Background: Many patients who receive cervical epidural steroid injections (ESIs) are referred for the injection from a physician who does not perform the procedure.

Purpose: To compare success rates of fluoroscopically-guided cervical ESIs in patients who had a clinical evaluation and recommendation for the injection by a fellowship-trained spine specialist who routinely performs ESIs (Group A), vs those who had a clinical evaluation by a fellowship-trained spine specialist who referred the patient for the procedure to be done by a different physician (Group B).

Study design/setting: Retrospective, observational, in vivo study of consecutive patients. Patient Sample. Patients undergoing cervical transforaminal (TF) or interlaminar (IL) ESIs at a single outpatient academic spine center.

Outcome measures: Numeric Rating Scale (NRS) pain score improvement.

Methods: Current procedural terminology (CPT) codes were used to search all consecutive patients who received a cervical TF or IL ESI between January 2010 and October 2018. All patients with pre and post-injection NRS pain scores within 60 days of the injection were included in the analysis.

Results: A total of 363 ESIs were analyzed (178 ​TF and 185 IL). 275 patients were evaluated and referred for the injection by a spine specialist who performs these procedures (Group A), and 88 were evaluated and referred by a spine specialist who does not perform these procedures (Group B). Success was defined as > 50% improvement in the NRS pain score. 52% [95% CI: 47-57%] of all patients who received a cervical ESI achieved a successful outcome. There were better results in Group A with a 57% [95% CI: 51-63%] success rate compared to a 38% [95% CI: 28-48%] success rate in Group B. Group A also had a higher proportion of patients who achieved at least 80% pain relief (31% [95% CI: 26-36%]) compared to Group B (17% [95% CI: 9-25%]).

Conclusion: This retrospective study demonstrated better results from cervical ESIs when patients were referred for the injection by a physician who performs ESIs. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Keywords: Cervical; Epidural; Interlaminar; Referral source; Transforaminal.

© 2021 The Author(s).

背景：

许多接受颈椎硬膜外类固醇注射（ESIs）的患者是由不亲自执行该程序的医生转介的。

目的：

比较由具有脊柱专科培训并常规进行ESIs的医生评估和推荐注射的患者（A组），与由同样具有脊柱专科培训但将患者转介给其他医生进行操作的医生评估的患者的荧光镜引导颈椎ESI的成功率。

研究设计/环境：

回顾性、观察性的体内连续病患研究。样本：在单个门诊学术脊柱中心接受颈椎经椎间孔（TF）或椎板间（IL）ESIs的患者。

结果指标：

数字评分量表（NRS）疼痛评分改善情况。

方法：

使用现行程序术语代码搜索2010年1月至2018年10月期间所有连续接受颈椎TF或IL ESI的患者。分析中包括在注射前后60天内有预后和术后NRS疼痛评分的所有患者。

结果：

共分析了363例ESIs（其中178为TF，185为IL）。275名患者由进行这些操作的脊柱专科医生评估并推荐进行注射（A组），而88名患者则由不亲自进行该操作但会将患者转介给其他医生的脊柱专科医生评估并推荐（B组）。成功定义为NRS疼痛评分改善超过50%。所有接受颈椎ESI患者的52% [95% CI: 47-57%] 达到了成功的治疗效果。A组的成功率为57% [95% CI: 51-63%]，而B组的成功率仅为38% [95% CI: 28-48%]。在达到至少80%疼痛缓解的比例方面，A组（31% [95% CI: 26-36%]）高于B组（17% [95% CI: 9-25%]）。

结论：

这项回顾性研究表明，当患者由执行ESIs的医生转介时，颈椎ESI的效果更好。该研究未从公共、商业或非营利部门的资金机构获得特定资助。

关键词：

颈椎；硬膜外；椎板间；转诊来源；经椎间孔。