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PubMedDate not supplied

The utility of anoscopy in the rapid diagnosis of symptomatic anorectal gonorrhea in men.

Thirty-nine homosexual men seeking treatment for symptomatic proctitis were examined for anorectal gonorrhea by study of gram-stained smears obtained via an anoscope and by a blindly obtained anorectal swab specimen. Anorectal specimens for culture were obtained from all men. The sensitivity of the anoscopically obtained smears was 79% as compared with 53% for the blindly obtained smears. It was concluded that gram-stained smears obtained through an anoscope can provide rapid diagnosis of most cases of symptomatic anorectal gonorrhea. All patients with symptomatic proctitis should have routine anoscopy and examination of gram-stained smears obtained via anoscopy as part of their diagnostic evaluation.

Anal Canal↗
PubMedDate not supplied

Symptomatic response to therapy of men with gonococcal urethritis: do all need posttreatment cultures?

Because the large majority of men with gonorrhea respond to antimicrobial therapy with the rapid disappearance of signs and symptoms, it was hypothesized that a symptomatic response to therapy would predict successful treatment. The records of 4897 men with gonorrhea, of whom 183 (3.7%) were treatment failures on days 3-7 after treatment were studied, and the clinical response to therapy with microbiologic outcome was correlated. Before therapy, 4662 men (95.2%) had dysuria and/or urethral discharge. Of the 582 men who remained symptomatic, 103 (17.7%) had a positive culture after treatment, as compared with only 78 (1.9%) of 4080 men who became asymptomatic (P less than .01). The conclusion was that men who are initially symptomatic and become asymptomatic after therapy have a small chance (one of 50) of being infected at the posttreatment visit. However, because of its very large size, this group contributed almost one-half of all treatment failures (78 of 183; 42.6%).

Amoxicillin↗
PubMedDate not supplied

Effect of oral acyclovir treatment on symptomatic and asymptomatic virus shedding in recurrent genital herpes.

Twenty-six men and women with recurrent genital herpes maintained diaries of their symptoms and signs of infection and submitted 6,515 self-collected cultures during a one-year study of acyclovir therapy. As compared with periods before or after treatment, the mean rates of experiencing symptoms or lesions, and of shedding virus were significantly lower during treatment. Acyclovir treatment reduced the rate of symptomatic shedding from 95 positive cultures to six per 1,000 cultures, but the rate of asymptomatic shedding remained relatively constant, averaging eight per 1,000 cultures. Among the isolates of herpes simplex virus studied, there was no differences in sensitivity to acyclovir between strains recovered on or off therapy or during symptomatic or asymptomatic recurrences. The endonuclease cleavage profiles of asymptomatically shed viruses were essentially the same as those of the symptomatically shed viruses from the same individual. Chronic acyclovir therapy significantly reduced the symptoms and signs of recurrent genital herpes but did not eliminate virus shedding, nor, therefore, the possibility of disease transmission.

Acyclovir↗
PubMed1995

1995 Volvo Award in clinical sciences. The diagnostic accuracy of magnetic resonance imaging, work perception, and psychosocial factors in identifying symptomatic disc herniations.

