Comparison of clinical effectiveness of cervical transforaminal steroid injection according to different radiological guidances (C-arm fluoroscopy vs. computed tomography fluoroscopy)

Background context: Transforaminal steroid injection using C-arm fluoroscopy has been regarded as a useful method of treatment for cervical herniated disc. But C-arm fluoroscopy cannot identify soft tissue; so there is controversy about its safety and efficacy. Computed tomography (CT) fluoroscopy permits precise anatomical resolution and has the potential to offer a safer technique compared with C-arm fluoroscopy.

Purpose: This study was to identify the clinical effectiveness of CT fluoroscopy guidance in cervical transforaminal steroid injection compared with C-arm fluoroscopy guidance.

Study design/setting: Prospective randomized controlled study/spine hospital. PATIENTS SAMPLE: Patients with neck pain and radiating upper limb pain resulting from cervical disc herniation participated in the study. They were allocated into either the CT (CT group, N=51) or C-arm (C group, N=65) fluoroscopy guidance group.

Outcome measure: Numeric Rating Scale (NRS) pain score and Neck Disability Index (NDI) values were measured at pretreatment and 8 weeks after treatment. Successful pain relief and functional improvement were defined as a 50% or more reduction in NRS and at least 40% reduction in NDI compared with pretreatment one. Numeric Rating Scale and NDI efficiency were also calculated by the difference between pre and 8 weeks after treatment to validate the degree of change in pain reduction and functional improvement.

Results: After 8 weeks, both groups showed pain reduction and functional improvement. The CT group showed significantly the better outcomes in reduction of NRS for arm pain score and improvement of NDI. Whereas the CT group had no cases of side effects, the C group had 10 cases.

Conclusions: The CT group, without any side effects, showed the better effectiveness than the C-arm group in the improvement of radiating pain and functional status in patients with cervical disc herniation. Therefore, CT fluoroscopy can be a substitute for C-arm fluoroscopy in transforaminal steroid injection when treating patients with cervical disc herniation.