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151. Efficacy of transforaminal steroid injections to prevent surgical treatment for patients with cervical radiculopathy
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Proceedings of the 34th Annual Meeting of the North American Spine Society / The Spine Journal 19 (2019) S59−S100
FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.163 150. Examining the relationship between epidural steroid injections and patient satisfaction Trevor R. Mordhorst, MS, BA1, Zachary McCormick, MD2, Darrel S. Brodke, MD2, Angela Presson2, Willem H. Collier, BS3, W. Ryan Spiker, MD4; 1 University of Washington, Seattle, WA, US; 2 University Orthopaedic Center, Salt Lake City, UT, US; 3 University of Utah, Salt Lake City, UT, US; 4 University of Utah Orthopaedics, Salt Lake City, UT, US BACKGROUND CONTEXT: Hospitals and policy makers have placed increasing importance on patient satisfaction during episodes of medical care. Minimal research exists on patient satisfaction in the context of epidural steroid injections (ESIs) and radicular pain. PURPOSE: This study stands to describe patient satisfaction with ESI for the treatment of radicular pain and identify patient demographic and clinical characteristics associated with patient satisfaction. STUDY DESIGN/SETTING: We performed a single-center retrospective study of patients from August 2006 to May 2018. PATIENT SAMPLE: Patients who underwent interlaminar or transforaminal ESI were identified using CPT codes. OUTCOME MEASURES: The primary outcomes were: overall Press Ganey (PG) score, patient satisfaction with physician, and likelihood to recommend both physician and practice. METHODS: We performed a single-center retrospective review of patients from August 2006 to May 2018. Patients who underwent interlaminar or transforaminal ESI were identified using CPT codes. Age, BMI, Charlson Comorbidity Index (CCI), immediate change in pain, sex, spinal segmental level of injection, prior opioid use, insurance status, and ethnicity were compared to the four PG measures of satisfaction using both univariable and multivariable logistic regressions. RESULTS: Two hundred-ninety patients underwent 377 injections. Overall, patients were highly satisfied; 86% recommended their physician and 85% recommended the practice, each with the highest possible PG score. The median overall PG score was 97.2 (IQR: 89.3, 100), and the median physician satisfaction score was 100 (IQR: 95, 100). The median immediate reduction in pain was 3 points (IQR: 5, 2) on the NRS scale postinjection. Increasing age in decades was associated with increased satisfaction with the physician (RR: 0.97, 95% CI: 0.95, 0.99, p=0.018) and increased likelihood to recommend the physician (OR: 1.04, 95% CI: 1.01, 1.07, p=0.019) in multivariable analysis. Medicare as opposed to private insurance was associated with higher dissatisfaction with the physician (RR: 1.6, 95% CI: 1.12, 3.08, p=0.017). Other variables were not statistically significant. CONCLUSIONS: ESIs were associated with high patient satisfaction and significant immediate pain reduction. Patient satisfaction was lower in younger patients and in the Medicare population. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.164
151. Efficacy of transforaminal steroid injections to prevent surgical treatment for patients with cervical radiculopathy Swamy Kurra, MD1, Brandon A. Simonetta, MD2, Suehun G. Ho, MD3, Richard A. Tallarico, MD4, William F. Lavelle, MD4; 1 Syracuse, NY, US; 2 Orlando, FL, US; 3 UPMC, Pittsburgh, PA, US; 4 Upstate Orthopedics, East Syracuse, NY, US BACKGROUND CONTEXT: The use of epidural spinal injections (ESIs) is a nonoperative method to treat patients dealing with cervical radiculopathy. The efficacy of ESI as a treatment for cervical radiculopathy
varies significantly in literature and the possibility of prognostic indicators is controversial. PURPOSE: The objective of this study was to determine the efficacy of transforaminal steroid injections in the prevention of surgical treatment for patients with cervical radiculopathy. We also evaluated clinical and demographic factors that may correlate with the success rate of ESI. STUDY DESIGN/SETTING: Retrospective study from a single academic center. PATIENT SAMPLE: One hundred consecutive patients who received cervical transforaminal epidural steroid injections between February 2009 and March 2014. OUTCOME MEASURES: Using clinical and demographic data, we will determine the efficacy of ESIs in the prevention of surgical treatment for patients with cervical radiculopathy. METHODS: Clinical and demographic data were collected. Patients were categorized into surgical and nonsurgical treatment groups. Demographic data (gender, BMI, number of injections, number of levels affected, symptom duration, comorbidities) were analyzed in relation to the clinical outcome (surgery or no surgery). The analysis included Chi-square tests for categorical variables and ANOVA tests for continuous variables. RESULTS: Study sample, n=100; mean age was 51.5 years (range: 3282 years), and gender: males=50 and females= 50. The average followup was 3.7 years (range: 0-9 years). The average length of time between injection appointments