STUDY DESIGN: This was a prospective study of patients (study group) with symptomatic disc herniations and asymptomatic volunteers (control group) matched for age, sex, and work-related risk factors. OBJECTIVE: To determine the prevalence of disc herniation in a matched group of asymptomatic volunteers and to access the diagnostic accuracy of magnetic resonance imaging, work perception, and psychosocial factors in identifying symptomatic disc herniations. SUMMARY OF BACKGROUND DATA: Disc herniations have been reported to occur in 20-36% of asymptomatic volunteers. A valid comparison of asymptomatic individuals and patients with disc herniations has not been performed. METHODS: Forty-six patients with low back pain and sciatica severe enough to require a discectomy were compared with 46 age-, sex-, and risk factor-matched (heavy lifting, twisting and bending, vibration, and sedentary activity) asymptomatic volunteers. Both groups had a complete clinical and magnetic resonance imaging examination and completed a questionnaire to assess differences in the psychosocial and work perception profiles. The prevalence and the severity of morphologic alterations (disc herniation, disc degeneration, and neural compromise) was analyzed by tow independent radiologists in a blinded fashion. Differences between both groups regarding MRI findings, work perception (occupational mental stress, intensity of concentration, job satisfaction, and job-related resignation) and psychosocial factors (anxiety, depression, self-control, social support, and marital status) were compared using multivariate techniques. Stepwise discriminating analysis was used to identify the best discriminating variables within the magnetic resonance image, work perception, and psychosocial categories in terms of the diagnostic accuracy to predict group membership (study [pain] or control [no pain] group). RESULTS: Matched controls had significantly more risk factors than a group of normal individuals. The present study has presented evidence that an age-, gender-, and occupational risk factors-matched group of asymptomatic patients shows a high incidence rate of disc herniations (76%). Although significantly less than the symptomatic group incidence of 96%, this represents a much higher prevalence rate than generally expected and reported in other studies of unmatched asymptomatic volunteers. Patients had more severe disc herniations (disc extrusions) than asymptomatic volunteers (35% vs. 13%). There was no significant differences regarding disc degeneration between both groups (96% vs. 85%). The only substantial morphologic difference between both groups was the presence of a neural compromise (83% vs. 22%), which was highly significant (P < 0.0001). There were significant differences between both groups regarding work perception (occupational mental stress, intensity of concentration, job satisfaction, and resignation; P < 0.027) and psychosocial factors (anxiety, depression, self-control, marital status; P < 0.0001). The best single predictor of a group membership was the extent of neural compromise. A combination of this factor with occupational mental stress, depression, and marital status was the best predictive model. With this model, the false-negative rate (potential overtreatment of disc morphology) was reduced by more than half compared with morphologic factors (nerve root compression) alone (22% vs. 11%). CONCLUSIONS: In an age-, sex-, and risk factor-matched group of asymptomatic individuals, disc herniation had a substantially higher prevalence (76%) than previously reported in an unmatched group. Individuals with minor disc herniations (i.e., protrusion, contained discs) are at a very high risk that their magnetic resonance images are not a causal explanation of pain because a high rate of asymptomatic subjects (63%) had comparable morphologic findings. The only highly significant difference between the study group and control group regarding morphologic fi

Adult↗
PubMed1998

The natural history of the cervical foramen in symptomatic and asymptomatic individuals aged 20-60 years as measured by magnetic resonance imaging. A descriptive approach.

STUDY DESIGN: This study was intended to identify normal degenerative morphologic evolution in the bony foramen in asymptomatic subjects by decade in comparison with symptomatic subjects of like decades. OBJECTIVES: To determine normal degenerative changes in the cervical spine caused by the aging process that predispose a person to foraminal stenosis and radiculopathy. SUMMARY OF BACKGROUND DATA: Cervical radiculopathy is a common problem caused by degenerative changes as people age. The characteristics of the foramen that result in stenosis are not known. METHODS: Five to six symptomatic and asymptomatic people in each decade volunteered for magnetic resonance imaging. Lordosis, disc heights, and ratio of spinal cord diameter to spinal canal diameter were measured at C4-C5, C5-C6, and C6-C7 from sagittal magnetic resonance images. Foraminal heights, widths, and areas were measured at the isthmus of the same foramen from oblique images. RESULTS: Foraminal heights, widths, and areas were larger in asymptomatic patients than in symptomatic patients. Morphologic analysis showed that inferior facet hypertrophy tended to decrease the width of the foramen in aging people. Disc heights, lordosis, and ratio of spinal cord diameter to spinal canal diameter showed no significant differences. CONCLUSIONS: Foraminal height affects overall foraminal area but tends to change little with age. Width also affects overall area and not only decreases in older people but also significantly affects the available area for the exiting nerve root.

