ABSTRACT
Study design: Prospective case series.
Objective: To evaluate the effect of three repetitive transforaminal steroid injections in a
large series of selected patients with cervical radiculopathy caused by spondylosis.
Methods: Consecutively, 140 patients with long-lasting medical history, clinical findings,
and MRI indicating a cervical nerve root origin based on degenerative disease and
a positive selective transforaminal diagnostic nerve root blocks with local anesthetics
resulting in at least 50% temporary arm pain reduction were included.
Before treatment started, patients underwent a clinical examination by a neurosurgeon.
All patients were followed-up and evaluated by one physiotherapist at the neurosurgery
outpatient clinic. A designed outcome questionnaire including Neck Disability Index
(NDI), Symptoms Frequency Index, and Visual Analog Scale for pain intensity were used.
A series of three transforaminal steroid injections, with 3 weeks in between, were
performed by a neuroradiologist using image intensifier guidance in an x-ray suite.
At 12–14 weeks after the first injection, follow-up was performed. Criteria for positive
response to the treatment was > 50% radicular arm pain reduction. Except for occasional
painkillers, no other treatment was given to the patients.
Results: Positive response to the treatment was achieved in 49% (n = 69) with a significant
difference in NDI and pain intensity between responders and nonresponders.
Conclusions: Repetitive transforaminal steroid injections may reduce symptoms (frequency, intensity,
and fewer limitations of daily living activities) of radiculopathy in patients with
degenerative disease in the cervical spine at a short time follow-up.
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Final class of evidence-treatment
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Study design
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RCT
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Cohort
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Case control
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Case series
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Methods
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Concealed allocation (RCT)
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Intention to treat (RCT)
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Blinded/independent evaluation of primary outcome
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F/U ≥ 85%
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Adequate sample size
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Control for confounding
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Overall class of evidence
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IV
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The definiton of the different classes of evidence is available here.
