The effectiveness of cervical transforaminal epidural steroid injections for the treatment of cervical radicular pain: A prospective cohort study reporting 12-month outcomes

Aaron M Conger; Dustin J Randall; Beau P Sperry; Keith T Kuo; Russell Petersen; A Michael Henrie; Richard W Kendall; Erica F Bisson; Masaru Teramoto; Brook I Martin; Taylor R Burnham; Zachary L McCormick

doi:10.1016/j.inpm.2023.100379

The effectiveness of cervical transforaminal epidural steroid injections for the treatment of cervical radicular pain: A prospective cohort study reporting 12-month outcomes

Interv Pain Med. 2023 Dec 22;3(1):100379. doi: 10.1016/j.inpm.2023.100379. eCollection 2024 Mar.

Affiliations

¹ Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA.
² Department of Physical Medicine and Rehabilitation, Stanford University, Stanford, CA, USA.
³ David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
⁴ University of Utah School of Medicine, Salt Lake City, UT, USA.
⁵ Alabama College of Osteopathic Medicine, Dothan, AL, USA.
⁶ Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, UT, USA.
⁷ Department of Orthopedics, University of Utah, Salt Lake City, UT, USA.

Abstract

Objectives: To evaluate the effectiveness of cervical transforaminal epidural steroid injection (CTFESI) for the treatment of unilateral cervical radicular pain.

Design: Single-group prospective cohort study.

Methods: Outcomes included ≥50% reductions in Numeric Rating Scale (NRS) for arm pain, ≥30% Neck Disability Index (NDI-5) improvement, health-related quality of life (EQ-5D), global improvement (PGIC), personal goal achievement (COMBI), Chronic Pain Sleep Index (CPSI), and healthcare utilization at one, three, six, and 12 months. Data analysis included descriptive statistics with the calculations of 95% confidence intervals (CIs), contingency table analysis, and multilevel logistic regression (LR) analysis, including a worst-case (WC) sensitivity analysis in which missing data were treated as treatment failure. Participants who were treated surgically were considered failures in the categorical analyses.

Results: 33 consecutively enrolled participants (63.6% females, 51.2 ± 12.2 years of age, BMI 28.3 ± 4.5 kg/m²) were analyzed. Success rates for ≥50% reduction in NRS for arm pain at one, three, six and 12 months were 57.6% (95% CI 40.8-72.8%), 71.9% (95% CI 54.6-84.4%), 64.5% (95% CI 46.9-78.9%), and 64.5% (95% CI 46.9-78.9%). Success rates for ≥30% improvement in NDI-5 were 60.6% (95% CI 43.7-75.3%), 68.8% (95% CI 51.4-82.0%), 61.3% (95% CI 43.8-76.3%), and 71.0% (95% CI 53.4-83.9%). In WC analysis, success rates for ≥50% arm NRS and NDI-5 were 0-4.3% lower between 1 and 12 months. PGIC scores were at least "much improved" or "very much improved," in 48.4-65.6% of participants between 1 and 12 months. 6.1%, 6.1%, and 3.0% had one, two, or three repeat injections, respectively. 18.2% of participants underwent surgery by 12 months. Participants showed significant improvements in arm NRS and NDI-5 after treatment (p < 0.05), multilevel logistic regression models showed no significant decline in improvements across the follow-up time points (p > 0.05).

Conclusion: Statistically significant and clinically meaningful improvements in pain and disability were observed after CTFESI for up to 12 months in individuals with unilateral cervical radicular pain.

Keywords: Cervical radiculopathy; Epidural; Injection; Pain; Transforaminal.