Cost-Effectiveness of Cervical Epidural Steroid Injections: A 3-Month Pilot Study

Study Design: Retrospective cohort. Objectives: There are conflicting reports on the short- and long-term quality of life (QOL) outcomes and cost-effectiveness of cervical epidural steroid injections (ESIs). The present study analyzes the cost-effectiveness analysis of ESIs versus conservative management for patients with radiculopathy or neck pain in the short term. Methods: Fifty patients who underwent cervical ESI and 29 patients who received physical therapy and pain medication alone for cervical radiculopathy and neck pain of <6 months duration were included. Three-month postoperative health outcomes were assessed based on EuroQol-5 Dimensions (EQ-5D; measured in quality-adjusted life years [QALYs]). Medical costs were estimated using Medicare national payment amounts. Cost/utility ratios and the incremental cost-effectiveness ratio (ICER) were calculated to assess for cost-effectiveness. Results: The ESI cohort experienced significant ( P < .01) improvement in the EQ-5D score while the control cohort did not (0.13 vs 0.02 QALYs, respectively; P = .01). There were no significant differences in costs between the cohorts. The cost-utility ratio for the ESI cohort was significantly lower ($21 884/QALY gained) than that for the control cohort ($176 412/QALY gained) ( P < .01). The ICER for an ESI versus conservative management was negative, indicating that ESIs provide greater improvement in QOL at a lower cost. Conclusions: ESIs provide significant improvement in QOL within 3 months for patients with cervical radiculopathy and neck pain. ESIs are more cost-effective compared than conservative management alone in the shor -term. The durability of these results must be analyzed with longer term cost-utility analysis studies.

Cervical Spinal Stenosis

Cervical spinal stenosis is the narrowing of the spinal canal. Degenerative cervical spinal stenosis can occur as a result of disc degeneration, osteophyte formation, and hypertrophy of spinal canal ligaments. Diagnosis is primarily made with clinical history and examination in order to assess for classic myelopathic signs (motor weakness, hyperreflexia, and other specific tests). Radiologic imaging is used to validation the diagnosis and to determine the extent of stenosis. Magnetic resonance imaging is the most useful and noninvasive modality. Cervical spinal stenosis without myelopathy can be managed nonsurgically with strengthening, physical therapy, traction, orthosis, and pain management (cervical epidural steroid injections and selective nerve root blocks). Cervical spondylolisthesis has received insufficient attention in comparison to spondylolisthesis of the lumbar spine. It is primarily considered a surgical condition, yet few publications have been dedicated to the topic.