Transforaminal steroid injections for the treatment of cervical radiculopathy: a prospective and randomised study

Abstract

Steroid injections are often employed as an alternative treatment for radicular pain in patients with degenerative spinal disorders. Prospective randomised studies of the lumbar spine reveal contradictory results and non-randomised and most often retrospective studies of the cervical spine indicate pain reduction from steroid injections. No prospective randomised study on transforaminal steroid injections for the treatment of radicular pain in the cervical spine focusing on short-term results has been performed. Forty consecutive patients were employed for the study. The inclusion criteria were one-sided cervical radiculopathy with radicular distribution of arm pain distal to the elbow and corresponding significant degenerative pathology of the cervical spine at one or two levels on the same side as the radicular pain and visualised by MRI. A transforaminal technique was used for all injections. A positive response to a diagnostic selective nerve root block at one or two nerve roots was mandatory for all patients. The patients were randomised for treatment with steroids/local anaesthetics or saline/local anaesthetic. Only the neuroradiologist performing the blocks was aware of the content of the injection; all other persons involved in the study were blinded. Follow up was made 3 weeks after the randomised treatment by a clinical investigation and with a questionnaire focusing on the subjective effects from the injections. At follow up, there were no differences in treatment results in the two patient groups. Statistical analysis of the results confirmed the lack of difference in treatment effect. Further studies have to be performed before excluding steroids in such treatment and for evaluating the influence of local anaesthetics on radiculopathy in transforaminal injections.

Transforaminal versus Intra-Articular Facet Corticosteroid Injections for the Treatment of Cervical Radiculopathy: A Randomized, Double-Blind, Controlled Study

“…Conversely, our results are in agreement with a randomized controlled study by Anderberg et al 23 These authors assigned 40 patients presenting with chronic cervical radiculopathy from degenerative spondylosis, with a mean duration of symptoms of 31 months, to receive 1 fluoroscopically guided TFSI. The treatment group received an injection of mepivacaine and methylprednisolone, while the control group received an injection of mepivacaine and saline.…”

Safety and Efficacy of CT-Guided Transforaminal Cervical Epidural Steroid Injections Using a Posterior Approach

“…These include the use of EMG, MR imaging, and preprocedural selective nerve blocks. 8,16,17 Patients in this practice present for treatment after undergoing a variety of diagnostic tools, including CT, MR imaging, and EMG. Patients do not receive diagnostic nerve blocks before epidural injection.…”

A Rare Case of T1-2 Thoracic Disc Herniation Mimicking Cervical Radiculopathy

“…Perineural injections including trans-laminar and transforaminal epidurals, selective nerve root blocks may be performed under radiographic guidance. 22,23 However, there is little highquality evidence on the best non-operative therapy for radiculopathy, although it has been reported that a multi-modal approach may alleviate symptoms. 24 In the current case physical therapy and medication for pain were used but these conservative methods did not resolve the symptoms.…”