Transforaminal steroid injections in the treatment of cervical radiculopathy. A prospective outcome study |
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Authors: | F Kolstad G Leivseth O P Nygaard |
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Institution: | (1) National Centre of Spinal Disorders, Norwegian University of Science and Technology, University Hospital of Trondheim, Trondheim, Norway;(2) Department of Neuroscience and Motion, Norwegian University of Science and Technology, University Hospital of Trondheim, Trondheim, Norway |
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Abstract: | Summary Background. The aim of this study was to assess if transforaminal steroid injections applied to cohort of patients waiting for cervical
disc surgery, reduce the pain of cervical radiculopathy and hence reduce the need for surgical intervention.
Cervical radiculopathy due to cervical disc herniation or spondylosis is a common indication for cervical disc surgery. Surgery
is however not always successful, and is not done without risk of complications.
Transforaminal injection of steroids has gained popularity due to the rationale that inflammation of the spinal nerve roots
causes radicular pain, and therefore steroids placed locally should relieve symptoms.
Methods. During a 12-month period, 21 secondary referral patients with unilateral cervical radiculopathy entered the study. Cervical
disc herniation or spondylosis affecting the corresponding nerve root was demonstrated by appropriate investigation (MRI or
myelography).
The patients then received 2 transforaminal steroid injections, at 2 weeks interval, while waiting for operative treatment.
The pain intensity (VAS), Odom’s criteria and operative indications were registered at 6 weeks and 4 months.
Findings. After receiving injection treatment 5 of the 21 patients decided to cancel the operation due to clinical improvement. A statistically
significant reduction (0.02) in radicular pain score was simultaneously measured. This corresponds well with the reduction
in operative requirements since radicular pain is the main indication for operative treatment. The responders experienced
a long-lasting effect.
Those responding positively however improved neck pain to the same extent as radicular pain, and patients with cervical spondylosis
responded as positively as those with disc herniation.
Interpetation. This prospective cohort study indicates a reduction in the need for operative treatment due to injection treatment. The clinical
effect is measurable, and a statistically significant improvement of the radicular pain is registered.
Routine transforaminal injection treatment prior to surgery seems rewarding, but the complication risk must be taken into
consideration. |
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Keywords: | : Cervical radiculopathy transforaminal steroid injections operative treatment |
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