European Spine Journal

, 16:321 | Cite as

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

  • Leif Anderberg
  • Mårten Annertz
  • Liselott Persson
  • Lennart Brandt
  • Hans Säveland
Original Article


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.


Nerve root block Cervical spine Radiculopathy Treatment Randomised 



The study was supported by a grant from the Swedish Society for Spine Surgeons.


  1. 1.
    Akkerveeken van PF (1993) The diagnostic value of nerve root sheath infiltration. Acta Orthop 64(Suppl. 251):61–63CrossRefGoogle Scholar
  2. 2.
    Anderberg L, Annertz M, Brandt L, Säveland H (2004) Selective diagnostic cervical nerve root blocks: correlation with clinical symptoms and MRI-pathology. Acta Neurochir 146(6):559–565CrossRefGoogle Scholar
  3. 3.
    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(1–2):211–215PubMedCrossRefGoogle Scholar
  4. 4.
    Barnsley L, Lord SM, Wallis BJ, Bogduk N (1994) Lack of effect of intraarticular corticosteroids for chronic pain in the cervical zygapophyseal joints. N Engl J Med 330(15):1083–1084CrossRefGoogle Scholar
  5. 5.
    Basal S, Turtle MJ (2003) Inadvertent subdural spread complicating epidural steroid injection with local anaesthetic agent. Anaesth Intensive Care 31(5):570–572Google Scholar
  6. 6.
    Botwin KP, Gruber RD, Bouchlas CG, Torres-Ramos FM, Sanelli J, Feeman ED, Slaten WK, Rao S (2002) Fluoroscopically guided lumbar transforaminal epidural steroid injections in degenerative lumbar stenosis: an outcome study. Am J Phys Med Rehabil 81(12):898–905PubMedCrossRefGoogle Scholar
  7. 7.
    Buchbinder R, Green S, Youd JM (2003) Corticosteroid injections for shoulder pain. Cochrane Database Syst Rev 1:CD004016PubMedGoogle Scholar
  8. 8.
    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(5):319–325PubMedCrossRefGoogle Scholar
  9. 9.
    Byrod G, Otani K, Brisby H, Rydevik B, Olmarker K (2000) Methylprednisolone reduces the early permeability increase in spinal nerve roots induced by epidural nucleus pulposus application. J Orthop Res 18(6):983–987PubMedCrossRefGoogle Scholar
  10. 10.
    Cuckler JM, Bernini PA, Wiesel SW, Booth RE Jr, Rothman RH, Pickens GT (1985) The use of epidural steroids in the treatment of lumbar radicular pain. A prospective, randomized, double blind study. J Bone Joint Surg Am 67(1):63–66PubMedGoogle Scholar
  11. 11.
    Cyteval C, Thomas E, Decoux E, Sarrabere MP, Cottin A, Blotman F, Taourel P (2004) Cervical radiculopathy: open study on percutaneus periradicular steroid infiltration performed under CT control in 30 patients. Am J Neuroradiol 25(3):441–445PubMedGoogle Scholar
  12. 12.
    Ferrante FM, Wilson SP, Iacobo C, Orav EJ, Rocco AG, Lipson S (1993) Clinical classification as a predictor of therapeutic outcome after cervical epidural steroid injection. Spine 18(6):730–736PubMedCrossRefGoogle Scholar
  13. 13.
    Furman MB, Giovanniello MT, O’Brien EM (2003) Incidence of intravascular penetration in transforaminal cervical epidural injections. Spine 28(1):21–25PubMedCrossRefGoogle Scholar
  14. 14.
    Hayashi N, Weinstein JN, Meller ST, Lee HM, Spratt KF, Gebhardt GF (1998) The effect of epidural injection of betamethasone or bupivacaine in a rat model of lumbar radiculopathy. Spine 23(8):877–885PubMedCrossRefGoogle Scholar
  15. 15.
    Jönsson B, Strömqvist B, Annertz M, Holtås S, Sundén G (1988) Diagnostic lumbar nerve root block. J Spinal Disord 3:232–235Google Scholar
  16. 16.
    Karppinen J, Malmivaara A, Kurulahti M, Kyllonen E, Pienimaki T, Nieminen P, Ohinmaa A, Tervonen O, Vanharanta H (2001) Periradicular infiltration for sciatica: a randomized controlled trial. Spine 26(9):1059–1067PubMedCrossRefGoogle Scholar
  17. 17.
    Kikuchi S, Macnab P, Moreu P (1981) Localization of the level of symptomatic cervical disc degeneration. J Bone Joint Surg 2:272–277Google Scholar
  18. 18.
    Kikuchi S (1982) Anatomical and experimental studies of nerve root infiltration. Nippon Seikeigeka Gakkai Zasshi 56:605–614PubMedGoogle Scholar
  19. 19.