was 3.64 months (range: 0.5-17 months). The average duration of injection treatment for those with multiple appointments was 5.53 months (range: 0.5-34 months). Sixty-three patients (63%) did not require surgery and thirty-seven patients (37%) required surgery following ESIs. The average age was no different between the groups, surgery group (52 years) and nonsurgical group (50 years), p=0.34. The surgery rate was lower in patients with one level of radiculopathy (29%) compared to patients with multilevel radiculopathy (46%), p=0.06. The surgery rate was 57% with patients suffering from acute pain and 34% with patients suffering chronic pain, p=0.08. The average time period between the initial injection and surgery in the surgery group was 5.2 months (1-29 months). No difference was noticed for gender, BMI, comorbidities and the average number of injections between the surgical group and nonsurgical group. CONCLUSIONS: The surgery rate was lower in single-level radiculopathy patients who received transforaminal epidural steroid injections. There was a trend toward a higher rate of surgical treatment in patients who had multilevel radiculopathy and were suffering from acute pain. The small study sample and retrospective nature of the study were limitations. FDA DEVICE/DRUG STATUS: Epidural spinal injection (Approved for this indication). https://doi.org/10.1016/j.spinee.2019.05.165 152. Stem cell therapy for pressure injury: a pilot study with autologous bone marrow derived stem cell (BM-MNC) Rajeshwar N. Srivastava, MD1, Mukesh K. Dwivedi, PhD, PhD2, Amit K. Bhagat, PhD1, Lavini Raj, BS1; 1 King George’s Medical University, Department of Orthopaedic Surgery, Lucknow, Uttar Pradesh, India; 2 Department of Orthopaedic Surgery, Lucknow, Uttar Pradesh, India BACKGROUND CONTEXT: Pressure injuries (PIs) are a common yet challenging problem especially in people with spinal cord injury (SCI) because of immobility and anesthetic skin. They are difficult to treat with standard medical care and often recur. Recent interest in the treatment of chronic wounds like PIs has shifted from the type of dressing with or without pharmaceutical topical agents to different therapies like negative pressure wound therapy (NPWT), gene therapy and stem cell based therapies. The rationale behind the use of cell-based therapies is the fact that cells in chronic wounds are phenotypically altered or senescent or both. Therefore, they have a limited capacity to divide and are less responsive to stimulation by growth factors. Promising results have been reported in the treatment of small series of mainly chronic lower-extremity wounds with bone marrowderived stem cells (BM-MNC).
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.
Proceedings of the 34th Annual Meeting of the North American Spine Society / The Spine Journal 19 (2019) S59−S100
FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.163 150. Examining the relationship between epidural steroid injections and patient satisfaction Trevor R. Mordhorst, MS, BA1, Zachary McCormick, MD2, Darrel S. Brodke, MD2, Angela Presson2, Willem H. Collier, BS3, W. Ryan Spiker, MD4; 1 University of Washington, Seattle, WA, US; 2 University Orthopaedic Center, Salt Lake City, UT, US; 3 University of Utah, Salt Lake City, UT, US; 4 University of Utah Orthopaedics, Salt Lake City, UT, US BACKGROUND CONTEXT: Hospitals and policy makers have placed increasing importance on patient satisfaction during episodes of medical care. Minimal research exists on patient satisfaction in the context of epidural steroid injections (ESIs) and radicular pain. PURPOSE: This study stands to describe patient satisfaction with ESI for the treatment of radicular pain and identify patient demographic and clinical characteristics associated with patient satisfaction. STUDY DESIGN/SETTING: We performed a single-center retrospective study of patients from August 2006 to May 2018. PATIENT SAMPLE: Patients who underwent interlaminar or transforaminal ESI were identified using CPT codes. OUTCOME MEASURES: The primary outcomes were: overall Press Ganey (PG) score, patient satisfaction with physician, and likelihood to recommend both physician and practice. METHODS: We performed a single-center retrospective review of patients from August 2006 to May 2018. Patients who underwent interlaminar or transforaminal ESI were identified using CPT codes. Age, BMI, Charlson Comorbidity Index (CCI), immediate change in pain, sex, spinal segmental level of injection, prior opioid use, insurance status, and ethnicity were compared to the four PG measures of satisfaction using both univariable and multivariable logistic regressions. RESULTS: Two hundred-ninety patients underwent 377 injections. Overall, patients were highly satisfied; 86% recommended their physician and 85% recommended the practice, each with the highest possible PG score. The median overall PG score was 97.2 (IQR: 89.3, 100), and the median physician satisfaction score was 100 (IQR: 95, 100). The median immediate reduction in pain was 3 points (IQR: 5, 2) on the NRS scale postinjection. Increasing age in decades was associated with increased satisfaction with the physician (RR: 0.97, 95% CI: 0.95, 0.99, p=0.018) and increased likelihood to recommend the physician (OR: 1.04, 95% CI: 1.01, 1.07, p=0.019) in multivariable analysis. Medicare as opposed to private insurance was associated with higher dissatisfaction with the physician (RR: 1.6, 95% CI: 1.12, 3.08, p=0.017). Other variables were not statistically significant. CONCLUSIONS: ESIs were associated with high patient satisfaction and significant immediate pain reduction. Patient satisfaction was lower in younger patients and in the Medicare population. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.164