Adult↗
PubMed2001

Spinal radiation before surgical decompression adversely affects outcomes of surgery for symptomatic metastatic spinal cord compression.

STUDY DESIGN: A retrospective chart review was performed. OBJECTIVE: To determine whether preoperative spinal radiation increases the number of major wound complications in patients with cancer who have symptomatic spinal cord compression. SUMMARY OF BACKGROUND DATA: Many factors have increased the number of patients hospitalized with symptomatic spinal cord compression after spinal irradiation. The surgical management of metastatic spinal cord compression may be complicated by preoperative radiation. METHODS: A retrospective review of 123 patients admitted with symptomatic metastatic spinal cord compression from 1970 through 1996 was conducted. The final study population of 85 patients was separated into three treatment groups: 1) radiation only, 2) radiation followed by surgery, and 3) de novo surgery followed by radiation. RESULTS: The major wound complication rate for patients who had radiation before surgical decompression and stabilization was 32%, or threefold, higher than the 12% observed in patients who had de novo surgery (P < 0.05). No other clinical factor or condition predicted the development of a major wound complication. Patients treated initially with surgery had superior functional outcomes in an analysis stratified by Frankel grade (P < 0.05). Of the ambulatory patients who underwent de novo surgery, 75% remained ambulatory and continent 30 days after treatment, whereas only 50% of those treated with radiation before surgery had similar outcomes. CONCLUSIONS: Spinal radiation before surgical decompression for metastatic spinal cord compression is associated with a significantly higher major wound complication rate. In addition, preoperative spinal irradiation might adversely affect the surgical outcome.

Adult↗
PubMed2002

Bilateral symptomatic synovial cysts of the lumbar spine caused by calcium pyrophosphate deposition disease: a case report.

STUDY DESIGN: A case of bilateral symptomatic facet joint synovial cysts arising in association with calcium pyrophosphate deposition disease is reported. OBJECTIVE: To present a previously unreported cause for symptomatic synovial cysts of the lumbar spine. SUMMARY OF BACKGROUND DATA: Synovial cysts of the facet joints occur most commonly in association with degenerative disease of the spine in older individuals. The association of these cysts with trauma, rheumatoid arthritis, spondylolysis, and kissing spinous processes also has been reported. These cysts can cause symptoms and signs from direct compression of the dura. Chondrocalcinosis has not been previously reported to cause symptomatic synovial cysts. METHODS: A 67-year-old woman presented with right lower limb sciatica caused by a right L4-L5 facet joint cyst, which resolved after surgical decompression. A year later, she presented with left lower limb sciatica caused by development of a new L4-L5 facet joint cyst, which also resolved after surgical decompression. RESULTS: Histopathologic examination of each cyst showed a cyst wall of fibrous tissue with synovial lining, inflammation, and granulation tissue. Examination of the tissue under polarized light showed positively birefringent, short blunt crystals of calcium pyrophosphate dihydrate. CONCLUSIONS: In patients with a history of gout or pseudogout, a rare possibility of a synovial cyst should be considered in the differential diagnosis during investigation for the cause of neural compression resulting in sciatic syndrome.

Aged↗
PubMed1999

Administration of hypertonic (3%) sodium chloride/acetate in hyponatremic patients with symptomatic vasospasm following subarachnoid hemorrhage.

