Skeletal Radiology

, Volume 47, Issue 12, pp 1625–1633 | Cite as

Comparison of three CT-guided epidural steroid injection approaches in 104 patients with cervical radicular pain: transforaminal anterolateral, posterolateral, and transfacet indirect

  • Sylvain Bise
  • Lionel Pesquer
  • Mathieu Feldis
  • Myriam Bou Antoun
  • Alain Silvestre
  • Arnaud Hocquelet
  • Benjamin Dallaudière
Scientific Article



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.


Steroid Injection Pain Radicular Cervical CT-guided Approaches 



Cervical radicular pain


Epidural steroid injections


Transforaminal anterolateral approach


Transforaminal posterolateral approach


Transfacet approach


Interventional musculoskeletal radiologists


Visual analog scale score


Neck disability index


Start of the study


Authors’ contributions

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.

Ethical approval

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

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© ISS 2018

Authors and Affiliations

  • Sylvain Bise
    • 1
    • 2
  • Lionel Pesquer
    • 1
  • Mathieu Feldis
    • 1
  • Myriam Bou Antoun
    • 1
  • Alain Silvestre
    • 1
  • Arnaud Hocquelet
    • 3
  • Benjamin Dallaudière
    • 1
    • 2
  1. 1.Centre d’imagerie ostéo-articulaireClinique du sport de BordeauxMérignacFrance
  2. 2.Département d’imagerie musculo-squelettiqueCentre hospitalier universitaire PellegrinBordeauxFrance
  3. 3.Service de radiologie et d’imagerie diagnostique et interventionnelleCHU VaudoisLausanneSwitzerland

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