Skip to main content
Log in

Intradiscal corticosteroid injections in spondylotic cervical radiculopathy

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

The purpose of this study was to evaluate treatment outcomes with intradiscal injection of corticosteroids (IDIC) in cervical spondylotic radiculopathy. Twenty consecutive patients were treated with intradiscal injection of 25 mg of acetate of prednisolone under fluoroscopic control. All patients had previously received a nonsurgical treatment for at least 3 months without success. Outcomes were assessed 1, 3 and 6 months after IDIC. Radicular pain reduction as scored on a visual analogue scale (VAS 100-mm length) was statistically significant at 1 month (19.0±28.0 mm; p=0.008), 3 months (25.2±27.5 mm; p=0.002), and 6 months (24.6±28.4 mm; p=0.001). In all, 40% of treated patients described at least 50% pain improvement 6 months after treatment. Four patients had complete relief of radicular pain. In conclusion, IDIC should be an alternative in the nonsurgical management of cervical spondylotic radiculopathy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Carette S, Fehlings MG (2005) Clinical practice. Cervical radiculopathy. N Engl J Med 353:392–399

    Article  PubMed  CAS  Google Scholar 

  2. Radhakrishnan K, Litchy WJ, O’Fallon WM, Kurland LT (1994) Epidemiology of cervical radiculopathy: a population-based study from Rochester, Minnesota, 1976 through 1990. Brain 117:325–335

    Article  PubMed  Google Scholar 

  3. Salemi G, Savettieri G, Meneghini F, Di Benedetto ME, Ragonese P, Morgante L, Reggio A, Patti F, Grigoletto F, Di Perri R (1996) Prevalence of cervical spondylotic radiculopathy: a door-to-door survey in a Sicilian municipality. Acta Neurol Scand 93:184–188

    Article  PubMed  CAS  Google Scholar 

  4. Sampath P, Bendebba M, Davis JD, Ducker T (1999) Outcome in patients with cervical radiculopathy: prospective, multicenter study with independent clinical review. Spine 24:591–597

    Article  PubMed  CAS  Google Scholar 

  5. Gallucci M, Puglielli E, Splendiani A, Pistoia F, Spacca G (2005) Degenerative disorders of the spine. Eur Radiol 15:591–598

    Article  PubMed  Google Scholar 

  6. Cicala RS, Thoni K, Angel JJ (1989) Long-term results of cervical epidural steroid injections. Clin J Pain 5:143–145

    Article  PubMed  CAS  Google Scholar 

  7. Bush K, Hillier S (1996) Outcome of cervical radiculopathy treated with periradicular/epidural corticosteroid injections: a prospective study with independent clinical review. Eur Spine J 5:319–325

    Article  PubMed  CAS  Google Scholar 

  8. Slipman CW, Lipetz JS, Jackson HB, Rogers DP, Vresilovic EJ (2000) Therapeutic selective nerve root block in the nonsurgical treatment of atraumatic cervical spondylotic radicular pain: a retrospective analysis with independent clinical review. Arch Phys Med Rehabil 81:741–746

    PubMed  CAS  Google Scholar 

  9. Vallee JN, Feydy A, Carlier RY, Mutschler C, Mompoint D, Vallee CA (2001) Chronic cervical radiculopathy: lateral-approach periradicular corticosteroid injection. Radiology 218:886–892

    PubMed  CAS  Google Scholar 

  10. Dietrich CL, Smith CE (2004) Epidural granuloma and intracranial hypotension resulting from cervical epidural steroid injection. Anesthesiology 100:445–447

    Article  PubMed  Google Scholar 

  11. Ludwig MA, Burns SP (2005) Spinal cord infarction following cervical transforaminal epidural injection: a case report. Spine 30:E266–E268

    Article  PubMed  Google Scholar 

  12. Botwin KP, Castellanos R, Rao S, Hanna AF, Torres-Ramos FM, Gruber RD, Bouchlas CG, Fuoco GS (2003) Complications of fluoroscopically guided interlaminar cervical epidural injections. Arch Phys Med Rehabil 84:627–633

    PubMed  Google Scholar 

  13. Rathmell JP, Aprill C, Bogduk N (2004) Cervical transforaminal injection of steroids. Anesthesiology 100:1595–1600

    Article  PubMed  Google Scholar 

  14. Huntoon MA (2005) Anatomy of the cervical intervertebral foramina: vulnerable arteries and ischemic neurologic injuries after transforaminal epidural injections. Pain 117:104–111

    Article  PubMed  Google Scholar 

  15. Brouwers PJ, Kottink EJ, Simon MA, Prevo RL (2001) A cervical anterior spinal artery syndrome after diagnostic blockade of the right C6-nerve root. Pain 91:397–399

    Article  PubMed  CAS  Google Scholar 

  16. Reitman CA, Watters W (2002) Subdural hematoma after cervical epidural steroid injection. Spine 27:E174–E176

    Article  PubMed  Google Scholar 

  17. Hodges SD, Castleberg RL, Miller T, Ward R, Thornburg C (1998) Cervical epidural steroid injection with intrinsic spinal cord damage. Two case reports. Spine 23:2137–2142