151. Efficacy of transforaminal steroid injections to prevent surgical treatment for patients with cervical radiculopathy Swamy Kurra, MD1, Brandon A. Simonetta, MD2, Suehun G. Ho, MD3, Richard A. Tallarico, MD4, William F. Lavelle, MD4; 1 Syracuse, NY, US; 2 Orlando, FL, US; 3 UPMC, Pittsburgh, PA, US; 4 Upstate Orthopedics, East Syracuse, NY, US BACKGROUND CONTEXT: The use of epidural spinal injections (ESIs) is a nonoperative method to treat patients dealing with cervical radiculopathy. The efficacy of ESI as a treatment for cervical radiculopathy
varies significantly in literature and the possibility of prognostic indicators is controversial. PURPOSE: The objective of this study was to determine the efficacy of transforaminal steroid injections in the prevention of surgical treatment for patients with cervical radiculopathy. We also evaluated clinical and demographic factors that may correlate with the success rate of ESI. STUDY DESIGN/SETTING: Retrospective study from a single academic center. PATIENT SAMPLE: One hundred consecutive patients who received cervical transforaminal epidural steroid injections between February 2009 and March 2014. OUTCOME MEASURES: Using clinical and demographic data, we will determine the efficacy of ESIs in the prevention of surgical treatment for patients with cervical radiculopathy. METHODS: Clinical and demographic data were collected. Patients were categorized into surgical and nonsurgical treatment groups. Demographic data (gender, BMI, number of injections, number of levels affected, symptom duration, comorbidities) were analyzed in relation to the clinical outcome (surgery or no surgery). The analysis included Chi-square tests for categorical variables and ANOVA tests for continuous variables. RESULTS: Study sample, n=100; mean age was 51.5 years (range: 3282 years), and gender: males=50 and females= 50. The average followup was 3.7 years (range: 0-9 years). The average length of time between injection appointments was 3.64 months (range: 0.5-17 months). The average duration of injection treatment for those with multiple appointments was 5.53 months (range: 0.5-34 months). Sixty-three patients (63%) did not require surgery and thirty-seven patients (37%) required surgery following ESIs. The average age was no different between the groups, surgery group (52 years) and nonsurgical group (50 years), p=0.34. The surgery rate was lower in patients with one level of radiculopathy (29%) compared to patients with multilevel radiculopathy (46%), p=0.06. The surgery rate was 57% with patients suffering from acute pain and 34% with patients suffering chronic pain, p=0.08. The average time period between the initial injection and surgery in the surgery group was 5.2 months (1-29 months). No difference was noticed for gender, BMI, comorbidities and the average number of injections between the surgical group and nonsurgical group. CONCLUSIONS: The surgery rate was lower in single-level radiculopathy patients who received transforaminal epidural steroid injections. There was a trend toward a higher rate of surgical treatment in patients who had multilevel radiculopathy and were suffering from acute pain. The small study sample and retrospective nature of the study were limitations. FDA DEVICE/DRUG STATUS: Epidural spinal injection (Approved for this indication). https://doi.org/10.1016/j.spinee.2019.05.165 152. Stem cell therapy for pressure injury: a pilot study with autologous bone marrow derived stem cell (BM-MNC) Rajeshwar N. Srivastava, MD1, Mukesh K. Dwivedi, PhD, PhD2, Amit K. Bhagat, PhD1, Lavini Raj, BS1; 1 King George’s Medical University, Department of Orthopaedic Surgery, Lucknow, Uttar Pradesh, India; 2 Department of Orthopaedic Surgery, Lucknow, Uttar Pradesh, India BACKGROUND CONTEXT: Pressure injuries (PIs) are a common yet challenging problem especially in people with spinal cord injury (SCI) because of immobility and anesthetic skin. They are difficult to treat with standard medical care and often recur. Recent interest in the treatment of chronic wounds like PIs has shifted from the type of dressing with or without pharmaceutical topical agents to different therapies like negative pressure wound therapy (NPWT), gene therapy and stem cell based therapies. The rationale behind the use of cell-based therapies is the fact that cells in chronic wounds are phenotypically altered or senescent or both. Therefore, they have a limited capacity to divide and are less responsive to stimulation by growth factors. Promising results have been reported in the treatment of small series of mainly chronic lower-extremity wounds with bone marrowderived stem cells (BM-MNC).
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.