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

• Published in: American journal of neuroradiology : AJNR 2014-08, Vol.35 (8), p.1467-1474
• Main Authors: Bureau, N J, Moser, T, Dagher, J H, Shedid, D, Li, M, Brassard, P, Leduc, B E
• Format: Article
• Language: English
• Subjects: Adrenal Cortex Hormones - administration & dosage; Adult; Aged; Double-Blind Method; EDITOR'S CHOICE; Evidence-Based Medicine Level 1; Female; Humans; Injections, Epidural - adverse effects; Injections, Epidural - methods; Injections, Intra-Articular - adverse effects; Injections, Intra-Articular - methods; Level 1 EBM Expedited Publication; Male; Middle Aged; Pain - drug therapy; Pain - etiology; Pain Measurement; Radiculopathy - drug therapy; Treatment Outcome
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.A4026

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. 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. 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. Facet injections are effective for the treatment of cervical radiculopathy and represent a valid and safer alternative to transforaminal injections.