Spinal Injections Versus Conservative Treatment for Spinal Pain: The Korean Spine Patient Outcomes Research Trial (K‐SPORT) Observational Cohort

Abstract

Objective: Spinal injections are increasingly used in the treatment of spinal pain, but its efficacy has been criticized. The purpose of this study was to compare the treatment effects of spinal injections and conservative care. Methods: This is a prospective observational cohort of nonsurgical candidates with spinal pain who were treated in one institute. Spinal injections included conventional injections, such as epidural steroid injection, selective nerve root block, medial branch block, interlaminar epidural block, caudal block, and sacroiliac joint block, and percutaneous epidural neuroplasty. Conservative treatment included medications, physical therapy, and exercise. Results: Primary outcome measures were changes from baseline in the visual analogue scale of lower back and leg pain (VAS_back and VAS_leg, respectively), 36-item Short Form Survey (SF-36), Euro Quality of Life-5 Dimensions (EQ-5D), and Oswestry Disability Index (ODI) at 1, 3, and 6 months. Secondary outcome that served as measure of clinical success was 50% (or 4-point) reduction from baseline VAS_back or VAS_leg and no increase from baseline ODI and SF-36 or 30% (or 2-point) reduction from baseline VAS_back or VAS_leg with 30% (or 3-point) reduction in ODI from baseline or 30% (or 20-point) increase from baseline SF-36. Of the 142 patients followed up to 6 months, 47 patients underwent spinal injection and 95 patients underwent conservative treatment. The initial VA_leg, EQ-5D_mobility, EQ-5D_pain/discomfort, and SF-36_bodily pain was higher in the injection group (p=0.0309, p=0.0258, p=0.0042, and p=0.0474 respectively). In both groups, spinal pain significantly decreased at 1-month follow-up, and the effect was maintained for 6 months (p<0.001). At all follow-up periods, there was no difference in the clinical success between the spinal injection and conservative treatment groups. Conclusion: The treatment effect was not different according to the diagnosis or disease severity. Both treatments were equally effective in carefully selected patients with spinal pain.