1. 2014;17;487-492Contrast Dispersion Pattern and Efficacy of Computed Tomography-Guided Cervical Transforaminal Epidural Steroid Injection
   Prospective Study
   Chan Hong Park, MD, PhD, and Sang-Ho Lee, MD, PhD.

BACKGROUND: The causes of upper extremity radicular pain or neck pain are varied, often involving disc herniation, spinal stenosis, or spondylosis. Cervical transformaminal epidural steroid injection (C-TFESI) is a common treatment for such pain. However, its efficacy conceivably may depend on needle-tip placement, linking the degree of pain reduction achieved to the pattern of contrast dispersion.

OBJECTIVE: The current study explores this relationship, evaluating contrast dispersion patterns of C-TFESI in conjunction with short-term patient outcomes.

STUDY DESIGN: This study was conducted prospectively.

METHODS: A total of 67 patients with cervical radicular pain were enrolled, each of whom underwent computed tomography (CT)-guided C-TFESI. Procedural contrast dispersion was judged as either intraforaminal or extraforaminal. Using the Roland 5-point pain scale, outcomes were scored 2 weeks after injection and then grouped as improvement (scores, 0 – 2) or no improvement (scores, 3 – 5).

RESULTS: Contrast dispersion was largely intraforaminal (50 patients), as opposed to extraforaminal (17 patients), with no statistically significant difference in short-term pain relief by contrast pattern (intraforaminal: 56%, 28/50; extraforaminal: 53%, 9/17; P = 0.459). Of the 50 procedures where dispersion of contrast was intraforaminal, 44% (22/50) were scored as unfavorable outcomes.

LIMITATIONS: Secondary outcomes were not measured and And we did could not classification contrast spread patterns depend on epidural, epiradicular, both epidural and epiradicular vs neither due to CT could not found this anatomic structure.

CONCLUSION: C-TFESI is an effective treatment for cervical radicular pain that is refractory to conventional conservative remedies. However, therapeutic response to C-TFESI and dispersion pattern of injected contrast failed to correlate in this study.