PMID- 33091610
OWN - NLM
STAT- MEDLINE
DCOM- 20210728
LR  - 20210728
IS  - 1878-1632 (Electronic)
IS  - 1529-9430 (Linking)
VI  - 21
IP  - 2
DP  - 2021 Feb
TI  - Evaluation of transforaminal epidural steroid injections for discogenic axial 
      lumbosacral back pain utilizing PROMIS as an outcome measure.
PG  - 202-211
LID - S1529-9430(20)31181-5 [pii]
LID - 10.1016/j.spinee.2020.10.018 [doi]
AB  - BACKGROUND CONTEXT: Discogenic lumbosacral back pain continues to present a 
      challenging clinical entity with limited, controversial therapeutic options. No 
      study to date has evaluated the efficacy of fluoroscopically guided 
      transforaminal epidural steroid injections (TFESI) in a homogenous patient 
      population with axial lumbosacral back pain from discogenic pathology utilizing 
      strict, explicitly clinical and radiographic criteria. Additionally, there is a 
      paucity of published data utilizing Patient Reported Outcome Measurement 
      Information System (PROMIS) scores as an outcome measure for interventional spine 
      procedures. PURPOSE: Evaluate the therapeutic effect of TFESIs in a specific 
      subset of patients with discogenic axial lumbosacral back pain. Investigate 
      PROMIS as an outcome measure for interventional spine procedures targeting focal 
      degenerative spinal pathology. STUDY DESIGN/SETTING: Retrospective review of 
      patients presenting to a multidisciplinary, tertiary academic spine center. 
      PATIENT SAMPLE: Three thousand eight hundred eighty-one patients were screened 
      for inclusion. A total of 26 patients with discogenic axial low back, based on 
      strict clinical and radiographic criteria, underwent TFESIs. All patients had 
      axial low back pain without radicular pain, >/=3 clinical features of discogenic 
      pain, corroborative radiographic features of active discogenic pathology on 
      lumbar spine magnetic resonance imaging without confounding spinal pathology. 
      OUTCOME MEASURES: PROMIS Pain Interference (PI) v1.1, PROMIS Physical Function 
      (PF) v1.2/v2.0, and PROMIS Depression (D) v1.0 outcome scores were collected at 
      baseline and postprocedure follow-up. METHODS: Query of an institutional, patient 
      reported outcome database and subsequent retrospective review of electronic 
      medical records was performed. Statistical analysis comparing baseline and 
      postprocedural PROMIS outcome scores and correlation between these instruments 
      was performed. Additionally, an exploratory investigation of minimal clinically 
      important difference achievement rates was performed. RESULTS: Analysis 
      determined a statistically significant improvement in PROMIS PI (p=.017, 95% 
      CI=-8.02 to -1.82) and PROMIS PF (p=.003, 95% CI=0.91-8.72) scores after 
      treatment with TFESIs. At post treatment time points, TFESI had medium effect 
      size on pain (d=0.55) and function (d=0.59). Change in PROMIS D scores (p=.488, 
      95% CI -1.74-3.54; d=.08) did not demonstrate statistical significance. Pearson 
      correlation demonstrated a moderate negative correlation (r=-0.544, p=.004) 
      between PROMIS PF with PROMIS PI. Correlation between PROMIS PF (r=-0.239, p=.24) 
      and PROMIS PI (r=0.198, p=.33) with PROMIS D was not significant. Fourteen 
      (53.8%) and 9 (34.6%) subjects achieved minimum clinically important difference 
      (MCID) for PROMIS PI and PROMIS PF, respectively. Nine subjects (34.6%) achieved 
      MCID for PROMIS D despite not otherwise reaching statistical significance 
      otherwise. CONCLUSIONS: Utilizing PROMIS as an outcome measure, discogenic axial 
      lumbosacral back pain patients appear to benefit from TFESI in terms of pain and 
      physical function. This study contributes to the growing body of literature 
      utilizing PROMIS scores in patients with clinical sequelae of degenerative spinal 
      pathology; however, prospective studies are needed.
CI  - Copyright (c) 2020 Elsevier Inc. All rights reserved.
FAU - Michalik, Adam J
AU  - Michalik AJ
AD  - University of Utah School of Medicine, Division of Physical Medicine and 
      Rehabilitation, Salt Lake City, UT, USA. Electronic address: 
      adam.michalik@hsc.utah.edu.
FAU - Patel, Rajeev K
AU  - Patel RK
AD  - University of Rochester Medical Center, Department of Physical Medicine and 
      Rehabilitation, Rochester, NY, USA.
LA  - eng
PT  - Journal Article
DEP - 20201020
PL  - United States
TA  - Spine J
JT  - The spine journal : official journal of the North American Spine Society
JID - 101130732
RN  - 0 (Steroids)
SB  - IM
MH  - Humans
MH  - Information Systems
MH  - Injections, Epidural
MH  - *Low Back Pain/diagnostic imaging/drug therapy/etiology
MH  - Lumbar Vertebrae/diagnostic imaging
MH  - Outcome Assessment, Health Care
MH  - Patient Reported Outcome Measures
MH  - Prospective Studies
MH  - Retrospective Studies
MH  - Steroids/therapeutic use
OTO - NOTNLM
OT  - Disc degeneration
OT  - Discogenic
OT  - Epidural steroid Herniation High-intensity zone Low back pain Lumbar Modic
OT  - Transforaminal
EDAT- 2020/10/23 06:00
MHDA- 2021/07/29 06:00
CRDT- 2020/10/22 20:12
PHST- 2020/06/24 00:00 [received]
PHST- 2020/09/17 00:00 [revised]
PHST- 2020/10/14 00:00 [accepted]
PHST- 2020/10/23 06:00 [pubmed]
PHST- 2021/07/29 06:00 [medline]
PHST- 2020/10/22 20:12 [entrez]
AID - S1529-9430(20)31181-5 [pii]
AID - 10.1016/j.spinee.2020.10.018 [doi]
PST - ppublish
SO  - Spine J. 2021 Feb;21(2):202-211. doi: 10.1016/j.spinee.2020.10.018. Epub 2020 Oct 
      20.