The effectiveness of cervical transforaminal epidural steroid injections for the treatment of cervical radicular pain: A prospective cohort study reporting 12-month outcomes.

Objectives: To evaluate the effectiveness of cervical transforaminal epidural steroid injection (CTFESI) for the treatment of unilateral cervical radicular pain. Design: Single-group prospective cohort study. Methods: Outcomes included ≥50% reductions in Numeric Rating Scale (NRS) for arm pain, ≥30% Neck Disability Index (NDI-5) improvement, health-related quality of life (EQ-5D), global improvement (PGIC), personal goal achievement (COMBI), Chronic Pain Sleep Index (CPSI), and healthcare utilization at one, three, six, and 12 months. Data analysis included descriptive statistics with the calculations of 95% confidence intervals (CIs), contingency table analysis, and multilevel logistic regression (LR) analysis, including a worst-case (WC) sensitivity analysis in which missing data were treated as treatment failure. Participants who were treated surgically were considered failures in the categorical analyses. Results: 33 consecutively enrolled participants (63.6% females, 51.2 ± 12.2 years of age, BMI 28.3 ± 4.5 kg/m2) were analyzed. Success rates for ≥50% reduction in NRS for arm pain at one, three, six and 12 months were 57.6% (95% CI 40.8-72.8%), 71.9% (95% CI 54.6-84.4%), 64.5% (95% CI 46.9-78.9%), and 64.5% (95% CI 46.9-78.9%). Success rates for ≥30% improvement in NDI-5 were 60.6% (95% CI 43.7-75.3%), 68.8% (95% CI 51.4-82.0%), 61.3% (95% CI 43.8-76.3%), and 71.0% (95% CI 53.4-83.9%). In WC analysis, success rates for ≥50% arm NRS and NDI-5 were 0-4.3% lower between 1 and 12 months. PGIC scores were at least "much improved" or "very much improved," in 48.4-65.6% of participants between 1 and 12 months. 6.1%, 6.1%, and 3.0% had one, two, or three repeat injections, respectively. 18.2% of participants underwent surgery by 12 months. Participants showed significant improvements in arm NRS and NDI-5 after treatment (p < 0.05), multilevel logistic regression models showed no significant decline in improvements across the follow-up time points (p > 0.05). Conclusion: Statistically significant and clinically meaningful improvements in pain and disability were observed after CTFESI for up to 12 months in individuals with unilateral cervical radicular pain.

Long-term clinical outcomes of genicular nerve radiofrequency ablation for chronic knee pain using a three-tined electrode for expanded nerve capture.

Objective: Genicular nerve radiofrequency ablation (GNRFA) is an effective treatment option for chronic knee pain in native knee osteoarthritis and total knee arthroplasty (TKA) patients. Recent dissections have revealed significant variability in typical genicular nerve targets and other sensory nerves not included in previous studies. Early, short-term results suggest that more complete sensory denervation with GNRFA may result in more significant pain reduction; however, no long-term clinical outcome exists. We aim to present long-term clinical outcomes after an expanded GNRFA technique with a three-tined radiofrequency cannula. Methods: Eleven consecutive patients with ≥6 months of knee pain underwent an expanded GNRFA protocol targeting the superomedial (SMGN), superolateral (SLGN), inferomedial genicular nerves (IMGN), in addition to the nerves to vastus medialis (NVM), lateralis (NVL), and intermedius (NVI). Long-term pain and impression of change outcomes were collected in a cross-sectional fashion. Results: At ≥18 months (mean 24 months) post-GNRFA, 91% (95% CI â€‹= â€‹59, 100%), 73% (95% CI â€‹= â€‹46, 99%), and 9% (95% CI â€‹= â€‹0, 26%) of patients reported ≥50%, ≥80%, and 100% pain relief, respectively. Additionally, 27% (95% CI â€‹= â€‹1, 54%) and 64% (95% CI â€‹= â€‹35, 92%) of individuals reported a PGIC score of 6 ("much improved") and 7 ("very much improved"), respectively. The proportion of individuals who reported the MCID for the PGIC (score of ≥6) was 91% (95% CI â€‹= â€‹59, 100%). There were no adverse events reported amongst the patients in this cohort. No patients progressed to surgery. Conclusion: This single-arm cohort suggests that an expanded GNRFA protocol targeting SMGN, SLGN, IMGN, NVM, NVL, and NVI nerves with a three-tined electrode, resulted in significant long-term (≥18 months) improvements in pain and patient-perceived global improvement. Large, head-to-head trials are needed to establish whether this GNRFA protocol is superior to those used in previous clinical studies and those currently used more commonly in practice.