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Transforaminal versus intra-articular facet corticosteroid injections for the treatment of cervical radiculopathy: a randomized, double-blind, controlled study.

AbstractBACKGROUND 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.
MATERIALS AND METHODS:
We randomly assigned 56 subjects to receive CT-guided transforaminal (15 men, 13 women; mean age, 52 years; range, 28-72 years) or facet (8 men, 20 women; mean, 44 years; range, 26-60 years) injections. The primary outcome was pain severity rated on a Visual Analog Scale (0-100). Secondary outcomes were the Neck Disability Index and the Medication Quantitative Scale.
RESULTS:
In the intention-to-treat and as-treated analyses, for a mean baseline score, facet injections demonstrated a significant pain score reduction of 45.3% (95% CI, 21.4-69.2) and 37.0% (95% CI, 9.2-64.7), while transforaminal injections showed a nonsignificant pain score reduction of 9.8% (95% CI, +11.5-31.2) and 17.8% (95% CI, +6.6-42.2). While facet injections demonstrated an improvement in the Neck Disability Index score of 24.3% (95% CI, +2.9-51.5) and 20.7% (95% CI, +6.2-47.6) as opposed to transforaminal injections of 9.6% (95% CI, +15.2-34.4) and 12.8% (95% CI, +11.2-36.7), the results were not statistically significant. Noninferiority of facet to transforaminal injections was demonstrated for baseline pain scores of ≤60, while noninferiority analysis was inconclusive for baseline pain scores of ≥80 and for the Neck Disability Index. Neither intervention showed a significant medication-intake score reduction with time.
CONCLUSIONS:
Facet injections are effective for the treatment of cervical radiculopathy and represent a valid and safer alternative to transforaminal injections.
AuthorsN J Bureau, T Moser, J H Dagher, D Shedid, M Li, P Brassard, B E Leduc
JournalAJNR. American journal of neuroradiology (AJNR Am J Neuroradiol) Vol. 35 Issue 8 Pg. 1467-74 (Aug 2014) ISSN: 1936-959X [Electronic] United States
PMID24874533 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
Copyright© 2014 by American Journal of Neuroradiology.
Chemical References
  • Adrenal Cortex Hormones
Topics
  • Adrenal Cortex Hormones (administration & dosage)
  • Adult
  • Aged
  • Double-Blind Method
  • Female
  • Humans
  • Injections, Epidural (adverse effects, methods)
  • Injections, Intra-Articular (adverse effects, methods)
  • Male
  • Middle Aged
  • Pain (drug therapy, etiology)
  • Pain Measurement
  • Radiculopathy (drug therapy)
  • Treatment Outcome

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