A retrospective study was carried out to evaluate the effect of hypertonic (3%) saline chloride/acetate on various hemodynamic parameters in mildly hyponatremic patients with symptomatic vasospasm following aneurysmal subarachnoid hemorrhage (SAH). We identified 29 hyponatremic (serum sodium < 135 mEq/L) patients who received hypertonic (3%) sodium chloride/acetate as a continuous infusion. Administration of hypertonic (3%) sodium chloride/acetate resulted in higher central venous pressures and positive fluid balance, with a concomitant increase in serum sodium and chloride concentrations without metabolic acidosis. There were no changes in mean cerebral blood flow velocities after infusion of hypertonic (3%) sodium chloride/acetate. We found no reports of congestive heart failure, pulmonary edema, metabolic acidosis, coagulopathy, intracranial hemorrhages, or central pontine myelinolysis in any of these patients. We conclude that hypertonic (3%) sodium chloride/acetate can be administered to patients with mild hyponatremia in the setting of symptomatic vasospasm following SAH without untoward effects. Sample size and limitations of a retrospective analysis preclude conclusions about safety and efficacy of hypertonic (3%) sodium chloride/acetate administration in this patient population. However, our results support justification for a prospective, randomized, double-blind trial of hypertonic (3%) sodium chloride/acetate versus normal saline in patients with symptomatic vasospasm following SAH.

Acetates↗
PubMed2002

Epidural injections for the treatment of symptomatic lumbar herniated discs.

Epidural steroid injections are widely used as part of the conservative care for symptomatic herniated lumbar discs. There are studies showing their effectiveness, and some studies demonstrating no clinical benefits. The purpose of this study was to evaluate the effectiveness of epidural steroid injections for patients with symptomatic lumbar disc herniations who were surgical candidates. Sixty-nine patients were diagnosed with a herniated disc in the lumbar spine and remained symptomatic despite conservative care, and were treated with an epidural injection in an attempt to avoid surgical discectomy. Of the total group of 69 patients (average age = 44.8 years, range 19-77 years, average follow-up = 1.5 years), 53 (77%) had successful resolution or significant decrease of their symptoms and were able to avoid surgery. Only 16 (23%) patients failed to have significant relief of their symptoms and required surgical treatment of their herniated disc. Epidural steroid injections have a reasonable success rate for the alleviation of radicular symptoms from lumbar herniated discs for up to twelve to twenty-seven months. Patients treated with injections may be able to avoid surgical treatment up to this period and perhaps even longer.

Adult↗
PubMed2005

Effects of symptomatic status and the menstrual cycle on hot flash-related thermoregulatory parameters.

OBJECTIVE: To compare core body temperature variation, sweating thresholds, and sweat rate in symptomatic and asymptomatic postmenopausal women and in eumenorrheic women in the follicular and luteal phases. DESIGN: Twelve symptomatic and 10 asymptomatic postmenopausal women and 12 eumenorrheic women were recorded in a temperature- and humidity-controlled laboratory during thermoneutral and warm conditions. Core body temperature variation was measured with an ingested radiotelemetry pill, basal body temperature with a rectal thermistor, skin temperature with four skin surface thermistors, and sweat rate with a capacitance hygrometer. RESULTS: Symptomatic women had significantly lower sweating thresholds and higher maximum sweat rates compared with all other women. These results could not be explained by differences in estrogen, progesterone, or body mass index. CONCLUSIONS: Postmenopausal women with hot flashes are uniquely characterized by low sweating thresholds and high sweat rates, relative to asymptomatic and eumenorrheic women.

Adult↗
PubMed1996

Predictive value for survival of soluble tumor necrosis factor receptors p55 and p75 during zidovudine-containing treatment in symptomatic human immunodeficiency virus type 1 infection.

