Long-term effectiveness of transforaminal anterolateral approach CT-guided cervical epidural steroid injections for cervical radiculopathy treatment

AIM: To evaluate the long-term clinical effectiveness of computed tomography (CT) -guided transforaminal cervical epidural steroid injection using an anterolateral approach for the treatment of cervical radiculopathy (CR) using well -established robust clinical scoring systems for neck pain and neck disability. Despite its widespread use, evidence to support the long-term bene fit of routine cervical epidural steroid injection is currently very limited. MATERIALS AND METHODS: This study included 113 patients with magnetic resonance imaging (MRI)-con firmed CR who underwent a steroid injection at a single cervical level via a unilateral transforaminal anterolateral approach. Pain was assessed quantitatively at preinjection, 15 minutes post -injection, 1 month, 3 months, and at 1 year. Neck disability was assessed using the Oswestry Neck Disability Index (NDI) at pre -injection, 1 month, 3 months, and 1 year time points. RESULTS: Eighty patients completed the study. Sixty per cent reported reduced neck pain (mean pain reduction, 55%), which was clinically signi ficant in 45% cases. Furthermore, 66% reported an improvement in neck disability (mean improvement, 51%), which was clinically signi ficant for 56% patients. Clinically signi ficant good outcomes in both neck pain and neck disability were evident from as early as 1 -month, and importantly, were independent both of pre-treatment CR characteristics (including severity of pre -injection neck pain or disability) and of findings on pre -injection MRI imaging. CONCLUSION: Transforaminal anterolateral approach CT -guided epidural steroid injection resulted in a clinically significant long-term improvement in both neck pain and disability for half of the present cohort of patients with unilateral single -level CR. This improvement was independent of the severity of the initial symptoms and pre -injection MRI findings. (c) 2024 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.