CT guided Epidural Steroid Injection

Background: The causes of upper extremity radicular pain or neck pain are varied, often involving disc herniation, spinal stenosis, or spondylosis. Cervical transformaminal epidural steroid injection (C-TFESI) is a common treatment for such pain. However, its efficacy conceivably may depend on needle-tip placement, linking the degree of pain reduction achieved to the pattern of contrast dispersion. Objective: The current study explores this relationship, evaluating contrast dispersion patterns of C-TFESI in conjunction with short-term patient outcomes. Study Design: Prospective evaluation. Methods: A total of 67 patients with cervical radicular pain were enrolled, each of whom underwent computed tomography (CT)-guided C-TFESI. Procedural contrast dispersion was judged as either intraforaminal or extraforaminal. Using the Roland 5-point pain scale, outcomes were scored 2 weeks after injection and then grouped as improvement (scores, 0 – 2) or no improvement (scores, 3 – 5). Results: Contrast dispersion was largely intraforaminal (50 patients), as opposed to extraforaminal (17 patients), with no statistically significant difference in short-term pain relief by contrast pattern (intraforaminal: 56%, 28/50; extraforaminal: 53%, 9/17; P = 0.459). Of the 50 procedures where dispersion of contrast was intraforaminal, 44% (22/50) were scored as unfavorable outcomes. Limitations: Small sample size, brief follow-up, and secondary outcomes were not measured. Authors also did not analyze other variables impacting C-TFESI, and classifying patterns of contrast spread anatomically as epidural or epiradicular (one, both, or neither as applicable) is simply not feasible by CT. Conclusion: C-TFESI is an effective treatment for cervical radicular pain that is refractory to conventional conservative remedies. However, therapeutic response to C-TFESI and dispersion pattern of injected contrast failed to correlate in this study. Key words: Cervical, epidural, contrast, CT-guided, TFESI

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Comparison of three CT-guided epidural steroid injection approaches in 104 patients with cervical radicular pain: transforaminal anterolateral, posterolateral, and transfacet indirect

Skeletal Radiology ◽

10.1007/s00256-018-3027-0 ◽

2018 ◽

Vol 47 (12) ◽

pp. 1625-1633 ◽

Cited By ~ 2

Author(s):

Sylvain Bise ◽

Lionel Pesquer ◽

Mathieu Feldis ◽

Myriam Bou Antoun ◽

Alain Silvestre ◽

...

Keyword(s):

Steroid Injection ◽

Radicular Pain ◽

Epidural Steroid Injection ◽

Ct Guided ◽

Epidural Steroid

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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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