title: Response to transforaminal injection of steroids and correlation to mri findings in patients with cervical radicular pain or radiculopathy due to disc herniation or spondylosis.
abstract: OBJECTIVE
  To determine the effectiveness of cervical transforaminal injection of steroids (CTFIS) and to explore possible determinants of response in patients with cervical disc herniation.
  
  
  METHODS
  Retrospective practice audit covering a time period of 6 months.
  
  
  METHODS
  Single spine center in which the patients underwent CTFIS, surgery, and subsequent treatment. Magnetic resonance images were reviewed independently by a radiologist and two neurosurgeons.
  
  
  METHODS
  Consecutive patients with cervical radicular pain and a magnetic resonance imaging demonstrating nerve root affection received CTFIS. Evaluation in terms of pain reduction and in relation to the level and side of the affected nerve root, the duration of pain, neck or radicular pain, and the presence of sensory or motor deficits. The radiological features assessed were the location, grading, and cause of the impingement.
  
  
  RESULTS
  Forty-eight patients were included. Only 35.4% of patients achieved at least 50% reduction in pain 1 month after treatment. The initial pain on the numeric rating scale was reduced from 6.8 to 1.8. None of the clinical or radiological features was associated with a successful outcome. 22.9% of the included patients had to undergo an operation. The duration of these patients' symptoms was significantly shorter (P = 0.01) than in patients without operation.
  
  
  CONCLUSIONS
  Only a minority of patients with disc herniation or spondylosis and a proven nerve root compression benefits from CTFIS. The potential advantage for the patient must be compared with the risk of the procedure. Even with the combination of clinical and radiological findings, the prediction of a favorable outcome of CTFIS was not possible.
authors.affiliation: Department of Neurosurgery, Nova Clinic, Biberach, Germany; Department of Neurosurgery, University of Ulm, Ulm, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Klessinger
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Freund
authors.forename: Georg
authors.initials: G
authors.lastname: Karpel-Massler
authors.forename: Marc-Eric
authors.initials: ME
authors.lastname: Halatsch
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000175:diagnosis / Q000188:drug therapy*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000187:drug effects* / Q000379:methods; D011843:Radiculopathy / Q000175:diagnosis / Q000188:drug therapy*; D012189:Retrospective Studies; D055009:Spondylosis / Q000175:diagnosis / Q000188:drug therapy*; D013256:Steroids / Q000008:administration & dosage*; D016896:Treatment Outcome; D014221:Triamcinolone / Q000008:administration & dosage
chemical_list: D013256:Steroids; D014221:Triamcinolone
keywords: Cervical; Clinical Significance; Epidural (injection space); Herniated Disc; Interventional; Interverterbral Disc; Nerve Block; Pain Management; Radiculopathy; Spine