Contrast dispersion pattern and efficacy of computed tomography-guided cervical transforaminal 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. © 2014,american society of interventional pain physicians. all rights reserved.