Contrast Dispersion Pattern and Efficacy of Computed Tomography-Guided Cervical Transforaminal Epidural Steroid Injection

Abstract

Background: The causes of upper extremity radicular pain or neck pain are varied, often involving disc herniation, spinal stenosis, or spondylosis. Cervical transformaminal epidural steroid injection (C-TFESI) is a common treatment for such pain. However, its efficacy conceivably may depend on needle-tip placement, linking the degree of pain reduction achieved to the pattern of contrast dispersion. Objective: The current study explores this relationship, evaluating contrast dispersion patterns of C-TFESI in conjunction with short-term patient outcomes. Study Design: Prospective evaluation. Methods: A total of 67 patients with cervical radicular pain were enrolled, each of whom underwent computed tomography (CT)-guided C-TFESI. Procedural contrast dispersion was judged as either intraforaminal or extraforaminal. Using the Roland 5-point pain scale, outcomes were scored 2 weeks after injection and then grouped as improvement (scores, 0 – 2) or no improvement (scores, 3 – 5). Results: Contrast dispersion was largely intraforaminal (50 patients), as opposed to extraforaminal (17 patients), with no statistically significant difference in short-term pain relief by contrast pattern (intraforaminal: 56%, 28/50; extraforaminal: 53%, 9/17; P = 0.459). Of the 50 procedures where dispersion of contrast was intraforaminal, 44% (22/50) were scored as unfavorable outcomes. Limitations: Small sample size, brief follow-up, and secondary outcomes were not measured. Authors also did not analyze other variables impacting C-TFESI, and classifying patterns of contrast spread anatomically as epidural or epiradicular (one, both, or neither as applicable) is simply not feasible by CT. Conclusion: C-TFESI is an effective treatment for cervical radicular pain that is refractory to conventional conservative remedies. However, therapeutic response to C-TFESI and dispersion pattern of injected contrast failed to correlate in this study. Key words: Cervical, epidural, contrast, CT-guided, TFESI