title: Cervical Transforaminal Epidural Steroid Injections: Diagnostic and Therapeutic Value.
abstract: BACKGROUND
  Cervical transforaminal epidural steroid injections (CTFESIs) may help decrease pain and restore function in patients with cervical radiculopathy. Evidence of the injections' effectiveness, however, remains controversial, and multiple case reports have identified potential complications. Such reports have led to diminished interest in including the procedure in patient care algorithms.
  
  
  OBJECTIVE
  Our retrospective analysis aims to evaluate the CTFESI-associated pain relief and possible decreased need for spine surgery, along with its potential predictive role in determining cervical surgical outcomes. Finally, our study intends to estimate associated complications.
  
  
  METHODS
  A pain management database registry was used to identify patients who were referred by spine surgeons for diagnostic CTFESIs in preparation for possible surgery between January 2001 and December 2009. Outcomes were defined as the incidence of cervical surgery after diagnostic injection and the associated pain relief. A Poisson distribution was used to obtain a 95% confidence interval for the incidence of complications.
  
  
  RESULTS
  Sixty-four patients met the inclusion and exclusion criteria. After diagnostic CTFESIs, 45 (70.3%) of the observed 64 patients did not require cervical spine surgery whereas 19 (29.7%) still did. The mean pain reduction was 4.4 units on the numeric rating scale, with no observed complications.
  
  
  CONCLUSIONS
  This retrospective analysis further demonstrates the safety, diagnostic value, and possible therapeutic role of CTFESIs. A larger, controlled, randomized study is needed to assess definitively the procedure's efficacy and safety.
authors.affiliation: From the *Pain Management Department, †Evidence-Based Pain Medicine Research, and ‡Outcomes Research Department, Cleveland Clinic, Cleveland; and §Ohio State University, Columbus, OH; and ∥Oakland University, Rochester, MI.
authors.forename: Shrif J
authors.initials: SJ
authors.lastname: Costandi
authors.forename: Gerges
authors.initials: G
authors.lastname: Azer
authors.forename: Yashar
authors.initials: Y
authors.lastname: Eshraghi
authors.forename: Yosaf
authors.initials: Y
authors.lastname: Zeyed
authors.forename: Jasmyn E
authors.initials: JE
authors.lastname: Atalla
authors.forename: Michael E
authors.initials: ME
authors.lastname: Looka
authors.forename: Nagy A
authors.initials: NA
authors.lastname: Mekhail
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae; D005260:Female; D006801:Humans; D007268:Injections, Epidural / Q000379:methods*; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D011843:Radiculopathy / Q000175:diagnosis* / Q000188:drug therapy*; D012042:Registries; D012189:Retrospective Studies; D013256:Steroids / Q000008:administration & dosage*
chemical_list: D013256:Steroids