Korean J Pain.  2023 Jul;36(3):358-368. 10.3344/kjp.23092.

Association between fatty infiltration in the cervical multifidus and treatment response following cervical interlaminar epidural steroid injection

• Kwon HJ
• Kim CS
• Kim S
• Yoon SH
• Koh J
• Kim YK
• Choi SS
• Shin JW
• Kim DH

• KMID: 2544247
• DOI: http://doi.org/10.3344/kjp.23092

Abstract

Background
Recent attention has been directed towards fatty infiltration in the cervical extensor muscles for predicting clinical outcomes in several cervical disorders. This study aimed to investigate the potential association between fatty infiltration in the cervical multifidus and treatment response following cervical interlaminar epidural steroid injection (CIESI) in patients with cervical radicular pain.
Methods
The data of patients with cervical radicular pain who received CIESIs between March 2021 and June 2022 were reviewed. A responder was defined as a patient with a numerical rating scale decrease of ≥ 50% from the baseline to three months after the procedure. The presence of fatty infiltration in the cervical multifidus was assessed, along with patient characteristics, and cervical spine disease severity. To assess cervical sarcopenia, fatty infiltration in the bilateral multifidus muscles was evaluated at the C5–C6 level using the Goutallier classification.
Results
Among 275 included patients, 113 (41.1%) and 162 (58.9%) were classified as non-responders and responders, respectively. The age, severity of disc degeneration, and grade of cervical multifidus fatty degeneration were significantly lower in responders. Multivariate logistic regression analysis revealed that pre-procedural symptoms (radicular pain with neck pain, odd ratio [OR] = 0.527, P = 0.024) and high-grade cervical multifidus fatty degeneration (Goutallier grade 2.5–4, OR = 0.320, P = 0.005) were significantly associated with an unsuccessful response to CIESI.
Conclusions
These results suggest high-grade cervical multifidus fatty infiltration is an independent predictor of poor response to CIESI in patients with cervical radicular pain.

Keyword

Cervical Vertebrae; Injections, Epidural; Neck Pain; Paraspinal Muscles; Radiculopathy; Sarcopenia; Steroids; Treatment Outcome

Figure

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  Fig. 1 Fatty infiltration in the bilateral multifidus muscles was evaluated with the Goutallier classification at the C5–C6 level. Axial cuts of T2-weighted magnetic resonance imaging sequences were utilized to assess Goutallier classification. Each grade of Goutallier classification was defined as follows: (A) Goutallier 0, no visible fat streaks; (B) Goutallier 1, minimal fatty streaks; (C) Goutallier 2, more muscle present than fat; (D) Goutallier 3, fat and muscle present in equal quantities; (E) Goutallier 4, more fat present than muscle.

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