Cervical Multifidus Fatty Degeneration and Bony Foraminal Stenosis Are Associated with Unsuccessful Response to Stellate Ganglion Block in Cervical Radicular Pain: A Retrospective Study.

Background and

Objectives

Ultrasound-guided stellate ganglion block is a promising alternative intervention for cervical radicular pain. However, factors associated with treatment responses remain unknown. This single-center, retrospective study aimed to identify clinical and radiological factors associated with treatment response to stellate ganglion block in patients with cervical radicular pain. Materials and

Methods

This study included patients with cervical radicular pain who underwent ultrasound-guided stellate ganglion block. Successful response was defined as a ≥4-point or ≥50% reduction in the numerical rating scale score at 3 months post-procedure compared with the pre-procedural baseline. Patients who did not meet these criteria or underwent additional interventional procedures for persistent cervical radicular pain within 3 months were classified as unsuccessful responders. Logistic regression analysis was performed to identify factors associated with treatment response.

Results

Multivariable logistic regression analysis demonstrated that substantial cervical multifidus fatty degeneration, defined as Goutallier grade ≥2 of the cervical multifidus muscles (vs. minimal fatty degeneration, odds ratio (OR) 0.23, 95% confidence interval (CI): 0.08-0.66, p = 0.007) and bony hypertrophy at the uncovertebral or facet joint as the primary etiology of foraminal stenosis (vs. disc herniation, OR 0.35, 95% CI: 0.14-0.87, p = 0.024) were independently associated with lower odds of a successful response to stellate ganglion block. Steroid use was not significantly associated with treatment response (OR 0.52, 95% CI: 0.18-1.49, p = 0.223). The successful response rate declined progressively with the number of risk factors: 94.7% (18/19), 50.0% (22/44), and 40.7% (11/27) for zero, one, and two factors, respectively (p < 0.001).

Conclusions

Substantial cervical multifidus fatty degeneration and foraminal stenosis attributable to bony hypertrophy may be associated with lower odds of a successful response to stellate ganglion block in patients with cervical radicular pain. These factors require prospective validation before routine clinical implementation.