CT fluoroscopy-guided transforaminal and intra-articular facet steroid injections for the treatment of cervical radiculopathy: injectate distribution patterns and association with clinical outcome.
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| Title: | CT fluoroscopy-guided transforaminal and intra-articular facet steroid injections for the treatment of cervical radiculopathy: injectate distribution patterns and association with clinical outcome. |
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| Authors: | Bureau, Nathalie J.1,2 (AUTHOR) nathalie.bureau@umontreal.ca, Moser, Thomas P.1,3 (AUTHOR), Gouvion, Arnaud1 (AUTHOR), Julien, Anne-Sophie4 (AUTHOR) |
| Source: | European Radiology. Nov2020, Vol. 30 Issue 11, p5933-5941. 9p. 5 Black and White Photographs, 1 Diagram, 3 Charts. |
| Subjects: | Radiculopathy, Treatment effectiveness, Epidural space, Intra-articular injections, Zygapophyseal joint, Cervical vertebrae |
| Abstract: | Objectives: To investigate injectate dispersal patterns and their association with therapeutic efficacy during a transforaminal (TFSI) or an intra-articular facet steroid injection (IFSI) to treat cervical radiculopathy. Methods: This retrospective study examined the post-intervention cervical spine CT of 56 patients randomized to receive one CT fluoroscopy–guided IFSI (29 patients; 10 (34.5%) males; mean age 45.0 years; SD 8.8 years; range 26–61 years) or TFSI (27 patients; 13 (48.2%) males; mean age 51.1 years; SD 11.2 years; range 29–72 years) (December 2010 to August 2013). The presence of contrast within the intra-articular facet, juxta-articular facet, retrodural, epidural, and foraminal and extraforaminal spaces during IFSI, and within the extraforaminal, foraminal, and epidural spaces during TFSI was assessed. Descriptive data are presented as frequencies. The association between injectate dispersal patterns and therapeutic efficacy, 4-week post-intervention, was assessed with ANCOVA models. Results: During IFSI, the injectate predominantly spread to the retrodural (62%; 18/29) or juxta-articular (21%; 6/29) space. During TFSI, the injectate predominantly spread to the extraforaminal/foraminal spaces (41%; 11/27) or to the extraforaminal/foraminal/epidural spaces (33%; 9/27). Injectate presence in the juxta-articular (p =.007) or extraforaminal (p <.001) space was a predictor of therapeutic efficacy but not in the foraminal (p =.54), epidural (p =.89), or retrodural (p =.75) space. Conclusions: TFSI and IFSI led to preferential extraforaminal and retrodural injectate spread, respectively. Targeting the extraforaminal or juxta-articular facet space improved the clinical efficacy of steroid injections when treating cervical radiculopathy. Key Points: • During intra-articular facet injection, the injectate spreads from the facet joint to the retrodural space and rarely reaches the epidural and/or foraminal spaces. • Epidural spread of the injectate during an anterolateral transforaminal steroid injection is the least effective for pain relief in patients with cervical radiculopathy. • Injection techniques targeting the extraforaminal or juxta-articular facet space are safer than transforaminal injections and effectively relieve pain in patients with cervical radiculopathy. [ABSTRACT FROM AUTHOR] |
| Copyright of European Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) | |
| Database: | Engineering Source |
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| Header | DbId: egs DbLabel: Engineering Source An: 146433035 AccessLevel: 6 PubType: Academic Journal PubTypeId: academicJournal PreciseRelevancyScore: 0 |
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| Items | – Name: Title Label: Title Group: Ti Data: CT fluoroscopy-guided transforaminal and intra-articular facet steroid injections for the treatment of cervical radiculopathy: injectate distribution patterns and association with clinical outcome. – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Bureau%2C+Nathalie+J%2E%22">Bureau, Nathalie J.</searchLink><relatesTo>1,2</relatesTo> (AUTHOR)<i> nathalie.bureau@umontreal.ca</i><br /><searchLink fieldCode="AR" term="%22Moser%2C+Thomas+P%2E%22">Moser, Thomas P.</searchLink><relatesTo>1,3</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Gouvion%2C+Arnaud%22">Gouvion, Arnaud</searchLink><relatesTo>1</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Julien%2C+Anne-Sophie%22">Julien, Anne-Sophie</searchLink><relatesTo>4</relatesTo> (AUTHOR) – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="JN" term="%22European+Radiology%22">European Radiology</searchLink>. Nov2020, Vol. 30 Issue 11, p5933-5941. 