Previous studies of asymptomatic human immunodeficiency virus (HIV) infection have shown that serum levels of soluble tumor necrosis factor receptors (sTNFR) are good predictors of disease progression and clinical outcome during zidovudine (ZDV) therapy. The present study of symptomatic HIV infection was designed to evaluate whether sTNFR p55 and p75 at weeks 0 (pretreatment) and 24 and 48 are predictors of death < or = 3 years after the start of ZDV 1,000 mg alone or combined with low-dose interferon-alpha (ZDV 500 mg + IFN-alpha 3 MIU three times weekly). CD4+ T-cell numbers and serum neopterin were analyzed in a similar way. Forty previously untreated symptomatic HIV-infected persons with CD4+ T-cell numbers > or = 150 x 10(6)/L were included. At baseline, in the nonsurvivor group, mean age (42.1 vs. 34.4 years, p = 0.002) and neopterin (24.7 vs. 18.0 nmol/L, p = 0.02) were higher, whereas mean CD4+ T-cell counts (202 vs. 295 x 10(6)/L, p = 0.02) were lower than in the survivors. All analyses were adjusted for age. For the pretreatment marker values, a significant relative risk (RR) for death was noted only in the univariate analysis for sTNFR-p55 > 1.7 ng/ml [RR 3.1; 95% confidence interval (CI) 1.1-8.8; p = 0.04]. During therapy, CD4+ counts < 200 x 10(6)/L at week 24 and 48 and neopterin > 20 nmol/ml at week 48 were independent predictors of survival in the uni- and multivariate analysis. Marker values relative to baseline were not predictive. sTNFR-p55 and p75 were of little use as surrogate markers for clinical efficacy during ZDV-containing drug regimens in symptomatic HIV-infected patients with CD4+ counts 150 x 10(6)/L.

Adult↗
PubMed2003

Bleb-limiting conjunctivoplasty for symptomatic circumferential trabeculectomy blebs.

PURPOSE: To describe a new surgical technique for limiting symptomatic circumferential conjunctival blebs, an uncommon complication after trabeculectomy. METHODS: Four eyes of 2 patients underwent conjunctivoplasty to limit the extent of symptomatic circumferential blebs. An 8/0 virgin silk corneal traction suture was used to allow better exposure of the conjunctiva. Radial conjunctival and Tenon incisions were made down to bare sclera in approximately the 10:30 and 1:30 clock hour positions. The conjunctival incisions were sutured, tacking down to the sclera. RESULTS: Immediate flattening of the interpalpebral bulbar conjunctiva was noted on the first postoperative day and there was no elevation of intraocular pressure or loss of bleb function. Both patients experienced a rapid improvement in their symptoms and no complications of the procedure were noted. Recurrence of bleb extension occurred in 1 eye 4 months postoperatively, and was treated with a repeat limiting conjunctivoplasty incision with a good result. CONCLUSIONS: Early results show that bleb-limiting conjunctivoplasty is an effective means of treating symptomatic circumferential trabeculectomy blebs.

Aged↗
PubMed2003

Long-term results of laparoscopic unroofing of symptomatic solitary nonparasitic hepatic cysts.

The long-term results of laparoscopic unroofing for symptomatic solitary nonparasitic hepatic cysts have not been well demonstrated. During the last 8 years, five patients with symptomatic solitary nonparasitic hepatic cysts underwent laparoscopic unroofing. Their symptoms were right-upper-quadrant pain (in three patients) and epigastric pain (in two). Accompanying the hepatic cysts were acute cholecystitis in one case and adenomyomatosis of the gallbladder in another. Perioperative data, including operation time, estimated blood loss, complications, hospital stay, and mortality rate, were evaluated. There were no conversions to open laparotomy. Cysts were located in segments 4 and 5 in three patients, segment 3 in one, and segment 8 in another, and the mean size of the cysts was 10.4 cm in diameter (range: 7-18 cm). In four cases cholecystectomy was performed simultaneously. Mean operation time, estimated blood loss, and postoperative hospital stay were 182 minutes (range: 72-270), 168 mL (range: minimal to 800 mL), and 9.4 days (range: 7-12), respectively. There were no deaths or instances of major morbidity. During a mean follow-up period of 66 months (range: 35-102), one patient had a recurrent lesion requiring reoperation. Laparoscopic unroofing is a feasible and safe procedure for patients with symptomatic solitary nonparasitic hepatic cysts. Strict patient selection, accurate location of the cyst within the liver, and a sufficiently wide unroofing technique are needed for the outcome to be successful.

