Romaric Loffroy, Abstract Co-Author: Nothing to Disclose

Boris Guiu, Abstract Co-Author: Nothing to Disclose

Aurélien Lambert MD, Abstract Co-Author: Nothing to Disclose

Nathalie Méjean, Abstract Co-Author: Nothing to Disclose

Jean Pierre Cercueil MD, Abstract Co-Author: Nothing to Disclose

Denis Krause MD, Presenter: Nothing to Disclose

To demonstrate, through a 8 years experience, the extreme feasibility, accuracy and efficacy of cervical foraminal corticosteroids injections under CT guidance, in the case of a cervico-brachial neuralgia (CBN) due to a disk fragment. Long-term clinical results were carefully analyzed.

From January 2000 to December 2007, 300 patients were treated with corticosteroids injections, directly in the middle part of the foramen, behind the painful ganglion, generally at the C6-C7 or C5-C6 level (80 % of cases. Under local anaesthesia, a 22 G needle is advanced, under CT control, against the articular process. Before the corticosteroids injection (Cortivazol 0,75 mg), a systematic CT control with contrast (0,3 ml) verified the liquid diffusion volume within the foramen, all around the ganglion and also in the intracanalar epidural space, so that the potential complications could be easily identified: accidental ponction of a foraminal vein, or of the subarachnoïd spaces, or of the synovial capsula. Each patient was given a scoring of pain, compared to baseline over the 15 following days based on a 0-10 point scale of pain (Analogic Visual Scale), for improvement or worsening. All patients were reviewed at 6 weeks, 6 months and after 1 year.  

The results analysis is based on the radicular pain improvement. A significant good and durable pain relief was observed in 73 % (219/300) during the 2 weeks following infiltrations. These long term good results are identical (mean delay 58-68 months). The operate failure rate is 13 % (39/300). For 42 others patients (14 %), the improvement is less rapid. After a 4-6 weeks delay a second procedure was performed in 36 others patients (12 %). No complications or side effects were observed in this series.

Cervical corticosteroids foraminal injection represents a very safe technique in ambulatory patients, which allows a significant improvement of the CBN, even in the case of a foraminal intricated uncarthrosis. At the expense of a rigorous controlled needle’s positioning with contrast this procedure is very safe. The failure rate is acceptable and allows to propose this procedure as a reliable and competitive management of CBN, resisting a 3-4 weeks medical treatment.

Foraminal corticosteroids infiltration in cervical neuralgias under CT guidance is a very safe procedure, given a 8-years experience.

Loffroy, R, Guiu, B, Lambert, A, Méjean, N, Cercueil, J, Krause, D, Foraminal Corticosteroids Infiltrations in Cervical Neuralgias under CT Guidance: A Long Term Analysis of Clinical Results (300 Patients).  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6015972.html