Does the Contrast Dispersion Pattern During Fluoroscopically Guided Cervical Transforaminal Epidural Steroid Injection Predict Short-Term Pain and Functional Outcomes? An Exploratory Analysis of Prospective Cohort Data

Abstract Summary of Background Data No study has evaluated the relationship between contrast dispersion patterns and outcomes after fluoroscopically guided cervical transforaminal epidural steroid injection (CTFESI). Objectives Determine whether contrast dispersion patterns predict pain and functional outcomes after CTFESI. Methods Secondary analysis of data collected during two prospective studies of CTFESI for the treatment of refractory radicular pain. Contrast dispersion patterns visualized by true anteroposterior (AP) projections during CTFESIs were categorized by flow: 1) completely external to the lateral border of the neuroforamen (zone 1); 2) within the neuroforamen but without entry into the lateral epidural space (zone 2); and 3) with extension into the lateral epidural space (zone 3). At baseline and at 1 month post-CTFESI, neck pain, arm pain, and “dominant index pain” (the greater of arm or neck pain) were evaluated using a numeric rating scale (NRS); physical function was assessed using the Five-Item Version of the Neck Disability Index (NDI-5). Results One-month post-CTFESI, neck pain, arm pain, and “dominant index pain” reductions of ≥50% were observed in 39.4% (95% confidence interval [CI], 28.2–51.8), 55.6% (95% CI, 43.0–67.5), and 44.1% (95% CI, 32.7–56.2) of participants, respectively. Regarding “dominant index pain,” 72.7% (95% CI, 40.8–91.2), 39.4% (95% CI, 24.2–57.0), and 37.5% (95% CI, 20.5–58.2) of participants reported ≥50% pain reduction when zone 1, zone 2, and zone 3 contrast flow patterns were observed. Contrast dispersion zone was not significantly associated with subgroup differences in neck pain, arm pain, or NDI-5 scores (P>0.05). Conclusion Improvements in pain and function 1 month after treatment with CTFESI did not differ significantly based on the contrast dispersion pattern. Future study is needed to confirm or refute these findings in other procedural settings, in broader patient populations, and with longer-term outcome assessment.

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The effectiveness of cervical transforaminal epidural steroid injection for the treatment of neck pain due to cervical disc herniation: long-term results

Pain Management ◽

10.2217/pmt-2018-0002 ◽

2018 ◽

Vol 8 (5) ◽

pp. 321-326 ◽

Cited By ~ 3

Author(s):

Serdar Kesikburun ◽

Berke Aras ◽

Bayram Kelle ◽

Ferdi Yavuz ◽

Evren Yaşar ◽

...

Keyword(s):

Neck Pain ◽

Disc Herniation ◽

Treatment Effect ◽

Steroid Injection ◽

Epidural Steroid Injection ◽

Cervical Disc Herniation ◽

Cervical Disc ◽

Transforaminal Epidural Steroid Injection ◽

The Mean ◽

Epidural Steroid

Aim: To investigate the long-term effect of fluoroscopy guided cervical transforaminal epidural steroid injection on neck pain radiating to the arm due to cervical disc herniation. Materials & methods: 64 patients (26 women [40.6%], 38 men [59.4%]; mean age, 44.9 ± 12.1 years) who had received fluoroscopy guided cervical transforaminal epidural steroid injection for neck pain due to cervical disc herniation at least 1 year before were included in the study. The effectiveness of transforaminal epidural steroid injection was assessed using data obtained by medical records and a standardized telephone questionnaire. Multiple linear regression analysis was applied to evaluate the factors affecting the pain reduction after injection and the duration of treatment effect. Results: The mean duration of neck pain symptom was 23.3 ± 23.9 months. Most of the patients received a single injection (50 patients, 78.1%). The mean time since injection at the time of interview was 21.4 ± 9.4 months. There was a significant reduction in mean pain visual analog scale (VAS [10 cm]) score, from 8.6 ± 1.4 at baseline to 3.2 ± 2.5 at check visit two weeks after injection (p < 0.001). 52 patients (81.2%) reported pain relief of more than 50%. The mean duration of treatment effect was 13.3 ± 9.44 months. Greater pain on the VAS was found to predict strongly the higher pain reduction and longer treatment effect (p = 0.042 and 0.011, respectively). Conclusion: The results suggested that cervical transforaminal epidural steroid injections might be an effective treatment for neck back pain radiating to the arm due to cervical disc herniation.

