This article was accepted as part of our Level 1 Evidence-Based Medicine Expedited Review Program.

Authors

N.J. Bureau, T. Moser, J.H. Dagher, D. Shedid, M. Li, P. Brassard and B.E. Leduc

From the Department of Radiology (N.J.B., T.M.), Research Center (N.J.B., T.M.), Department of Surgery (D.S.), Division of Neurosurgery, and Department of Medicine (B.E.L.), Centre hospitalier de l’Université de Montréal, Montreal, Quebec, Canada; Institut de réadaptation Gingras-Lindsay-de-Montréal (J.H.D.), Université de Montréal, Montreal, Quebec, Canada; Department of Surgery (M.L.), Division of Neurosurgery, Hôopital Maisonneuve-Rosemont, Université de Montréal, Montreal, Quebec, Canada; and Division of Clinical Epidemiology (P.B.), McGill University Health Center, Montreal, Quebec, Canada.

Abstract

Background and Purpose

Transforaminal corticosteroid injections can be performed in the management of cervical radiculopathy but carry the risk of catastrophic complications. This study compares the efficacy of transforaminal and facet corticosteroid injections at 4 weeks’ follow-up.

Materials and Methods

We randomly assigned 56 subjects to receive CT-guided transforaminal (15 men, 13 women; mean age, 52 years; range, 28–72 years) or facet (8 men, 20 women; mean, 44 years; range, 26–60 years) injections. The primary outcome was pain severity rated on a Visual Analog Scale (0–100). Secondary outcomes were the Neck Disability Index and the Medication Quantitative Scale.

Results

In the intention-to-treat and as-treated analyses, for a mean baseline score, facet injections demonstrated a significant pain score reduction of 45.3% (95% CI, 21.4–69.2) and 37.0% (95% CI, 9.2–64.7), while transforaminal injections showed a nonsignificant pain score reduction of 9.8% (95% CI, +11.5–31.2) and 17.8% (95% CI, +6.6–42.2). While facet injections demonstrated an improvement in the Neck Disability Index score of 24.3% (95% CI, +2.9–51.5) and 20.7% (95% CI, +6.2–47.6) as opposed to transforaminal injections of 9.6% (95% CI, +15.2–34.4) and 12.8% (95% CI, +11.2–36.7), the results were not statistically significant. Noninferiority of facet to transforaminal injections was demonstrated for baseline pain scores of ≤60, while noninferiority analysis was inconclusive for baseline pain scores of ≥80 and for the Neck Disability Index. Neither intervention showed a significant medication-intake score reduction with time.

Conclusions

Facet injections are effective for the treatment of cervical radiculopathy and represent a valid and safer alternative to transforaminal injections.

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