gms | German Medical Science

Objective: Infiltration therapy (IT) for degenerative spine disease is generally considered a valuable alternative to surgery in absence of severe neurological compromise. It was the aim of this prospective study to analyse the two-week outcome after CT-guided IT in various spinal disorders and to identify parameters positively or negatively associated with outcome.

Method: 1327 patients were treated by a single physician (A.N.) between 02/2007 and 06/2013, of which 1002 patients receiving IT with bupivacaine and betamethasone/mephamesone/triamcinolone for cervical disc herniation (CDH; n=167), lumbar disc herniation (LDH; n=412), lumbar spinal stenosis (LSS; n=199), cervical facet joint pain (CFJP; n=61), lumbar facet joint pain (LFJP; n=128) or iliosacral joint syndrome (IJS; n=35) met inclusion criteria and returned their follow-up questionnaire two weeks after IT. Pain outcome was graded as better, same or worse. The chi-square test was used for group comparisons.

Results: Pain outcomes were differently distributed across the various disorders treated (p=.022). Significant pain relief was achieved in 92/167 patients treated for CDH (55.1%), 295/412 for LDH (71.6%), 134/199 for LSS (67.3%), 35/61 for CFJP (57.4%), 87/128 for LFJP (68%) and 25/35 for IJS (71.4%). For CDH, no significant difference in outcome was shown between direct vs. indirect cervical nerve root infiltration technique (p=.921), while response to IT differed among the cervical segments (p=.046). The highest rate of pain relief was achieved for segment C6/7 (71.9%). For LDH, outcome tended to be better in patients receiving combined transforaminal and interlaminar IT as compared to interlaminar or transforaminal IT alone (p=.089). For LSS, any infiltration method (transforaminal, interlaminar or combined) resulted in similar outcomes (p =.748). There was no effect of type or dose of cortisone on outcome for any spinal disorder. Likewise, repeated infiltrations (up to nine) were equally effective in alleviating pain as compared to the first IT for all disorders.

Conclusions: CT-guided IT is effective for various spinal disorders with an overall positive response rate of 66.7% (n=1002) two weeks after treatment by a single physician at a tertiary radiology center. Various infiltration techniques, types and doses of cortisone were equally effective in our cohort. A further prospective study collecting long-term outcome results is warranted and currently conducted at our institution.