Abstract
Transforaminal corticosteroid injections can be performed in the management of cervical radiculopathy but carry the risk of catastrophic complications. This study compares the efficacy of transforaminal and facet corticosteroid injections at 4 weeks' follow-up. We randomly assigned 56 subjects to receive CT-guided transforaminal (15 men, 13 women; mean age, 52 years; range, 28-72 years) or facet (8 men, 20 women; mean, 44 years; range, 26-60 years) injections. The primary outcome was pain severity rated on a Visual Analog Scale (0-100). Secondary outcomes were the Neck Disability Index and the Medication Quantitative Scale. In the intention-to-treat and as-treated analyses, for a mean baseline score, facet injections demonstrated a significant pain score reduction of 45.3% (95% CI, 21.4-69.2) and 37.0% (95% CI, 9.2-64.7), while transforaminal injections showed a nonsignificant pain score reduction of 9.8% (95% CI, +11.5-31.2) and 17.8% (95% CI, +6.6-42.2). While facet injections demonstrated an improvement in the Neck Disability Index score of 24.3% (95% CI, +2.9-51.5) and 20.7% (95% CI, +6.2-47.6) as opposed to transforaminal injections of 9.6% (95% CI, +15.2-34.4) and 12.8% (95% CI, +11.2-36.7), the results were not statistically significant. Noninferiority of facet to transforaminal injections was demonstrated for baseline pain scores of ≤60, while noninferiority analysis was inconclusive for baseline pain scores of ≥80 and for the Neck Disability Index. Neither intervention showed a significant medication-intake score reduction with time. Facet injections are effective for the treatment of cervical radiculopathy and represent a valid and safer alternative to transforaminal injections.
Highlights
BACKGROUND AND PURPOSETransforaminal corticosteroid injections can be performed in the management of cervical radiculopathy but carry the risk of catastrophic complications
Facet injections are effective for the treatment of cervical radiculopathy and represent a valid and safer alternative to transforaminal injections
Cervical radiculopathy is a debilitating condition caused by the irritation of a cervical spinal nerve root
Summary
We randomly assigned 56 subjects to receive CT-guided transforaminal (15 men, 13 women; mean age, 52 years; range, 28 –72 years) or facet (8 men, 20 women; mean, 44 years; range, 26 – 60 years) injections. The primary outcome was pain severity rated on a Visual Analog Scale (0 –100). The Research Ethics Committee of our institution approved this study. The study was performed according to the Declaration of Helsinki, was approved by the scientific committee of the Research Funding Agency of the Quebec Government (grant 21230 –2), and was registered at the University of Montreal as part of a master’s thesis in biomedical science. 56 adults with cervical radiculopathy, capable of giving written consent, were enrolled in the study. One of 2 physiatrists or 1 of 2 neurosurgeons performed a clinical evaluation of the subjects to confirm the diagnosis of cervical radiculopathy according to eligibility criteria, similar to criteria used in previous studies,[5,9] and to identify the presence of exclusion criteria
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