Relationship of specific MRI findings to treatment outcomes in patients receiving transforaminal epidural steroid injections.
OBJECTIVE
To determine whether specific MRI findings are related to outcomes after lumbar transforaminal epidural steroid injections (TFESI) and to assess the inter-rater reliability of imaging diagnosis.


METHODS
A prospective outcomes study on 156 consecutive patients with 1-month follow-up outcomes data and MRI within 3 months of TFESI was conducted. Pain levels (numerical rating scale) (NRS) were recorded prior to injection. Overall 'improvement' was determined using the Patients Global Impression of Change (PGIC) scale and NRS data were collected at three time points post injection. Two radiologists independently evaluated all images blinded to treatment outcome for reliability of diagnosis. The Chi-square test compared MRI findings for the senior radiologist to 'improvement'. NRS change scores were compared to MRI findings with the unpaired t-test or ANOVA. Kappa and percent agreement assessed inter-rater agreement of diagnosis.


RESULTS
The only abnormality linked to 'improvement' (p = 0.03) and higher NRS change scores (p = 0.0001) at 1 month was the disc herniation morphology 'protrusion + sequestration'. Patients with degeneration by osteophytes (p = 0.034), grade 3 foraminal nerve root compression (p = 0.01) and foraminal/extraforaminal location of herniation (p = 0.014) also had higher 1 month NRS change scores. Reliability of diagnosis was 'fair' to 'substantial' depending on MRI findings.


CONCLUSIONS
Patients with disc protrusion plus sequestration were significantly more likely to report overall improvement and more pain reduction at 1 month. Higher pain reduction was noted in patients with degeneration by osteophytes, grade 3 foraminal nerve root compression, or foraminal/extraforaminal disc herniation location.
Department of Radiology, Orthopaedic University Hospital Balgrist, University of Zürich, Forchstrasse 340, 8008, Zürich, Switzerland.
Marco
M
Lechmann
Department of Radiology, Orthopaedic University Hospital Balgrist, University of Zürich, Forchstrasse 340, 8008, Zürich, Switzerland.
Andrea
A
Rosskopf
Department of Radiology, Orthopaedic University Hospital Balgrist, University of Zürich, Forchstrasse 340, 8008, Zürich, Switzerland.
Christine
C
Ehrmann
Department of Radiology, Orthopaedic University Hospital Balgrist, University of Zürich, Forchstrasse 340, 8008, Zürich, Switzerland.
Reto
R
Sutter
Department of Radiology, Orthopaedic University Hospital Balgrist, University of Zürich, Forchstrasse 340, 8008, Zürich, Switzerland.
Christian W A
CW
Pfirrmann
Department of Radiology, Orthopaedic University Hospital Balgrist, University of Zürich, Forchstrasse 340, 8008, Zürich, Switzerland. cynthia.peterson@balgrist.ch.
Cynthia K
CK
Peterson
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007268:Injections, Epidural; D007405:Intervertebral Disc Displacement / Q000628:therapy*; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010147:Pain Measurement; D011446:Prospective Studies; D015203:Reproducibility of Results; D013130:Spinal Stenosis / Q000628:therapy*; D013256:Steroids / Q000008:administration & dosage*; D016896:Treatment Outcome
D013256:Steroids
Clinical competence; Epidural; Injections; Intraspinal; Treatment outcome
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