    Article  PubMed  CAS  Google Scholar 

  18. Baker R, Dreyfuss P, Mercer S, Bogduk N (2003) Cervical transforaminal injection of corticosteroids into a radicular artery: a possible mechanism for spinal cord injury. Pain 103:211–215

    Article  PubMed  Google Scholar 

  19. Williams KN, Jackowski A, Evans PJ (1990) Epidural haematoma requiring surgical decompression following repeated cervical epidural steroid injections for chronic pain. Pain 42:197–199

    Article  PubMed  CAS  Google Scholar 

  20. McMillan MR, Crumpton C (2003) Cortical blindness and neurologic injury complicating cervical transforaminal injection for cervical radiculopathy. Anesthesiology 99:509–511

    Article  PubMed  Google Scholar 

  21. Rozin L, Rozin R, Koehler SA, Shakir A, Ladham S, Barmada M, Dominick J, Wecht CH (2003) Death during transforaminal epidural steroid nerve root block (C7) due to perforation of the left vertebral artery. Am J Forensic Med Pathol 24:351–355

    Article  PubMed  Google Scholar 

  22. Bland JH, Boushey DR (1992) The cervical spine, from anatomy and physiology to clinical care. In: Berthoz A, Vidal PP, Graf W (eds) The head-neck sensory motor system. Oxford University Press, pp 135–140

  23. Schellhas KP, Smith MD, Gundry CR, Pollei SR (1991) Cervical discogenic pain. Prospective correlation of magnetic resonance imaging and discography in asyptomatic subjects and pain sufferers. Spine 21:300–311

    Article  Google Scholar 

  24. Zeidman SM, Thompson K, Ducker TB (1995) Complications of cervical discography: analysis of 4400 diagnostic disc injections. Neurosurgery 37:414–417

    Article  PubMed  CAS  Google Scholar 

  25. Gomez-Castresana FB, Vazquez Herrero C, Baltes Horche JL (1995) Cervical chemonucleolysis. Orthopedics 18:237–242

    PubMed  CAS  Google Scholar 

  26. Grubb SA, Kelly CK (2000) Cervical discography: clinical implications from 12 years of experience. Spine 25:1382–1389

    Article  PubMed  CAS  Google Scholar 

  27. Guyer RD, Ohnmeiss DD, Mason SL, Shelokov AP (1997) Complications of cervical discography: findings in a large series. J Spinal Disord 10:95–101

    Article  PubMed  CAS  Google Scholar 

  28. Connor PM, Darden BV (1993) Cervical discography complications and clinical efficacy. Spine 18:2035–2038

    Article  PubMed  CAS  Google Scholar 

  29. Osti OL, Fraser RD, Vernon-Roberts B (1990) Discitis after discography. The role of prophylactic antibiotics. J Bone Joint Surg 72B:271–274

    Google Scholar 

  30. Laun A, Lorenz R, Agnoli AL (1981) Complications of cervical discography. J Neurosurg Sci 25:17–20

    PubMed  CAS  Google Scholar 

  31. Smith MD, Kim SS (1990) A herniated cervical disc resulting from discography: an unusual complication. J Spinal Disord 3:392–394

    PubMed  CAS  Google Scholar 

  32. Tiso RL, Cutler T, Catania JA, Whalen K (2004) Adverse central nervous system sequelae after selective transforaminal block: the role of corticosteroids. Spine J 4:468–474

    Article  PubMed  Google Scholar 

  33. Furman MB, Giovanniello MT, O’Brien EM (2003) Incidence of intravascular penetration in transforaminal cervical epidural steroid injections. Spine 28:21–25

    Article  PubMed  Google Scholar 

  34. Fouyas IP, Statham PF, Sandercock PA (2002) Cochrane review on the role of surgery in cervical spondylotic radiculomyelopathy. Spine 27:736–747

    Article  PubMed  Google Scholar 

  35. Andreula CF, Simonetti L, De Santis F, Agati R, Ricci R, Leonardi M (2003) Minimally invasive oxygen-ozone therapy for lumbar disk herniation. Am J Neuroradiol 24:996–1000

    PubMed  Google Scholar 

  36. Muto M, Andreula C, Leonardi M (2004) Treatment of herniated lumbar disc by intradiscal and intraforaminal oxygen-ozone (O2-O3) injection. J Neuroradiol 31:183–189

    Article  PubMed  CAS  Google Scholar 

  37. Alexandre A, Coro L, Azuelos A, Buric J, Salgado H, Murga M, Marin F, Giocoli H (2005) Intradiscal injection of oxygen-ozone gas mixture for the treatment of cervical disc herniations. Acta Neurochir (Suppl 92):79–82

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Fouad Fayad.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fayad, F., Rannou, F., Drapé, J.L. et al. Intradiscal corticosteroid injections in spondylotic cervical radiculopathy. Eur Radiol 17, 1156–1161 (2007). https://doi.org/10.1007/s00330-006-0416-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-006-0416-x

Keywords

Navigation