title: The effectiveness and risks of fluoroscopically guided cervical transforaminal injections of steroids: a systematic review with comprehensive analysis of the published data.
abstract: OBJECTIVE
  To determine the effectiveness and risks of fluoroscopically guided cervical transforaminal injection of corticosteroids in the treatment of radicular pain.
  
  
  METHODS
  Systematic review of the literature with comprehensive analysis of the published data.
  
  
  METHODS
  Three reviewers with formal training in evidence-based medicine searched the literature on fluoroscopically guided cervical transforaminal injection of steroids (CTFIS). Each reviewer independently assessed the methodology of studies found and appraised the quality of the evidence presented.
  
  
  METHODS
  The primary outcome assessed was relief of radicular pain. Other outcomes such as reduction in surgery rate and complications were noted if reported. The evidence on each outcome was appraised in accordance with the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system of evaluating evidence.
  
  
  RESULTS
  The searches yielded 16 primary publications on effectiveness. Available evidence, derived mainly from observational studies, suggests that approximately 50% of patients experience 50% relief of radicular pain for at least 4 weeks after CTFIS, and the intervention may have surgery-sparing effects. The literature also contains 21 articles with primary reports of serious complications, including 13 deaths and many catastrophic neurological injuries. The evidence of pain-relieving effects, of surgery-sparing effects, and of risks of CTFIS were all rated as of very low quality according to the GRADE system.
  
  
  CONCLUSIONS
  In patients with cervical radicular pain, fluoroscopically guided CTFIS may be effective in easing pain and reducing need for surgery. However, the evidence of effectiveness is of very low quality, and the benefits of the procedure are compromised by the risks of serious complications.
authors.affiliation: Continental Anesthesia, Oak Brook, Illinois, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Engel
authors.forename: Wade
authors.initials: W
authors.lastname: King
authors.forename: John
authors.initials: J
authors.lastname: MacVicar
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000627:therapeutic use; D005471:Fluoroscopy; D006801:Humans; D007268:Injections, Epidural / Q000379:methods*; D008159:Lumbar Vertebrae / Q000601:surgery; D010146:Pain / Q000188:drug therapy*; D011843:Radiculopathy / Q000188:drug therapy; D013256:Steroids / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D000305:Adrenal Cortex Hormones; D013256:Steroids
keywords: Cervical; Fluoroscopy; Injection; Radicular Pain; Steroids; Transforaminal