The preliminary results of a new CT-guided periradicular cervical steroid injection technique: safety and feasibility of the lateral peri-isthmic approach in 28 patients.

Abstract

Computed tomography (CT)-guided cervical nerve injections are broadly being used in the treatment of cervical radiculopathy; however, catastrophic complications have been reported. Herein, we aimed to evaluate the efficacy, feasibility, and safety of a novel CT-guided cervical injection technique. We prospectively performed cervical injections in 28 patients with cervical radiculopathies using a novel CT-guided cervical transforaminal injection technique; lateral peri-isthmic approach in which the tip of the needle advanced to the lateral cortex of the isthmus instead of the foraminal area. Patients' pain reduction rates were evaluated using visual analog scores (VAS) at pre-treatment, immediately after treatment, at 3weeks and 6months after the treatment. Intra-vascular contrast medium injections and distribution of the contrast material into the foraminal, epidural or extraforaminal area during the procedure were noted. Pre-treatment pain scores were reduced by 4.2 ± 1.4 (p < 0.001), 3.9 ± 1.37 (p < 0.001) and 3.25 ± 1.53 (p < 0.001) immediately after the treatment, 3weeks and 6months after the treatment respectively. The number of patients with >50% pain relief as measured by VAS were 21 (75%) immediately after the procedure, 19 (67.8%) at 3weeks and 17 (60%) at 6months after the procedure. The injected contrast material was dispersed into the neural foramen in 9 cases (32.1%), the foraminal and epidural area in 14 cases (50%) and the extraforaminal area in 5 cases (17.9%). The CT-guided lateral peri-isthmic approach seems to be a secure and feasible method for cervical injections with satisfactory pain reduction.