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Rates of cervical spine surgery and repeat epidural injections after cervical transforaminal epidural steroid
Andrew R Stephens1, Ramzi El-Hassan2, Ashley Rogerson3
1Stanford University Division of Physical Medicine and Rehabilitation Department of Orthopaedics, 450 Broadway, Redwood City, CA, 94603, United States of America.
Background:
Cervical transforaminal epidural steroid injections (CTFESI) are commonly performed to treat cervical radicular pain and decrease the need of surgery. The literature is mixed regarding the efficacy of CTFESI in obviating the need for cervical spine surgery.
Objective:
The purpose of this study was to assess the rates of cervical spine surgery and spinal interventions after initial CTFESI for patients with radicular pain.
Methods:
TriNetX, a large national database, was queried from 2004 to 2025 for patients who underwent CTFESI for cervical radiculopathy. The rates of treatment progression after initial CTFESI were calculated. Treatment progression included: no additional treatment, repeat CTFEI, cervical interlaminar epidural steroid injection (CIESI), and cervical spine surgery. Cervical spine surgeries analyzed included anterior cervical decompression and fusion (ACDF), foraminotomy, and total disc replacement (TDR). Treatment rates were also calculated for patients after a second CTFESI.
Results:
There were 28,345 patients who underwent CTFESI during this study period. After initial CTFESI, 57 % of patients did not undergo any additional procedures/surgeries, 23.7 % had a repeat CTFESI, 5.6 % received a CILESI, 7.4 % underwent ACDF, 1.6 % underwent a foraminotomy, and 1.8 % underwent a TDR. Together, after initial CTFESI, 10.8 % of patients went on to cervical spine surgery as a second line treatment. Of the 6,711 patients who received a repeat CTFESI, 74.5 % had no additional interventional treatment, 8.2 % underwent a CIESI, 10.6 % underwent ACDF, 2.5 % underwent a foraminotomy, and 2.2 % underwent a TDR. In total, 15.3 % of patients underwent cervical spine surgery after a second CTFESI. A third consecutive CTFESI was not attempted in any patients.
Conclusion:
This study demonstrates rates of surgery after an initial CTFESI and a repeat CTFEIS to be low.
