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CT fluoroscopy-guided transforaminal and intra-articular facet steroid injections for the treatment of cervical radiculopathy: injectate distribution patterns and association with clinical outcome

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

Abstract

Objectives

To investigate injectate dispersal patterns and their association with therapeutic efficacy during a transforaminal (TFSI) or an intra-articular facet steroid injection (IFSI) to treat cervical radiculopathy.

Methods

This retrospective study examined the post-intervention cervical spine CT of 56 patients randomized to receive one CT fluoroscopy–guided IFSI (29 patients; 10 (34.5%) males; mean age 45.0 years; SD 8.8 years; range 26–61 years) or TFSI (27 patients; 13 (48.2%) males; mean age 51.1 years; SD 11.2 years; range 29–72 years) (December 2010 to August 2013). The presence of contrast within the intra-articular facet, juxta-articular facet, retrodural, epidural, and foraminal and extraforaminal spaces during IFSI, and within the extraforaminal, foraminal, and epidural spaces during TFSI was assessed. Descriptive data are presented as frequencies. The association between injectate dispersal patterns and therapeutic efficacy, 4-week post-intervention, was assessed with ANCOVA models.

Results

During IFSI, the injectate predominantly spread to the retrodural (62%; 18/29) or juxta-articular (21%; 6/29) space. During TFSI, the injectate predominantly spread to the extraforaminal/foraminal spaces (41%; 11/27) or to the extraforaminal/foraminal/epidural spaces (33%; 9/27). Injectate presence in the juxta-articular (p = .007) or extraforaminal (p < .001) space was a predictor of therapeutic efficacy but not in the foraminal (p = .54), epidural (p = .89), or retrodural (p = .75) space.

Conclusions

TFSI and IFSI led to preferential extraforaminal and retrodural injectate spread, respectively. Targeting the extraforaminal or juxta-articular facet space improved the clinical efficacy of steroid injections when treating cervical radiculopathy.

Key Points

• During intra-articular facet injection, the injectate spreads from the facet joint to the retrodural space and rarely reaches the epidural and/or foraminal spaces.

• Epidural spread of the injectate during an anterolateral transforaminal steroid injection is the least effective for pain relief in patients with cervical radiculopathy.

• Injection techniques targeting the extraforaminal or juxta-articular facet space are safer than transforaminal injections and effectively relieve pain in patients with cervical radiculopathy.

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Abbreviations

IFSI:

Intra-articular facet steroid injection

TFSI:

Transforaminal steroid injection

VAS:

Visual analog scale

VAS%:

Relative difference between baseline and 4-week post-intervention VAS pain scores

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Acknowledgments

Nathalie J Bureau is supported by a research scholarship from the Fonds de Recherche du Québec – Santé (FRQ-S) and the Fondation de l’Association des Radiologistes du Québec (FRQS-ARQ 266408). The authors wish to thank gratefully Ms. Kathleen Beaumont for providing manuscript editorial assistance.

Funding

This work was funded by the Fonds de recherche du Québec-Santé (Quebec Government Funding Agency) (grant 21230-2).

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Authors and Affiliations

  1. Department of Radiology, Centre hospitalier de l’Université de Montréal (CHUM), 1000 rue Saint-Denis, Montreal, Quebec, H2X 0C1, Canada

    Nathalie J. Bureau, Thomas P. Moser & Arnaud Gouvion

  2. Research Center, Centre hospitalier de l’Université de Montréal (CHUM), Tour Viger (local R11- 430) 900 rue Saint-Denis, Montreal, Quebec, H2X 0A9, Canada

    Nathalie J. Bureau

  3. Imagix – Radiologie Laënnec, 1100 Avenue Beaumont Bureau 104, Mount Royal, Quebec, H3P 3H5, Canada

    Thomas P. Moser

  4. Department of Mathematics and Statistics, Université Laval, 1045 avenue de la Médecine, Québec, G1V 0A6, Canada

    Anne-Sophie Julien

Authors
  1. Nathalie J. Bureau
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  2. Thomas P. Moser
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  3. Arnaud Gouvion
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  4. Anne-Sophie Julien
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Corresponding author

Correspondence to Nathalie J. Bureau.

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Guarantor

The scientific guarantor of this publication is Nathalie Bureau.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise: Anne-Sophie Julien, Department of Mathematics and Statistics, Université Laval, 1045 avenue de la Médecine, Québec, G1V 0A6 Canada.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained. This study was approved by the Centre hospitalier de l’Université de Montréal Review Board (CE 10.078) and patients signed an informed consent.

Study subjects or cohorts overlap

The present study presents secondary analyses of data from a previously published randomized controlled trial: Bureau NJ, Moser T, Dagher JH, Shedid D, Li M, Brassard P, Leduc BE. Transforaminal versus intra-articular facet corticosteroid injections for the treatment of cervical radiculopathy: a randomized double-blind, controlled study. AJNR Am J Neuroradiol. 2014 Aug;35(8):1467-74. https://doi.org/10.3174/ajnr.A4026. Epub 2014 May 29 PMID:24874533.

Methodology

• Retrospective

• Observational

• Performed at one institution

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Bureau, N.J., Moser, T.P., Gouvion, A. et al. CT fluoroscopy-guided transforaminal and intra-articular facet steroid injections for the treatment of cervical radiculopathy: injectate distribution patterns and association with clinical outcome. Eur Radiol 30, 5933–5941 (2020). https://doi.org/10.1007/s00330-020-06974-8

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  • DOI: https://doi.org/10.1007/s00330-020-06974-8

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