Transforaminal versus Intra-Articular Facet Corticosteroid Injections for the Treatment of Cervical Radiculopathy: A Randomized, Double-Blind, Controlled Study

Bureau, Nathalie J.; Moser, Thomas; Dagher, Jehane H.; Shédid, Daniel; Li, M.; Brassard, Paul; Leduc, Bernard

doi:10.3174/ajnr.a4026

Cited by 19 publications

(25 citation statements)

References 21 publications

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“…19,21 Percentage change could not be calculated from the presented data in one. 22 Bureau et al, 19 Bise et al, 21 and Kumar and Gowda 23 also reported NDI before and after CTFESI, showing 12.8%, 18%, and 35.2% improvement, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…21-23 Quality appraisal of the included studies is summarized in Table I. Regarding randomization protocols of the RCTs, simple randomization by random-number table was used in one, 18 block randomization in one, 19 and an unspecified method in one. 20…”

Section: Resultsmentioning

confidence: 99%

“…Imaging modality. Four studies (360 injections; 81.3%) used CT guidance for CTFESI, 18,19,21,22 injections under ultrasound control were reported in one study (20 injections; 4.5%), 18 and two studies used fluoroscopy (66 injections; 14.9%). [20][21][22][23] A single study by Obernauer et al 18 directly compared USS-and CTguided CTFESI.…”

Section: Particulate Versus Non-particulate Steroid Preparationsmentioning

confidence: 99%

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Cervical transforaminal epidural steroid injections for radicular pain

Borton

Oakley

Clamp

et al. 2022

The Bone & Joint Journal

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Aims Cervical radiculopathy is a significant cause of pain and morbidity. For patients with severe and poorly controlled symptoms who may not be candidates for surgical management, treatment with transforaminal epidural steroid injections (CTFESI) has gained widespread acceptance. However, a paucity of high-quality evidence supporting their use balanced against perceived high risks of the procedure potentially undermines the confidence of clinicians who use the technique. We undertook a systematic review of the available literature regarding CTFESI to assess the clinical efficacy and complication rates of the procedure. Methods OVID, MEDLINE, and Embase database searches were performed independently by two authors who subsequently completed title, abstract, and full-text screening for inclusion against set criteria. Clinical outcomes and complication data were extracted, and a narrative synthesis presented. Results Six studies (three randomized controlled trials and three non-randomized observational studies; 443 patients) were included in the final review. The aggregate data support the efficacy of CTFESI in excess of the likely minimal clinically important difference. No major complications were described. Conclusion There is increasing evidence supporting the efficacy of CTFESI. Concerns regarding the occurrence of catastrophic complications, widely shared in the case report and anecdotal literature, were not found when reviewing the best available evidence. However, the strength of these findings remains limited by the lack of highly powered high-level studies and the heterogeneity of the studies available. Further high-quality studies are recommended to address the issues of efficacy and safety with CTFESI. Cite this article: Bone Joint J 2022;104-B(5):567–574.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Particulate Versus Non-particulate Steroid Preparationsmentioning

confidence: 99%

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Cervical transforaminal epidural steroid injections for radicular pain

Borton

Oakley

Clamp

et al. 2022

The Bone & Joint Journal

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“…For instance, among steroid injection, facet injection has been suggested to be more effective and safer than transforaminal injection. 41 The combination of bupivacaine and betamethasone has also been shown to achieve better response rates than using bupivacaine alone. 42 Autotraction seems to perform better with regard to traction pain relief compared to conventional passive traction methods.…”

Section: Discussionmentioning

confidence: 99%

The effectiveness of therapeutic strategies for patients with radiculopathy: A network meta-analysis

