Cervical Transforaminal Epidural Steroid Injection (TFESI): Role of MR Imaging and Epidurography

Abstract

Cervical transforaminal epidural steroid injections (TFESIs) play an important role in the conservative treatment of the symptoms of neck pain with a radicular component secondary to cervical herniated intervertebral disc (HIVD) or spinal stenosis (1-3). Although some investigators have reported no serious complications resulting from the use of cervical TFESIs, recent reports emphasize the risks of this procedure, including a high incidence of intravascular penetration (4) and serious brain and spinal cord injury (5-7). Therefore, it is important to consider the risks and benefits of TFESI. MR imaging of the cervical spine combined with plain radiography represents the reference-standard examina- Purpose: To evaluate the relationship between MR/epidurographic findings and the clinical outcome after a fluoroscopy-guided transforaminal epidural steroid injection (TFESI) in patients with cervical radicular pain. Materials and Methods: Forty-five patients who had taken a cervical TFESI in our department were included in this study. We retrospectively reviewed MR and epidurographic findings to see if there was a relationship between these methods and the amount of pain relief, by way of a multiple regression analysis. Results: On MR imaging, there was significant relationship between the amount of pain relief and location of herniated intervertebral disc (HIVD, central: 54.4%, lateral recess: 69.4%, foraminal: 59%; p = 0.048). There was no significant difference regarding the other MR findings. On epidurographic findings, there was significant difference in the amount of pain relief with the extent of the contrast (epidural and epineural space, 65.3%; epineural space only, 64.2%; p = 0.03) and location of the needle tip (in the foramen, 59.4%; outside the foramen, 68.4%; p = 0.002). Conclusion:The results indicate that TFESI could be more useful in patients with cervical HIVD in lateral recess rather than another location. Contrast spread into epidural reflux appears to be a favorable injection pattern. Needle tip location is recommended outside the foramen rather than in the foramen.