Repetitive transforaminal steroid injections in cervical radiculopathy: a prospective outcome study including 140 patients

STUDY DESIGN  Prospective case series. OBJECTIVE  To evaluate the effect of three repetitive transforaminal steroid injections in a large series of selected patients with cervical radiculopathy caused by spondylosis. METHODS  Consecutively, 140 patients with long-lasting medical history, clinical findings, and MRI indicating a cervical nerve root origin based on degenerative disease and a positive selective transforaminal diagnostic nerve root blocks with local anesthetics resulting in at least 50% temporary arm pain reduction were included. Before treatment started, patients underwent a clinical examination by a neurosurgeon. All patients were followed-up and evaluated by one physiotherapist at the neurosurgery outpatient clinic. A designed outcome questionnaire including Neck Disability Index (NDI), Symptoms Frequency Index, and Visual Analog Scale for pain intensity were used. A series of three transforaminal steroid injections, with 3 weeks in between, were performed by a neuroradiologist using image intensifier guidance in an x-ray suite. At 12-14 weeks after the first injection, follow-up was performed. Criteria for positive response to the treatment was >50% radicular arm pain reduction. Except for occasional painkillers, no other treatment was given to the patients. RESULTS  Positive response to the treatment was achieved in 49% (n = 69) with a significant difference in NDI and pain intensity between responders and nonresponders. CONCLUSIONS  Repetitive transforaminal steroid injections may reduce symptoms (frequency, intensity, and fewer limitations of daily living activities) of radiculopathy in patients with degenerative disease in the cervical spine at a short time follow-up. [Table: see text].