Comparison of three CT-guided epidural steroid injection approaches in 104 patients with cervical radicular pain: transforaminal anterolateral, posterolateral, and transfacet indirect
The treatment of persistent cervical radicular pain (CRP) by CT-guided epidural steroid injections (CTESI) by a transforaminal anterolateral (TFA) approach is associated with rare but serious complications. Two recently described transforaminal posterolateral (TFP) and transfacet indirect (TFT) approaches may be safer options, but have not been extensively evaluated. We compared the efficacy of three CTESI approaches (TFA, TFP, and TFT) in the treatment of persistent CRP (>6 weeks).
Patients were prospectively assessed for pain using the visual analog scale (VAS) and for functional disability by the Neck Disability Index (NDI) before treatment, then 6 weeks and 6 months after CTESI.
A total of 104 patients were included (n = 30 TFA, n = 36 TFP, and n = 38 TFT approaches). Each group was found to have a statistically significant improvement at 6 weeks (median VAS values: 7 (2–9) at D0 and 2 (3–6) at 6 weeks p < 0.01; median NDI values: 38 (24–50) at D0 and 29 (18–42) at 6 weeks (p < 0.01)), and at 6 months (median VAS values: 7 (2–9) at D0 and 4 (2–6) at 6 months (p < 0.01); median NDI values: 38 (24–50) at D0 and 28 (13–40) at 6 months (p < 0.01)). No significant difference was observed in the decrease in VAS and NDI scores among the three approaches at 6 weeks (p = 0.635 and p = 0.54 for VAS and NDI respectively) or 6 months (p = 0.704 and p = 0.315 for VAS and NDI respectively). No major complications were noted.
The results of CTESI using the TFP or TFT approach are similar to those for TFA in the treatment of persistent CRP and could be a safer option.
KeywordsSteroid Injection Pain Radicular Cervical CT-guided Approaches
Cervical radicular pain
Epidural steroid injections
Transforaminal anterolateral approach
Transforaminal posterolateral approach
Interventional musculoskeletal radiologists
Visual analog scale score
Neck disability index
Start of the study
Study concept and design: BD, SB.
Acquisition of data: SB, LP, MF, MBA, AS, BD.
Analysis and interpretation: SB, BD.
Writing the manuscript: SB, BD, AH.
Statistical analysis: AH.
Compliance with ethical standards
Conflicts of interest
The authors declare that they have no conflicts of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.