indirect cervical nerve-root-blocks in comparison to MRI findings.
Material and Methods
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.
Results
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).
Conclusion
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.
Key Points
• Good long term outcomes after indirect nerve root infiltrations with non-particulate steroids.
• The presence of nerve root compression was a predictive finding of ‘improvement’.
• Significantly less patients subsequently having surgery had lower NRS scores 1-month post injection.
• There is less pain relief in patients with disc extrusions.
• There are less improvement in patients with modic type I changes.