Adult↗
PubMed2006

Is symptomatic improvement in clinical trials of cognitive-behavioral therapy for psychosis clinically significant?

Although cognitive-behavioral therapy (CBT) is becoming increasingly popular as an adjunctive treatment for psychosis, few studies to date have examined the clinical (in contrast to statistical) significance of treatment gains using standardized methods. The aim of the current study was to investigate the clinical significance of symptomatic reductions reported in trials of CBT for schizophrenia and related disorders using standardized group methods of analysis. An electronic literature search identified 12 studies that met the inclusion criteria of being randomized, controlled trials that compared CBT to routine care alone or to another comparison treatment. The analysis involved the following steps. First, reliable change on symptom measures was examined. Next, the proportion of patients in each study estimated to show clinically significant symptomatic reductions (i.e., two standard deviations) was calculated. When both post-treatment and follow-up data were considered, 42% of CBT conditions compared with only 25% of comparison conditions demonstrated reliable change on at least one psychotic symptom measure per study. Proportions of clinically significant symptomatic improvement in studies showing reliable change were similar between CBT and comparison conditions. Due to the adjunctive nature of CBT for schizophrenia and the limits imposed by the evaluation of group datasets, results of the current study are considered promising but preliminary. Future trials should examine clinical significance using similar standardized methods within studies, as well as broader functional outcome measures, to provide a clearer picture of the benefits derived from this type of intervention.

Cognitive Behavioral Therapy↗
PubMed2006

Effect of mifepristone for symptomatic leiomyomata on quality of life and uterine size: a randomized controlled trial.

OBJECTIVE: To assess the effect of low-dose mifepristone on quality of life, pain, bleeding, and uterine size among women with symptomatic leiomyomata. METHODS: Forty-two women with symptomatic uterine leiomyomata and uterine volume of 160 mL or more were randomized to mifepristone, 5 mg daily, or placebo for 26 weeks. Quality of life (Uterine Fibroid Symptoms Quality of Life Questionnaire and Medical Outcomes Study 36-Item Short Form survey) and uterine and leiomyoma size (ultrasonography) were assessed at baseline, and at 1 month, 3 months, and 6 months of treatment. Bleeding (daily logs and pictorial charts) and pain (McGill Pain Questionnaire) were assessed monthly. Endometrial pathology was assessed at baseline and 6 months. RESULTS: Forty-two women were randomized; 37 women completed all 6 months. Women randomized to mifepristone showed an improvement in leiomyoma-specific quality of life. Forty-one percent became amenorrheic, rates of anemia improved, and adjusted uterine size was reduced by 47%. Compared with the placebo group, improvements in these outcomes in the treatment group were significantly greater (P<.05 to .001). There were no significant differences in adverse effects between the groups. No endometrial hyperplasia was noted in any participant. CONCLUSION: Low-dose mifepristone improves leiomyoma-specific quality of life and reduces leiomyoma size among women with symptomatic leiomyomata. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov www.clinicaltrials.gov NCT00133705 LEVEL OF EVIDENCE: I.

Adult↗
PubMed2003

Spontaneous symptomatic pseudoarthrosis at the T11-T12 intervertebral space with diffuse idiopathic skeletal hyperostosis: a case report.

STUDY DESIGN: We report on a 69-year-old male who had severe back pain due to spontaneous symptomatic pseudoarthrosis at the T11-T12 intervertebral space with diffuse idiopathic skeletal hyperostosis. OBJECTIVE: To describe a rare clinical entity and successful treatment by spinal fusion with a 4-year follow-up. SUMMARY OF BACKGROUND DATA: There have been a few reports of spontaneous symptomatic pseudoarthrosis of an intervertebral space associated with diffuse idiopathic skeletal hyperostosis, but there have been no reports of surgical treatment for this clinical condition. METHODS: Plain radiographs of the patient, who was admitted to our hospital with severe back pain but no history of trauma, revealed manifestations of diffuse idiopathic skeletal hyperostosis and a pseudoarthrosis at the T11-T12 intervertebral space. Posterior instrumentation from T9 to L2 and anterior bone grafting at the T11-T12 intervertebral space were performed. RESULTS: The patient has been followed for 4 years and is currently asymptomatic. CONCLUSIONS: A rare case of spontaneous symptomatic pseudoarthrosis at the T11-T12 intervertebral space with diffuse idiopathic skeletal hyperostosis was treated successfully by spinal fusion.

