Cervical Steroid Injections Are Not Effective for Prevention of Surgical Treatment of Degenerative Cervical Myelopathy

Abstract

Study Design: Retrospective cohort study. Objective: The objective of this study is to determine how often patients with degenerative cervical myelopathy (DCM) and initially treated with cervical steroid injections (CSI) and to determine whether these injections provide any benefit in delaying ultimate surgical treatment. Methods: All patients with a new diagnosis of DCM, without previous cervical spine surgery or steroid injections, were identified in PearlDiver, a large insurance database. Steroid injection and surgery timing was identified using Current Procedural Terminology (CPT) codes. Multivariate logistic regression identified associations with surgical treatment. Results: A total of 686 patients with DCM were identified. Pre-surgical cervical spine steroid injections were utilized in 244 patients (35.6%). All patients underwent eventual surgical treatment. Median time from initial DCM diagnosis to surgery was 75.5 days (mean 351.6 days; standard deviation 544.9 days). Cervical steroid injections were associated with higher odds of surgery within 1 year (compared to patients without injections, OR = 1.44, P < .001) and at each examined time point through 5 years (OR = 2.01, P < .001). In multivariate analysis comparing injection types, none of the 3 injection types were associated with decreased odds of surgery within 1 month of diagnosis. Conclusions: While cervical steroid injections continue to be commonly performed in patients with DCM, there is an overall increased odds of surgery after any type of cervical injection. Therefore injections should not be used to prevent surgical management of DCM.

Factors associated with treatment success after interlaminar epidural steroid injection for cervical radicular pain

“…To the best of our knowledge, the present study is the first to evaluate the effect of cervical canal stenosis grade on epidural steroid injection therapy. Manzur et al (17) evaluated the data of 244 patients with cervical myelopathy (Grade 3 according to the classification of Kang et al ( 6)) and reported that epidural steroid injections did not delay surgical treatment. In our clinical practice, we refer patients with myelopathy in cervical spinal MRI and severe symptoms to surgical treatment, as their condition may be progressive.…”

Spine

“…Into this discussion has stepped a team from Philadelphia (Pennsylvania, USA) who have carried out a retrospective cohort study of 686 patients treated for DCM, comparing the outcomes in those who received steroid injections with those who did not. 2 The findings revealed that cervical steroid injections did not effectively prevent the need for surgical treatment in patients with DCM. No significant difference in the rates of surgical intervention between the group that received cervical steroid injections and the group that did not was observed, suggesting that the use of cervical steroid injections as a standalone treatment for DCM is not supported.…”

Blood-spinal cord barrier disruption in degenerative cervical myelopathy

“…Late-onset neurological deterioration may also occur despite adequate mechanical decompression [ 133 , 134 ]. There is insufficient evidence to support the long-term efficacy of non-operative management approaches for DCM such as physiotherapy, nutritional supplementation, use of analgesics and non-steroidal anti-inflammatory drugs (NSAIDs), cervical steroid injections (CSIs), traction, and acupuncture [ 10 , 135 – 137 ]. Few DCM-related therapeutics have undergone clinical testing.…”