Outcomes after cervical transforaminal epidural steroid injections vs cervical interlaminar epidural steroid...

Cervical transforaminal and interlaminar epidural steroid injections (CTFESI and CILESI) are commonly used to treat cervical radicular symptoms. There is limited literature comparing the two procedures with some concerns of increased risk of complications after CTFESI.

Compare the rates of cervical spine surgery, post-procedure opioid use, and complications after CTFESI and CILESI.

Retrospective propensity matched cohort comparison utilizing a large global database was performed of adult patients with diagnostic codes for cervical radiculopathy undergoing CTFESI or CILESI. Each cohort was matched for age, sex, race/ethnicity, BMI and obesity codes, nicotine use, mental health diagnoses, chronic cardiovascular, pulmonary and renal diseases, pre-procedural opioid use, and prior spine surgery. The primary outcome was the rate of eventual anterior cervical decompression and fusion, total disc replacement, and/or neuroforaminotomy. Secondary outcomes included post-procedure opioid use and major (stroke, myocardial infarction, paralysis, and seizure) and minor (headache, pallor, syncope, flushing) complications.

The rate of cervical spine surgery was higher for CTFESI compared to CILESI. Post-procedure opioid use was also higher for the CTFESI. Compared to CILESI, CTFESI was associated with greater risk of stroke, seizures, myocardial infarction and minor complications. There was no difference in risk of paralysis.

This study demonstrates that patients undergoing CILESI were less likely to use opioid medications post-procedurally, have less major and minor complications and lower likelihood of having surgery as compared to CTFESI. These differences may be due to sampling biases between the two groups that were part of the clinical decision process in selecting the approach.