    Kolsi I, Delecrin J, Berthelot JM, Thomas L, Prost A, Maugars Y (2000) Efficacy of nerve root versus interspinous injections of glucocorticoids in the treatment of disk-related sciatica. A pilot, prospective, randomized, double blind study. Joint Bone Spine 67(2):113–118PubMedGoogle Scholar
  20. 20.
    Lee H-M, Weinstein JN, Meller ST, Hayashi N, Spratt KF, Gebhardt GF (1998) The role of steroids and their effects on phospholipas A2: an animal model of radiculopathy. Spine 23(11):1191–1196PubMedCrossRefGoogle Scholar
  21. 21.
    Marshall S, Tardif G, Ashworth N (2002) Local corticosteroid injection for carpal tunnel syndrome. Cochrane Database Syst Rev (4):CD001554Google Scholar
  22. 22.
    Persson LC, Carlsson CA, Carlsson JY (1997) Long-lasting cervical radicular pain managed with surgery, physiotherapy, or a cervical collar. A prospective, randomized study. Spine 22(7):751–758PubMedCrossRefGoogle Scholar
  23. 23.
    Riew KD, Yin Y, Gilula L, Bridwell KH, Lenke LG, Lauryssen C, Goette K (2000) The effect of nerve root injections on the need for operative treatment of lumbar radicular pain. A prospective, randomized, controlled, double blind study. J Bone Joint Surg Am 82-A(11):1589–1593PubMedGoogle Scholar
  24. 24.
    Rosen CD, Kahanovitz N, Bernstein R, Viola K (1988) A retrospective analysis of the efficacy epidural steroid injections. Clin Orthop 228:270–272PubMedGoogle Scholar
  25. 25.
    Rozin L, Rozin R, Koehler SA, Shakir A, Ladham S, Barmada M, Dominick J, Wecht CH (2003) Death during transforaminal steroid nerve root block (C7) due to perforation of the left vertebral artery. Am J Forensic Med Pathol 24:351–355PubMedCrossRefGoogle Scholar
  26. 26.
    Simmons JW, McMillin JN, Emery SF, Kimmich SJ (1992) Intradiscal steroids. A prospective double blind trial. Spine 17(6):S172–S175Google Scholar
  27. 27.
    Slipman CW, Plastaras CT, Palmitier RA, Huston CW, Sterenfeld EB (1998) Symptom provocation of fluoroscopically guided cervical nerve root stimulation. Are dynatomal maps identical to dermatomal maps?. Spine 23(20):2235–2242PubMedCrossRefGoogle Scholar
  28. 28.
    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(6):741–746PubMedGoogle Scholar
  29. 29.
    Slipman CW, Chow DW (2002) Therapeutic spinal corticosteroid injections for the management of radiculopathies. Phys Med Rehabil Clin N Am 13(3):697–711PubMedGoogle Scholar
  30. 30.
    Slipman CW, Lipetz JS, DePalma MJ, Jackson HB (2004) Therapeutic selective nerve root block in the non-surgical treatment of traumatically induced cervical spondylotic radiculopathy radicular pain. Am J Phys Med Rehabil 83(6):446–454PubMedCrossRefGoogle Scholar
  31. 31.
    Strobel K, Pfirrmann CW, Schmid M, Hodler J, Boos N, Zanetti M (2004) Cervical nerve root blocks, indication and role of MR imaging. Radiology 233(1):87–92PubMedCrossRefGoogle Scholar
  32. 32.
    Tanaka N, Fujimoto Y, An H, Ikuta Y, Yasuda M (2000) The anatomic relation among the nerve roots, intervertebral foramina, and intervertebral discs of the cervical spine. Spine 25(3):286–291PubMedCrossRefGoogle Scholar
  33. 33.
    Vad VB, Bhat AL, Lutz GE, Cammisa F (2002) Transforaminal epidural steroid injections in lumbosacral radiculopathy: a prospective randomised study. Spine 27(1):11–16PubMedCrossRefGoogle Scholar
  34. 34.
    Wilsom-MacDonald J, Burt G, Griffin D, Glynn C (2005) Epidural steroid injection for nerve root compression. A randomised, controlled trial. J Bone Joint Surg Br 87(3):352–355CrossRefGoogle Scholar
  35. 35.
    Yabuki S, Kawaguchi Y, Nordborg C, Kikuchi S, Rydevik B, Olmarker K (1998) Effect of lidocaine on nucleus pulposus-induced nerve root injury: a neurophysiologic and histologic study of the pig cauda equina. Spine 23(22):2383–2390PubMedCrossRefGoogle Scholar
  36. 36.
    Zennaro H, Dousset V, Viaud B, Allard M, Dehais J, Sénégas J, Caillé JM (1998) Periganglionic foraminal steroid injections performed under CT control. Am J Neuroradiol 19:349–352PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Leif Anderberg
    • 1
  • Mårten Annertz
    • 2
  • Liselott Persson
    • 1
  • Lennart Brandt
    • 1
  • Hans Säveland
    • 1
  1. 1.Department of NeurosurgeryUniversity HospitalLundSweden
  2. 2.Department of NeuroradiologyUniversity HospitalLundSweden

Personalised recommendations