Zhang

Wen

et al. 2018

Mol Pain

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ObjectivesThe aim of this network meta-analysis is to assess the effectiveness of therapeutic strategies for patients with radiculopathy, including physical, medical, surgical, and other therapies.MethodsWe electronically searched electronic databases including PubMed and Embase for randomized controlled trials. The response rate and visual analog scale of pain change were considered as primary outcomes. The outcomes were measured by odds ratio (OR) value and corresponding 95% credible intervals (CrIs) or standardized mean difference (MD) with 95% CrIs. Besides, surface under cumulative ranking curve (SUCRA) were performed to rank efficacy and safety of treatments on each end points.ResultsA total of 16 eligible studies with 1071 subjects were included in this analysis. Our results showed that corticosteroid was significantly more effective than control regarding the response rate (OR = 3.86, 95% CrI: 1.16, 12.55). Surgery had a better performance in pain change compared with control (MD = −1.92, 95% CrI: −3.58, −0.15). According to the SUCRA results, corticosteroid, collar, and physiotherapy ranked the highest concerning response rate (SUCRA = 0.656, 0.652, and 0.610, respectively). Surgery, traction, and corticosteroid were superior to others in pain change (SUCRA = 0.866, 0.748, and 0.589, respectively).ConclusionAccording to the network meta-analysis result, we recommended surgery as the optimal treatment for radiculopathy patients; traction and corticosteroids were also recommended for their beneficial interventions.

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“…noted the “catastrophic complications” that may be seen with cervical ESI (BUREAU 2014). [4] To minimize these risks, they designed a 4-week randomized double blind controlled study to compare the safety/efficacy for cervical intrafacet steroid injections (noted to have fewer AE (Adverse Events)) vs. TFESI. Twenty-eight patients had facet injections alone vs. 28 who underwent cervical CT-fuided TFESI; facet injections significantly reduced the pain score by 45.3% vs. TFESI that showed a “nonsignificant” pain score reduction of just 9.8%.…”

Section: Cervical Epidural Spinal Injectionsmentioning

confidence: 99%

Neurological complications of lumbar and cervical dural punctures with a focus on epidural injections

Epstein¹

2017

Surg Neurol Int

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Background:Various types of lumbar dural punctures may contribute to neurological injury. The etiologies of dural injury include; inadvertent dural punctures due to epidurals placed for labor anesthesia, epidural steroid injections (ESI/transforaminal TESI; approximately 9 million ESI performed in the US per year), deliberate placement of intradural pain devices, and spontaneous cerebrospinal fluid (CSF) fistulas. Resulting neurological complications may include; spinal headaches/intracranial hypotension, subdural hematomas, and 6th nerve cranial palsies. Furthermore, uniquely in the cervical spine, inadvertent cervical dural punctures attributed to cervcial ESI (CESI) may lead to intramedullary spinal cord injuries (e.g. resulting in monoparesis to quadriplegia) or spinal cord strokes due to intravascular/vertebral artery injections.Methods/Results:In 8 studies, inadvertent lumbar dural punctures contributed to intracranial hypotension, subdural hematomas, and double vision/6th cranial nerve palsies. In 5 of the 6 studies, inadvertent dural punctures occurring during CESI were responsible for intramedullary spinal cord injuries, or direct intravascular/vertebral injections resulting in monoplegia/quadriplegia.Conclusions:Inadvertent lumbar dural punctures led to multiple neurological complications including intracranial hypotension, subdural hematomas, and double vision/6th cranial nerve palsies. Uniquely, inadvertent cervical dural punctures solely due to CESI directly resulted in intramedullary spinal cord injuries or cord stroked and monoplegia/quadriplegia attributed to intravascular/vertebral artery injections. The potential neurological risks/complications/adverse events attributed to lumbar and cervical ESI must be taken into account before spine surgeons and others order these procedures.

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Transforaminal versus Intra-Articular Facet Corticosteroid Injections for the Treatment of Cervical Radiculopathy: A Randomized, Double-Blind, Controlled Study

Abstract: BACKGROUND AND PURPOSE:Transforaminal corticosteroid injections can be performed in the management of cervical radiculopathy but carry the risk of catastrophic complications. This study compares the efficacy of transforaminal and facet corticosteroid injections at 4 weeks' follow-up.

Cited by 19 publications

References 21 publications

Cervical transforaminal epidural steroid injections for radicular pain

Cervical transforaminal epidural steroid injections for radicular pain

The effectiveness of therapeutic strategies for patients with radiculopathy: A network meta-analysis

Neurological complications of lumbar and cervical dural punctures with a focus on epidural injections

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