Purpose: Cervical foraminal injection performed with a direct approach
of the foramen may induce serious neurologic complications. Cervical
facet joint (CFJ) injections are easier to perform and safe, and may
diffuse in the epidural and foraminal spaces. We analyzed the efficiency
and tolerance of CT-guided CFJ slow-acting corticosteroid injection in
patients with radiculopathy related to disc herniation.
Methods and materials: Pilot study included 17 patients presenting
typical cervical radiculopathy related to disc herniation without relief of
pain after medical treatment (one month duration). CFJ puncture was
performed under CT guidance with a lateral approach. CT control of
the CFJ opacification was performed after injections of contrast agent
(1 ml), followed by slow-acting corticosteroid (25 mg). Main criteria for
judgment was pain relief one month later (delta visual analogical scale
VAS for 0 to 100 mm). Diffusion of iodinated contrast agent in the
foramen was assessed by two radiologists in consensus.
Results: Pain relief was significant at one month (delta VAS 22 ± 23
mm, p = 0.001) and 41% (7/17) of patients had pain relief more than
50%. In cases with foraminal diffusion, pain relief more than 50%
occured in 5 patients (50%) and only in 2 patients (29%) in cases
without foraminal diffusion. No complication occurred.
Conclusion: CT-guided CFJ slow-acting corticosteroid injection is safe
and provided good results at one month follow-up. It may be considered
as an interesting percutaneous treatment in patients suffering from
cervical radicular pain related to disc herniation.