European Radiology

, Volume 17, Issue 5, pp 1156–1161 | Cite as

Intradiscal corticosteroid injections in spondylotic cervical radiculopathy

  • Fouad Fayad
  • François Rannou
  • Jean Luc Drapé
  • Lamia Rahmani
  • Marie-Martine Lefevre-Colau
  • Alain Nys
  • Serge Poiraudeau
  • Michel Ledoux
  • Alain Chevrot
  • Michel Revel
Musculoskeletal

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.

Keywords

Cervical radiculopathy Spinal injection Corticosteroids Intradiscal Discography 

References

  1. 1.
    Carette S, Fehlings MG (2005) Clinical practice. Cervical radiculopathy. N Engl J Med 353:392–399PubMedCrossRefGoogle Scholar
  2. 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 117:325–335PubMedCrossRefGoogle Scholar
  3. 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 93:184–188PubMedCrossRefGoogle Scholar
  4. 4.
    Sampath P, Bendebba M, Davis JD, Ducker T (1999) Outcome in patients with cervical radiculopathy: prospective, multicenter study with independent clinical review. Spine 24:591–597PubMedCrossRefGoogle Scholar
  5. 5.
    Gallucci M, Puglielli E, Splendiani A, Pistoia F, Spacca G (2005) Degenerative disorders of the spine. Eur Radiol 15:591–598PubMedCrossRefGoogle Scholar
  6. 6.
    Cicala RS, Thoni K, Angel JJ (1989) Long-term results of cervical epidural steroid injections. Clin J Pain 5:143–145PubMedCrossRefGoogle Scholar
  7. 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 5:319–325PubMedCrossRefGoogle Scholar
  8. 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 81:741–746PubMedGoogle Scholar
  9. 9.
    Vallee JN, Feydy A, Carlier RY, Mutschler C, Mompoint D, Vallee CA (2001) Chronic cervical radiculopathy: lateral-approach periradicular corticosteroid injection. Radiology 218:886–892PubMedGoogle Scholar
  10. 10.
    Dietrich CL, Smith CE (2004) Epidural granuloma and intracranial hypotension resulting from cervical epidural steroid injection. Anesthesiology 100:445–447PubMedCrossRefGoogle Scholar
  11. 11.
    Ludwig MA, Burns SP (2005) Spinal cord infarction following cervical transforaminal epidural injection: a case report. Spine 30:E266–E268PubMedCrossRefGoogle Scholar
  12. 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 84:627–633PubMedGoogle Scholar
  13. 13.
    Rathmell JP, Aprill C, Bogduk N (2004) Cervical transforaminal injection of steroids. Anesthesiology 100:1595–1600PubMedCrossRefGoogle Scholar
  14. 14.
    Huntoon MA (2005) Anatomy of the cervical intervertebral foramina: vulnerable arteries and ischemic neurologic injuries after transforaminal epidural injections. Pain 117:104–111PubMedCrossRefGoogle Scholar
  15. 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 91:397–399PubMedCrossRefGoogle Scholar
  16. 16.
    Reitman CA, Watters W (2002) Subdural hematoma after cervical epidural steroid injection. Spine 27:E174–E176PubMedCrossRefGoogle Scholar
  17. 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 23:2137–2142PubMedCrossRefGoogle Scholar
  18. 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 103:211–215PubMedCrossRefGoogle Scholar
  19. 19.
    Williams KN, Jackowski A, Evans PJ (1990) Epidural haematoma requiring surgical decompression following repeated cervical epidural steroid injections for chronic pain. Pain 42:197–199PubMedCrossRefGoogle Scholar
  20. 20.
    McMillan MR, Crumpton C (2003) Cortical blindness and neurologic injury complicating cervical transforaminal injection for cervical radiculopathy. Anesthesiology 99:509–511PubMedCrossRefGoogle Scholar
  21. 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 24:351–355PubMedCrossRefGoogle Scholar
  22. 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 135–140Google Scholar
  23. 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 21:300–311CrossRefGoogle Scholar
  24. 24.
    Zeidman SM, Thompson K, Ducker TB (1995) Complications of cervical discography: analysis of 4400 diagnostic disc injections. Neurosurgery 37:414–417PubMedCrossRefGoogle Scholar
  25. 25.
    Gomez-Castresana FB, Vazquez Herrero C, Baltes Horche JL (1995) Cervical chemonucleolysis. Orthopedics 18:237–242PubMedGoogle Scholar
  26. 26.
    Grubb SA, Kelly CK (2000) Cervical discography: clinical implications from 12 years of experience. Spine 25:1382–1389PubMedCrossRefGoogle Scholar
  27. 27.
    Guyer RD, Ohnmeiss DD, Mason SL, Shelokov AP (1997) Complications of cervical discography: findings in a large series. J Spinal Disord 10:95–101PubMedCrossRefGoogle Scholar
  28. 28.
    Connor PM, Darden BV (1993) Cervical discography complications and clinical efficacy. Spine 18:2035–2038PubMedCrossRefGoogle Scholar
  29. 29.
    Osti OL, Fraser RD, Vernon-Roberts B (1990) Discitis after discography. The role of prophylactic antibiotics. J Bone Joint Surg 72B:271–274Google Scholar
  30. 30.
    Laun A, Lorenz R, Agnoli AL (1981) Complications of cervical discography. J Neurosurg Sci 25:17–20PubMedGoogle Scholar
  31. 31.
    Smith MD, Kim SS (1990) A herniated cervical disc resulting from discography: an unusual complication. J Spinal Disord 3:392–394PubMedGoogle Scholar
  32. 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 4:468–474PubMedCrossRefGoogle Scholar
  33. 33.
    Furman MB, Giovanniello MT, O’Brien EM (2003) Incidence of intravascular penetration in transforaminal cervical epidural steroid injections. Spine 28:21–25PubMedCrossRefGoogle Scholar
  34. 34.
    Fouyas IP, Statham PF, Sandercock PA (2002) Cochrane review on the role of surgery in cervical spondylotic radiculomyelopathy. Spine 27:736–747PubMedCrossRefGoogle Scholar
  35. 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 24:996–1000PubMedGoogle Scholar
  36. 36.
    Muto M, Andreula C, Leonardi M (2004) Treatment of herniated lumbar disc by intradiscal and intraforaminal oxygen-ozone (O2-O3) injection. J Neuroradiol 31:183–189PubMedCrossRefGoogle Scholar
  37. 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):79–82CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Fouad Fayad
    • 1
  • François Rannou
    • 1
  • Jean Luc Drapé
    • 2
  • Lamia Rahmani
    • 1
  • Marie-Martine Lefevre-Colau
    • 1
  • Alain Nys
    • 1
  • Serge Poiraudeau
    • 1
  • Michel Ledoux
    • 1
  • Alain Chevrot
    • 2
  • Michel Revel
    • 1
  1. 1.Service de rééducation et de réadaptation de l’appareil locomoteur et des pathologies du rachisHôpital Cochin (AP-HP) Université Paris 5ParisFrance
  2. 2.Department of Radiology BHôpital Cochin (AP-HP)ParisFrance

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