Aged↗
PubMed2003

Symptomatic spinal epidural varices presenting with nerve impingement: report of two cases and review of the literature.

STUDY DESIGN: Two cases of symptomatic epidural varices are presented and the literature was reviewed on this entity. OBJECTIVE: To raise awareness of this rare condition in the interpretation of preoperative magnetic resonance imaging scans and to assess the results of surgical treatment. BACKGROUND: Symptomatic epidural varices presenting with radiculopathy are extremely rare, and the diagnosis is often missed in the preoperative evaluation. This condition commonly masquerades as a herniated nucleus pulposus. Diagnosis is often only made intraoperatively. MATERIALS AND METHODS: Case 1 is a 40-year-old man presenting with acute exacerbation of lower back pain associated with radiculopathy down his right lower limb. Magnetic resonance imaging showed a paracentral disc prolapse. At operation, a congested epidural vein impinging on the L5 nerve root was noted with no intervertebral foramens stenosis. Excision of the vein was performed. The second case, a 50-year-old man with previous spinal instrumentation, was admitted for acute onset of radiculopathy down his left lower limb. At operation, an epidural varix compressing on the L4 nerve root was noted. Retrospectively, features of epidural varices were noted in the preoperative magnetic resonance imaging scans. Both patients reported resolution of symptoms after surgery. RESULTS: Excision was done for the first patient, and coagulative ablation was done in the second patient. Both patients had symptomatic relief and neurologic recovery on follow-up. CONCLUSION: Our experience and the literature demonstrated that a favorable outcome with resolution of neurologic symptoms can often be achieved after excision or ablation of the epidural varices.

Adult↗
PubMed2006

Cervical epidural steroid injections for symptomatic disc herniations.

OBJECTIVES: Cervical disc herniations are a common cause of radicular pain from nerve root impingement and may necessitate surgical decompression to alleviate symptoms. The use of cervical epidural injections has not been studied in detail. The objective of this retrospective study was to examine the efficacy of cervical epidural steroid injections for the treatment of symptomatic herniated cervical discs. METHODS: Patients with herniated cervical discs without myelopathy that had failed conservative management and were otherwise surgical candidates were offered a trial of cervical epidural injections. The results and benefits of the injections were examined as well as the incidence of proceeding to surgical intervention. RESULTS: Of the 70 treated patients, 44 (63%) had significant relief of their symptoms and did not wish to proceed with surgical treatment. Of the 26 patients who underwent surgical decompression, 92% had successful resolution of their symptoms. The nonsurgical and surgical groups were similar in terms of gender, preinjection symptoms, or number of injections. However, significant differences between the two groups were found with regard to age (P<0.05) and time from initial consultation to initial injection (P<0.05). With an average of 13-month follow-up, 45 (65.3%) patients reported a good/excellent result per Odom criteria. In addition, 53 (75%) would attempt cervical epidural steroid injections again in the future. No complications were noted in our series. CONCLUSIONS: Cervical epidural injections are a reasonable part of the nonoperative treatment of patients with symptomatic cervical disc herniations. The success rates appear to be very similar to prior studies of lumbar epidural injections for symptomatic lumbar disc herniations. It appears that a large percentage of the patients may obtain relief from radicular symptoms and avoid surgery for the follow-up period up to 1 year. In addition, patients older than 50 years and those who received the injections earlier, less than 100 days from diagnosis, seemed to have a more favorable outcome.

Adult↗