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CT-guided transforaminal epidural steroid injection for discogenic lumbar radiculopathy: influence of contrast dispersion and radiologist’s experience on clinical outcome

Skeletal Radiology ◽

10.1007/s00256-021-03881-x ◽

2021 ◽

Author(s):

Christoph Germann ◽

Dimitri N. Graf ◽

Benjamin Fritz ◽

Reto Sutter

Keyword(s):

Pain Relief ◽

Steroid Injection ◽

Pain Reduction ◽

Therapeutic Outcome ◽

Epidural Steroid Injection ◽

Dispersion Pattern ◽

Ct Guided ◽

Transforaminal Epidural Steroid Injection ◽

Epidural Steroid ◽

The Impact

Abstract Objective To investigate the impact of contrast dispersion pattern/location during lumbar CT-guided transforaminal epidural steroid injection (TFESI) and experience of the performing radiologist on therapeutic outcome. Materials and methods In this single-center retrospective cohort study, two observers analyzed contrast dispersion during CT-guided TFESI of 204 patients (age 61.1 ± 14 years) with discogenic unilateral single-level L4 or L5 radiculopathy. The contrast dispersion pattern was classified as “focal,” “linear,” or “tram-track”; the location was divided into “extraforaminal,” “foraminal,” or “recessal.” Pain was assessed before and 4 weeks after treatment using a numerical rating scale (0, no pain; 10, intolerable pain). Additionally, the patient global impression of change (PGIC) was assessed. The TFESI was performed by musculoskeletal radiologists (experience range: first year of musculoskeletal fellowship training to 19 years). Contrast pattern/location and radiologist’s experience were compared between “good responder” (≥ 50% pain reduction) and “poor responder” (< 50%). A p-value < 0.05 was considered to be statistically significant. Results Overall, CT-guided TFESI resulted in a substantial pain reduction in 46.6% of patients with discogenic radiculopathy. The contrast dispersion pattern and location had no effect on pain relief (p = 0.75 and p = 0.09) and PGIC (p = 0.70 and p = 0.21) 4 weeks after TFESI. Additionally, the experience of the radiologist had no influence on pain reduction (p = 0.92) or PGIC (p = 0.75). Regarding pre-interventional imaging findings, both the location and grading of nerve compression had no effect on pain relief (p = 0.91 and p = 0.85) and PGIC (p = 0.18 and p = 0.31). Conclusion Our results indicate that neither contrast agent dispersion/location nor the experience of the radiologist allows predicting the therapeutic outcome 4 weeks after the procedure.

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Successful treatment of unilateral neck pain with transforaminal epidural steroid injection on the left C3 nerve root: a case report

Journal of International Medical Research ◽

10.1177/0300060520969538 ◽

2020 ◽

Vol 48 (11) ◽

pp. 030006052096953

Author(s):

Min Cheol Chang ◽

Mathieu Boudier-Revéret ◽

Ming-Yen Hsiao ◽

Shaw-Gang Shyu

Keyword(s):

Case Report ◽

Neck Pain ◽

Nerve Root ◽

Rating Scale ◽

Steroid Injection ◽

Radicular Pain ◽

Epidural Steroid Injection ◽

Foraminal Stenosis ◽

Transforaminal Epidural Steroid Injection ◽

Epidural Steroid

In clinical practice, neck pain is one of the most common complaints. Although most of the cervical radicular pain is manifested in the neck and upper extremities, C3 or C4 radicular pain only results in neck pain. It does not produce upper extremity radiating pain. This case report describes a 70-year-old male that presented with a numeric rating scale score of 5 out of 10 for the left neck pain that he had been experiencing for the previous 1 month. Hyperalgesia was present on the left C3 dermatome. Foraminal stenosis at the left C2–C3 was observed on cervical magnetic resonance imaging. In order to manage the neck pain on the left side due to the foraminal stenosis at the left C2–C3, a transforaminal epidural steroid injection (TFESI) was undertaken on the left C3 nerve root. Thirty minutes after TFESI, the patient’s neck pain had completely resolved. At the 1-month and 3-month follow-ups, no neck pain was evident. Clinicians should consider the possibility of C3 radicular pain as a cause of neck pain, especially when the neck pain presents as neuropathic pain combined with sensory deficits.

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