경추 방사통을 위한 선택적 신경근 차단술의 1년 후 결과를 예측하는데에, 어느 시점이 가장 이상적인가? = When is the Optimal Time Point for Predicting the 1-Year Follow-up Outcome of Selective Nerve Root Block for Cervical Radiculopathy?

다국어 초록 (Multilingual Abstract)

Study Design: Retrospective study.
Objectives: In the current study, we aimed to (1) evaluate the early and late therapeutic effects of selective nerve root block (SNRB) for cervical radiculopathy, and (2) to determine the optimal time point for predicting the long-term effectiveness of cervical SNRB.
Summary of Literature Review: Although SNRB is an important option for cervical radiculopathy, various studies of cervical SNRB have failed to specify its efficacy, especially long-term effectiveness.
Materials and Methods: We retrospectively enrolled 35 patients with cervical radiculopathy who were regularly followed-up for at least 1 year after SNRB. Clinical outcomes were evaluated using a visual analogue scale (VAS) for pain intensity and the modified Kim’s method for patient satisfaction at regular follow-up intervals. In the correlation analysis, stepwise multiple linear regression was used to identify selected and unselected factors.
Results: The average VAS score decreased over time (p<0.05); the values just before the injection and at 1 week, 3 weeks, and 1 year of follow-up were 6.11, 3.29, 2.89, and 1.37, respectively. In the stepwise multiple regression analysis, the 1-week VAS score was related to the initial VAS score, the 3-week VAS score was related to the 1-week VAS score, and the last VAS score was related to the 3-week VAS score and symptom duration before the injection. The degree of satisfaction at the 1-year follow-up point was significantly associated with the 3-week VAS score (p=0.011).
Conclusions: The current study showed that pain intensity at the 3-week time point after cervical SNRB might be the optimal time point for predicting long-term effectiveness.
Key Words: Cervical spine, Radiculopathy, Selective nerve root block, Long-term effectiveness, Predictor

국문 초록 (Abstract)

연구 계획: 후향적 연구목적: 경부 방사통을 위한 신경근 차단술 후 1년간 결과를 평가하고, 1년 후 결과를 예측하는데에 차단술 후 어느 시점이 가장 이상적인지 알아보고자 한다.
선행 연구문헌의 요약: 경부 방사통을 위한 신경근 차단술이 효과적인 치료방법으로 알려져있으나, 아직 차단술의 유효성, 장기 결과 평가 및 관련 인자에 대해서는 연구가 부족하다.
대상 및 방법: 경추 방사통으로 선택적 신경근 차단술 후 1년 이상 추시가 된 35명의 환자를 대상으로 연구를 진행하였다. 통증 정도(VAS), 환자 만족도를평가하였으며, 평가를 위하여 단계적 다중회귀분석 방법을 이용하여 1년 후 결과와 가장 높은 상관성을 보이는 시기를 확인하였다.
결과: 통증 점수는 차단술 후 점차 완화되었고(p<0.05), 평균 점수는 시술 전 6.11, 시술 후 1주째 3.29, 3주째 2.89, 그리고 1년 후 1.37 이었다. 단계적다중회귀분석 통계 처리 후, 1주째 통증 점수는 차단술 전 통증 점수와 연관성을 보였고, 3주째 통증 점수는 1주째 통증 점수와, 1년 후 통증 점수는 3주째 통증 점수와 차단술 전 증상 지속 기간과 의미있는 연관성을 보였다. 차단술 1년 후 환자 만족도는 차단술 후 3주째 결과와 의미있는 연관성을 보였다(p=0.011).
결론: 선택적 신경근 차단술 후 3주째의 임상 결과 (통증 정도)는 차단술 1년 후의 결과와 가장 밀접한 연관성을 보였다.
약칭 제목: 경추의 선택적 신경근 차단술의 예후 평가

참고문헌 (Reference)

1 J.S. Yeom, "Value of Diagnostic Lumbar Selective Nerve Root Block: A Prospective Controlled Study" American Society of Neuroradiology (ASNR) 29 (29): 1017-1023, 2008

2 Haemi Jee, "Ultrasound-guided selective nerve root block versus fluoroscopy-guided transforaminal block for the treatment of radicular pain in the lower cervical spine: A randomized, blinded, controlled study" Springer Science and Business Media LLC 42 (42): 69-78, 2013

3 박용범, "Treatment Effects of Ultrasound Guide Selective Nerve Root Block for Lower Cervical Radicular Pain: A Retrospective Study of 1-Year Follow-up" 대한재활의학회 37 (37): 658-667, 2013

4 Amidevi Desai, "The short- and medium-term effectiveness of CT-guided selective cervical nerve root injection for pain and disability" Springer Science and Business Media LLC 43 (43): 973-978, 2014