9p. 5 Black and White Photographs, 1 Diagram, 3 Charts. – Name: Subject Label: Subjects Group: Su Data: <searchLink fieldCode="DE" term="%22Radiculopathy%22">Radiculopathy</searchLink><br /><searchLink fieldCode="DE" term="%22Treatment+effectiveness%22">Treatment effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Epidural+space%22">Epidural space</searchLink><br /><searchLink fieldCode="DE" term="%22Intra-articular+injections%22">Intra-articular injections</searchLink><br /><searchLink fieldCode="DE" term="%22Zygapophyseal+joint%22">Zygapophyseal joint</searchLink><br /><searchLink fieldCode="DE" term="%22Cervical+vertebrae%22">Cervical vertebrae</searchLink> – Name: Abstract Label: Abstract Group: Ab Data: Objectives: To investigate injectate dispersal patterns and their association with therapeutic efficacy during a transforaminal (TFSI) or an intra-articular facet steroid injection (IFSI) to treat cervical radiculopathy. Methods: This retrospective study examined the post-intervention cervical spine CT of 56 patients randomized to receive one CT fluoroscopy–guided IFSI (29 patients; 10 (34.5%) males; mean age 45.0 years; SD 8.8 years; range 26–61 years) or TFSI (27 patients; 13 (48.2%) males; mean age 51.1 years; SD 11.2 years; range 29–72 years) (December 2010 to August 2013). The presence of contrast within the intra-articular facet, juxta-articular facet, retrodural, epidural, and foraminal and extraforaminal spaces during IFSI, and within the extraforaminal, foraminal, and epidural spaces during TFSI was assessed. Descriptive data are presented as frequencies. The association between injectate dispersal patterns and therapeutic efficacy, 4-week post-intervention, was assessed with ANCOVA models. Results: During IFSI, the injectate predominantly spread to the retrodural (62%; 18/29) or juxta-articular (21%; 6/29) space. During TFSI, the injectate predominantly spread to the extraforaminal/foraminal spaces (41%; 11/27) or to the extraforaminal/foraminal/epidural spaces (33%; 9/27). Injectate presence in the juxta-articular (p =.007) or extraforaminal (p <.001) space was a predictor of therapeutic efficacy but not in the foraminal (p =.54), epidural (p =.89), or retrodural (p =.75) space. Conclusions: TFSI and IFSI led to preferential extraforaminal and retrodural injectate spread, respectively. Targeting the extraforaminal or juxta-articular facet space improved the clinical efficacy of steroid injections when treating cervical radiculopathy. Key Points: • During intra-articular facet injection, the injectate spreads from the facet joint to the retrodural space and rarely reaches the epidural and/or foraminal spaces. • Epidural spread of the injectate during an anterolateral transforaminal steroid injection is the least effective for pain relief in patients with cervical radiculopathy. • Injection techniques targeting the extraforaminal or juxta-articular facet space are safer than transforaminal injections and effectively relieve pain in patients with cervical radiculopathy. [ABSTRACT FROM AUTHOR] – Name: AbstractSuppliedCopyright Label: Group: Ab Data: <i>Copyright of European Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.) |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1007/s00330-020-06974-8 Languages: – Code: eng Text: English PhysicalDescription: Pagination: PageCount: 9 StartPage: 5933 Subjects: – SubjectFull: Radiculopathy Type: general – SubjectFull: Treatment effectiveness Type: general – SubjectFull: Epidural space Type: general – SubjectFull: Intra-articular injections Type: general – SubjectFull: Zygapophyseal joint Type: general – SubjectFull: Cervical vertebrae Type: general Titles: – TitleFull: CT fluoroscopy-guided transforaminal and intra-articular facet steroid injections for the treatment of cervical radiculopathy: injectate distribution patterns and association with clinical outcome. Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Bureau, Nathalie J. – PersonEntity: Name: NameFull: Moser, Thomas P. – PersonEntity: Name: NameFull: Gouvion, Arnaud – PersonEntity: Name: NameFull: Julien, Anne-Sophie IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 11 Text: Nov2020 Type: published Y: 2020 Identifiers: – Type: issn-print Value: 09387994 Numbering: – Type: volume Value: 30 – Type: issue Value: 11 Titles: – TitleFull: European Radiology Type: main |
| ResultId | 1 |
