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. 2018 Dec 31:12:171-177.
doi: 10.2147/JPR.S181915. eCollection 2019.

The effectiveness of ultrasound-guided cervical transforaminal epidural steroid injections in cervical radiculopathy: a prospective pilot study

Xin Zhang  1   2 , Haifeng Shi  1   3 , Jin Zhou  1 , Yongming Xu  1 , Shaofeng Pu  1 , Yingying Lv  1 , Junzhen Wu  1 , Yueping Cheng  1 , Dongping Du  1
Affiliations

The effectiveness of ultrasound-guided cervical transforaminal epidural steroid injections in cervical radiculopathy: a prospective pilot study

Xin Zhang et al. J Pain Res. .

Abstract

Background: Cervical transforaminal epidural steroid injection (CTFESI) is used to provide pain relief and restore function in patients with cervical radiculopathy. Traditionally, it is performed under the guidance of fluoroscopy or computed tomography. Here, we introduce a novel technique - ultrasound-guided CTFESI - with which operators can easily distinguish the close soft tissue (nerve, vessels) around the cervical foramina to avoid intravascular injection during the procedure.

Objective: To present the immediate and long-term effectiveness of ultrasound-guided CTFESI in patients with cervical radiculopathy in an academic pain-management center with prospective clinic experiments.

Methods: Fifteen patients with cervical radiculopathy who were resistant to conservative therapies and ultrasound-guided selective cervical spinal nerve-root injections, were treated with ultrasound-guided CTFESI. During the injection procedures, the needle tips were reconfirmed by real-time fluoroscopy. Pain numeric rating-scale and neck-disability-index scores were assessed from onset to six months after the procedures.

Results: During the procedures, based on real-time fluoroscopic confirmation, the injection solution outlined the spinal nerve root and spread into the epidural space in most cases (14 of 15). All patients reported pain relief within 10 minutes after the injection. The majority of patients (eleven of 15) experienced pain relief and neck-disability index-score improvement throughout the 6-month study period. No patient experienced any complication.

Conclusion: We suggest that ultrasound-guided CTFESI is an effective, safe, and simple procedure free of radiation or magnetization and provides sustained pain relief in patients with cervical radiculopathy who have failed previous conservation therapies.

Keywords: cervical radiculopathy; cervical transforaminal epidural steroid injection; steroid; ultrasound-guided.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
(A) Study protocol; (B) patient characteristics. Abbreviation: SNR, selective nerve root.
Figure 2
Figure 2
Illustration of ultrasound-guided CTFESI. Notes: Point-to-point transducer positions for each step. The patient was facing the physician, with the head seen at left in the images. Red lines show the foramina, the yellow star shows the target of the needle tip, and the blue line shows the spinal dura. Abbreviation: CTFESI, cervical transforaminal epidural steroid injection.
Figure 3
Figure 3
(A) Oblique view for C6 ultrasound-guided CTFESI under fluoroscopy; (B), anteroposterior view for C6 ultrasound-guided CTFESI under fluoroscopy; (C), oblique view for C6 ultrasound-guided SNR under fluoroscopy; (D): anteroposterior view for C6 ultrasound-guided SNR under fluoroscopy. Yellow dotted lines, contrast medium surrounding the spinal nerve; red dotted lines, contrast medium in epidural space. Abbreviation: CTFESI, cervical transforaminal epidural steroid injection; SNR, selective nerve root.
Figure 4
Figure 4
(A) The assessment of immediate and long-term pain relief and neck-function restoration after CTFESI; (B) success rate of CTFESI at different time points.
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