5 Hwan-Mo Lee, "The Role of Steroids and Their Effects on Phospholipase A2" Ovid Technologies (Wolters Kluwer Health) 23 (23): 1191-1196, 1998

6 Jae-Yoon Chung, "The Efficacy and Persistence of Selective Nerve Root Block under Fluoroscopic Guidance for Cervical Radiculopathy" Asian Spine Journal (ASJ) 6 (6): 227-232, 2012

7 Andrew Engel, "The Effectiveness and Risks of Fluoroscopically Guided Cervical Transforaminal Injections of Steroids: A Systematic Review with Comprehensive Analysis of the Published Data" Oxford University Press (OUP) 15 (15): 386-402, 2014

8 Leif Anderberg, "Selective diagnostic nerve root block for the evaluation of radicular pain in the multilevel degenerated cervical spine" Springer Science and Business Media LLC 15 (15): 794-801, 2006

9 Christian W. A. Pfirrmann, "Selective Nerve Root Blocks for the Treatment of Sciatica: Evaluation of Injection Site and Effectiveness—A Study with Patients and Cadavers" Radiological Society of North America (RSNA) 221 (221): 704-711, 2001

10 K.P. Schellhas, "Selective Cervical Nerve Root Blockade: Experience with a Safe and Reliable Technique Using an Anterolateral Approach for Needle Placement" American Society of Neuroradiology (ASNR) 28 (28): 1909-1914, 2007

11 Stephan Klessinger, "Response to Transforaminal Injection of Steroids and Correlation to MRI Findings in Patients with Cervical Radicular Pain or Radiculopathy due to Disc Herniation or Spondylosis" Oxford University Press (OUP) 15 (15): 929-937, 2014

12 Chen B, "Optimal needle entry angle for cervical transforaminal epidural injections" 17 (17): 139-144, 2014

13 Hirpara KM, "Nonoperative modalities to treat symptomatic cervical spondylosis" 2012 : 294857-, 2012

14 Juerg Hodler, "Must we discontinue selective cervical nerve root blocks?" Springer Science and Business Media LLC 22 (22): s466-s470, 2013

15 A. Johansson, "Local corticosteroid application blocks transmission in normal nociceptive C-fibres" Wiley 34 (34): 335-338, 1990

16 Paul I. Mallinson, "Factors that Affect the Efficacy of Fluoroscopically Guided Selective Spinal Nerve Root Block in the Treatment of Radicular Pain: A Prospective Cohort Study" SAGE Publications 64 (64): 370-375, 2013

17 Radhakrishnan K, "Epidemiology of cervical radiculopathy. A populationbased study from Rochester, Minnesota, 1976 through 1990" 117 (117): 325-335, 1994

18 Kaye AD, "Efficacy of epidural injections in managing chronic spinal pain: A best evidence synthesis" 18 (18): E939-E1004, 2015

19 Hee Seon Kim, "Efficacy of Epidural Steroid Injection in Lumbar Spinal Stenosis" Korean Society of Spine Surgery (KAMJE) 12 (12): 310-315, 2005

20 Shoji Yabuki, "Effects of Lidocaine on Nucleus Pulposus-Induced Nerve Root Injury" Ovid Technologies (Wolters Kluwer Health) 23 (23): 2383-2390, 1998

21 Diwan S, "Effectiveness of cervical epidural injections in the management of chronic neck and upper extremity pain" 15 (15): E405-E434, 2012

22 Huston CW, "Diagnostic selective nerve root blocks: indications and usefulness" 13 (13): 545-565, 2002

23 Wilson Z Ray, "Correlation of Foraminal Area and Response to Cervical Nerve Root Injections" Cureus, Inc. 7 (7): e286-, 2015

24 Jean-Noël Vallée, "Chronic Cervical Radiculopathy: Lateral-Approach Periradicular Corticosteroid Injection" Radiological Society of North America (RSNA) 218 (218): 886-892, 2001

25 Deanna Lynn Corey, "Cervical Radiculopathy" Elsevier BV 98 (98): 791-799, 2014

26 Barrett I. Woods, "Cervical Radiculopathy" Ovid Technologies (Wolters Kluwer Health) 28 (28): E251-E259, 2015

27 Lawrence McLean House, "Cervical Epidural Steroid Injection" Elsevier BV 29 (29): 1-17, 2018

28 Christopher M. Bono, "An evidence-based clinical guideline for the diagnosis and treatment of cervical radiculopathy from degenerative disorders" Elsevier BV 11 (11): 64-72, 2011

29 Mikinobu TAKEUCHI, "A Simple, 10-minute Procedure for Transforaminal Injection under Ultrasonic Guidance to Effect Cervical Selective Nerve Root Block" Japan Neurosurgical Society 54 (54): 746-751, 2014