Soo-Jung Choi MD, Presenter: Nothing to Disclose

Junghwan Kim MD, Abstract Co-Author: Nothing to Disclose

Jong Hyeog Lee, Abstract Co-Author: Nothing to Disclose

Man Soo Park, Abstract Co-Author: Nothing to Disclose

Dae Sik Ryu, Abstract Co-Author: Nothing to Disclose

Jae Hong Ahn, Abstract Co-Author: Nothing to Disclose

Seung Moon Jung, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

To evaluate the relationship between MR findings and clinical outcome after fluoroscopy-guided transforaminal ESI (TFESI) in patients with cervical radicular pain, and to suggest proper epidurographic findings.

Fifty-one consecutive patients with cervical radicular pain were treated with TFESI. Forty-five of 51 patients whose MRI and clinical follow-up were available (M:F = 19: 26; mean age, 46 years; range 33-66 years) were included in this study. MR findings were retrospectively reviewed with regard to causes and degree of nerve root compression, presence and location of herniated intervertebral disc (HIVD), and presence of foraminal or canal stenosis. Epidurographic findings were also reviewed with regard to the appearance of contrast spread, extent of contrast, and location of needle tip. The relationship between MR/epidurographic findings and level of pain relief at the time of first visit was analyzed by multiple regression analysis, respectively. First visit was one to four weeks after TFESI (mean 2.6 weeks). Pain relief was graded (0-100%) by using a visual analogue scale.

On MR imaging, there was significant relationship between the amount of pain relief and location of HIVD (intra-canal: 54.4%, foraminal entrance: 69.4%, intra-foraminal: 59%; p = .048) and inverse relationship regarding canal stenosis (present: 63.5%, absent: 66%, p = .09). There was no significant difference regarding the other MR parameters. On epidurographic findings, there was significant relationship between the amount of pain relief and appearance of contrast spread (smooth: 66.4%, linear: 66.4%, globular: 58.5%, p = .02), extent of contrast (visualization of the contrast in epidural space: 65.3%, epineural space: 64.2%, p = .03), and location of needle tip (epineural 68.4%, foraminal 59.4%, p = .002).

TFESI could be useful in patients with HIVD in foraminal entrance, without canal stenosis. In addition, smooth or linear contrast spread into epidural space appears to be appropriate injection pattern during the procedure. However, needle insertion into foramen could not be useful.

This study will be helpful in proper patient selection and guiding the technique for a cervical TFESI.

Choi, S, Kim, J, Lee, J, Park, M, Ryu, D, Ahn, J, Jung, S, et al, , et al, , Cervical Transforaminal Epidural Steroid Injection (TFESI): Role of MR Imaging and Epidurography.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5008778.html