Interventional spine therapy for neuropathic pain in individuals with paraplegia

Infiltrations of the spine can be used to treat nociceptive or neuropathic pain. There is little data in the literature on the use of spinal injections in patients with paraplegia.

The aim of this study is to determine whether patients with spinal cord injury experienced improvement in pain and spasticity following spinal injection.

19 (9 female, 10 male) patients (5 patients AIS A, 5 patients AIS C, 9 patients AIS D), including 9 tetraplegic and 10 paraplegic patients, with 22 injection techniques and a follow-up of 4.2 months (1-12 months) were retrospectively examined in our spinal cord injury Center in 2022 and 2023. The pain intensity on the NRS (Numerical Rating Scale), the MAS (Modified Ashworth Scale) for the graduation of muscle tone and the Spinal Cord Independence Measurement (SCIM) were assessed before infiltration and as part of the follow-up examination.

Image intensifier-assisted facet and sacroiliac joint infiltrations were performed in 12 patients, CT-guided nerve root infiltrations and epidural injections in 10 patients with corresponding symptoms and image morphological correlate without complications. In all patients, a statistically significant reduction in pain on the NRS could be achieved (4.05 ± 1.84; p < 0.0001). A trend towards improvement was documented in the analysis of the MAS (0.14 ± 0.35; p = 0.08), whereas a significant improvement was statistically detected in the analysis of the SCIM (-15.59 ± 18.23; p = 0.0006).

Our study represents the first retrospective exploratory analysis (phase I-style feasibility study) after spinal injection in patients with spinal cord injury. The primary results in terms of pain intensity, muscle tone and independence are promising and, in our view, represent a further therapeutic approach in addition to pharmacological and non-pharmacological therapy options. However, further investigations are necessary for this.