Evaluation of Fluoroscopically Guided Transforaminal Selective Nerve Root Sleeve Injections for Lumbar Spinal Stenosis With Radiculopathy Utilizing Patient Reported Outcome Measurement Information System as an Outcome Measure

Andrew R Stephens; Ramzi El-Hassan; Rajeev K Patel

doi:10.1016/j.apmr.2024.02.720

Evaluation of Fluoroscopically Guided Transforaminal Selective Nerve Root Sleeve Injections for Lumbar Spinal Stenosis With Radiculopathy Utilizing Patient Reported Outcome Measurement Information System as an Outcome Measure

Arch Phys Med Rehabil. 2024 Feb 29:S0003-9993(24)00831-1. doi: 10.1016/j.apmr.2024.02.720. Online ahead of print.

Authors

Andrew R Stephens¹, Ramzi El-Hassan², Rajeev K Patel²

Affiliations

¹ Department of Physical Medicine and Rehabilitation, University of Rochester Medical Center, Rochester, NY. Electronic address: Andrew_stephens@urmc.rochester.edu.
² Department of Physical Medicine and Rehabilitation, University of Rochester Medical Center, Rochester, NY.

PMID: 38430994
DOI: 10.1016/j.apmr.2024.02.720

Abstract

Objective: To evaluate the therapeutic effect of transforaminal selective nerve root sleeve injections (TFSNRIs) in a specific subset of patients with clinical symptoms and presentation consistent with spinal stenosis.

Design: Retrospective review.

Setting: Tertiary academic spine center.

Participants: A total of 176 patients with radicular leg pain with or without low back pain as well as ≥3 clinical features of spinal stenosis and corroborative radiographic features of spinal stenosis on lumbar spine magnetic resonance imaging without confounding spinal pathology (N=176).

Interventions: Fluoroscopically guided transforaminal selective nerve root sleeve injections.

Main outcome measures: Patient Reported Outcome Measurement Information System (PROMIS) Physical Function (PF) v1.2/v2.0, Pain Interference (PI) v1.1, and PROMIS (D) v1.0 were collected at baseline and post-procedure short term (<3-months) and long-term (6-12 month) follow-up. Statistical analysis comparing baseline and postprocedural PROMIS scores was performed. Differences were compared with previously established minimal clinically important differences in the spine population.

Results: For patients with spinal stenosis treated with TFSNRI, no statistically significant improvement was observed short- and long-term follow-up in PROMIS PF (P=.97, .77) and PROMIS Depression (P=.86, .85) scores. At short-term follow-up, PROMIS PI scores did significantly improve (P=.01) but the average difference of pre- and post-procedure scores did not reach clinical significance. No significant difference in PROMIS PI was noted at long-term follow-up (.75).

Conclusions: Although a statistically significant difference was observed for improvement in pain, in this retrospective study, TFSNRI did not provide clinically significant improvement in patients' function, pain, or depression for lumbar spinal stenosis at short- and long-term follow-up.

Keywords: Lumbar spinal stenosis; PROMIS; Patient Reported Outcomes; Rehabilitation; Transforaminal selective nerve root sleeve injections.