AAOM’s President-Elect Mulvaney and Team Publish New Findings on TBI
Neurobehavioral symptom changes following bilateral two-level stellate ganglion blocks in patients with traumatic brain injury: a retrospective analysis of 102 patients
• Sean W. Mulvaney 1 • Sanjay Mahadevan 2 • Kyle J. Dineen 2 • Roosevelt J Desronvilles 2 • Jessi Truett 2
Department of Emergency Medicine, Uniformed Services University, Bethesda, MD, United States
Orthobiologics Research Initiative Inc, North Bethesda, MD, United States
Abstract
Introduction:
Persistent neurobehavioral symptoms following traumatic brain injury (TBI) can substantially affect patient functioning, and effective treatment options remain limited. This study evaluated changes in neurobehavioral symptoms following bilateral two-level cervical sympathetic chain block (2LCSB) in patients with persistent TBI-related symptoms. A secondary objective was to examine whether changes in neurobehavioral symptoms differed by sex.
Methods:
A retrospective case series was conducted among 102 patients with TBI-related neurobehavioral symptoms of at least 3 months' duration who underwent ultrasound-guided bilateral 2LCSB between September 2022 and October 2024. Neurobehavioral Symptom Inventory (NSI) scores were assessed at baseline, 1 week, and 1 month following the procedure. The cohort included 69 males and 33 females. Changes in NSI total scores and subscores across assessment periods were evaluated using repeated-measures analysis of variance with Greenhouse–Geisser correction when the assumption of sphericity was not met. Post hoc comparisons were adjusted for multiple comparisons.
Results:
Of the 102 patients that underwent the bilateral SGB procedure, 92 had improvement in their NSI scores (90.19%) with 10 patients not reporting improvement (9.80%). Mean NSI total score decreased from 38.88 (SD, 14.96) at baseline to 21.03 (SD, 14.33) at 1 week and 20.75 (SD, 13.95) at 1 month. NSI total scores differed significantly across assessment periods, F(1.64,165.59) = 102.26, p < 0.001, partial η2 =0.503. Compared with baseline, mean NSI total score decreased by 17.85 points at 1 week and 18.14 points at 1 month (both adjusted p < 0.001). Scores did not differ significantly between 1 week and 1 month (adjusted p = 0.789), indicating maintenance of the observed reduction through 1 month. NSI subscores demonstrated a similar pattern, with a significant effect of time, F(1.47,148.09) = 35.83, p < 0.00. Although males and females demonstrated descriptive reductions in NSI scores following 2LCSB, there was no significant evidence that the longitudinal pattern of change differed by sex. The average NSI scores across 102 patients showed notable improvements in patient reported symptoms with an average of 43% improvement in TBI-related neurobehavioral symptoms.
Discussion:
The use of bilateral Two-Level Cervical Sympathetic Chain Block (2LCSB) may be helpful in providing short term neurobehavioral symptoms for patients' relief from prior TBI's based on NSI scores. 2LCSB may improve chronic TBI symptoms through this minimally invasive interventional procedure, although further validated studies are needed to establish causality.
