Safety and Efficacy of CT-Guided Transforaminal Cervical Epidural Steroid Injections Using a Posterior Approach

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Fig 1.
Anterolateral approach for CT-guided cervical epidural injection. A, Lateral placement of needle tip within the C6-C7 neuroforamen. B, Periganglionic flow and central flow of contrast into the epidural space.
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Fig 2.
Posterior approach for CT-guided cervical epidural injection. A, Posterior placement of needle tip at the lateral margin of the C6-C7 neuroforamen. B, Periganglionic and central flow of contrast into the epidural space.

Table 1:

Demographics, VNPS, and RMDI outcomes by approach

Approach Group	Overall		Anterolateral		Posterior		P Value
Approach Group	No.	Mean	No.	Mean	No.	Mean	P Value
Age (yr)	247	54.0 ± 12.1	77	53.3 ± 11.1	170	54.4 ± 12.6	.533
Male (%)	144	58.3	96	62.3	48	56.5	.386
Pain pre	219	5.3 ± 2.3	69	5.4 ± 2.3	150	5.1 ± 2.4	.373
Pain immediate	246	1.7 ± 1.9	77	1.3 ± 1.7	169	1.8 ± 2.0	.030
Pain 2 weeks post	172	3.3 ± 2.5	50	3.2 ± 2.4	122	3.6 ± 2.8	.641
Pain 2 months post	120	2.9 ± 2.3	32	2.9 ± 2.3	88	3.0 ± 2.5	.952
RMDI pre	219	9.3 ± 5.2	69	9.2 ± 5.7	150	9.3 ± 4.9	.671
RMDI 2 weeks post	172	6.8 ± 4.2	50	7.0 ± 4.2	122	6.7 ± 4.3	.613
RMDI 2 months post	120	5.0 ± 3.4	32	4.9 ± 3.4	88	5.1 ± 3.8	.969

Table 2:

Mixed-model estimates for change from preprocedure to 2 weeks and 2 months for both the VNPS and the RMDI

	VNPS		RMDI
	Estimated Change from Baseline (95% CI)	P Value	Estimated Change from Baseline (95% CI)	P Value
Prior to 2 weeks	−2.0 (−2.4 to −1.5)	<.0001	−2.5 (−3.3 to −1.7)	<.0001
Prior to 2 months	−2.1 (−2.6 to −1.6)	<.0001	−3.6 (−4.5 to −2.7)	<.0001
Anterolateral vs posterior	–	.832	–	.901

Table 3:

Proportion of patients at each follow-up visit by qualitative response

Procedure Location, Response Definition	VNPS			RMDI
Procedure Location, Response Definition	Immediate	2 week	2 month	2 week	2 month
All patients	(n = 218)	(n = 171)	(n = 119)	(n = 171)	(n = 119)
>50% Improvement	66.10%	35.10%	39.50%	22.80%	35.30%
Complete relief	41.06%	16.90%	17.50%	–	–
No improvement/worsening	12.84%	30.40%	29.40%	36.80%	32.80%
Anterolateral^a	(n = 69)	(n = 50)	(n = 32)	(n = 50)	(n = 32)
>50% Improvement	71.01%	42.00%	37.50%	26.00%	31.30%
Complete relief	50.65%^b	14.00%	15.60%	–	–
No improvement/worsening	11.59%	32.00%	31.30%	44.00%	37.50%
Posterior^a	(n = 149)	(n = 121)	(n = 87)	(n = 121)	(n = 87)
>50% Improvement	63.76%	32.20%	40.20%	21.50%	36.80%
Complete relief	36.69%^b	18.00%	18.20%	–	–
No improvement/worsening	13.42%	29.80%	28.70%	33.90%	31.00%

↵a Comparison of anterolateral vs posterior approach P values >.05, unless indicated.
↵b Comparison of immediate complete relief between anterolateral and posterior approach, P value = .039.