J Korean Med Sci.  2022 Jun;37(25):e208. 10.3346/jkms.2022.37.e208.

Facet Joint Versus Transforaminal Epidural Steroid Injections in Patients With Cervical Radicular Pain due to Foraminal Stenosis: A Retrospective Comparative Study

• Chae JS
• Kim Wj
• Jue MJ

• KMID: 2530839
• DOI: http://doi.org/10.3346/jkms.2022.37.e208

Abstract

Background
A cervical transforaminal epidural (TFE) steroid injection is a useful treatment option for cervical radicular pain, but it carries a small risk of catastrophic complications. Several studies have reported that cervical facet joint (FJ) steroid injection can reduce cervical radicular pain through an indirect epidural spread. The aim of this retrospective comparative study was to evaluate the pain scores and functional disability in subjects receiving cervical FJ or TFE steroid injection for the treatment of cervical radicular pain due to foraminal stenosis (FS).
Methods
We selected 278 patients 18 years of age and older who underwent cervical FJ (n = 130) or TFE (n= 148) steroid injection for cervical radicular pain. The primary outcomes included pain scores and functional disability during hospital visits one, three, and six months after the initial injection. Secondary outcomes were the proportion of responders and Medication Quantification Scale (MQS) scores. Adverse events and variables correlating with effectiveness one month after the initial injection were also evaluated.
Results
The Numeric Rating Scale and Neck Disability Index scores showed a significant improvement one, three, and six months after the initial injection in both groups, with no significant differences between the groups. No significant differences were observed in the success rates of the procedure one, three, and six months after the initial injection for either group. There were no significant differences in MQS between the groups during the followup period. Univariate and multivariate logistic regression analyses revealed that the injection method, age, sex, number of injections, FS severity, MQS, pain duration, and the presence of cervical disc herniation were not independent predictors of treatment success.
Conclusion
The efficacy of FJ steroid injection may not be inferior to that of TFE steroid injection in patients with cervical radicular pain due to FS.

Keyword

Spinal Stenosis; Pain; Radiating; Zygapophyseal Joint; Injections; Epidural; Fluoroscopy

Figure

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  Fig. 1 Procedure of cervical facet joint and transforaminal epidural steroid injections. (A) Lateral and (B) AP view of needle position and the spreads of contrast media in the cervical facet joint steroid injection. (C) Oblique and (D) AP view of needle position and the spreads of contrast media in the cervical transforaminal epidural steroid injection. Circle: needle entry site, Line: articular pillar’s lateral border, Dashed line: articular pillar’s medial border.AP = anteroposterior.

• 

  Fig. 2 Grading for cervical neural foraminal stenosis. (A) Grade 1, non-severe cervical neural foraminal stenosis, including the narrowest width of the neural foramen < (but > 50% of) the extraforaminal nerve root width. (B) Grade 2, severe cervical neural foraminal stenosis, including narrowest width of neural foramen same as or less than 50% of extraforaminal nerve root width.

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  Fig. 3 Flow diagram indicating patient progress through the study.FJ = facet joint, TFE = transforaminal epidural.

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  Fig. 4 Pain scores and functional disability. (A) NRS scores. (B) NDI scores.FJ = facet joint, NDI = Neck Disability Index, NRS = Numeric Rating Scale, TFE = transforaminal epidural.aP < 0.05: comparison of each variable at a specific time point with baseline.

• 

  Fig. 5 Sub-group analysis. (A) NRS and (B) NDI scores of the severe pain group. (C) NRS and (D) NDI scores of the moderate pain group.FJ = facet joint, NDI = Neck Disability Index, NRS = Numeric Rating Scale, TFE = transforaminal epidural.aP < 0.05: comparison of each variable at a specific time point with baseline; bP < 0.05: comparison of differences between the groups.

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  Fig. 6 Illustration of the responders.FJ = facet joint, TFE = transforaminal epidural.

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  Fig. 7 MQS score.MQS = Medication Quantification Scale, FJ = facet joint, TFE = transforaminal epidural.aP < 0.05: comparison of each variable at a specific time point with baseline.

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