Clinical Outcomes of Cervical Transforaminal Epidural Block Using Local Anesthetics with or without a Steroid for Cervical Spondylotic Radiculopathy

Study Design: A retrospective chart review. Objectives: To evaluate and compare the clinical outcomes of cervical transforaminal epidural block (CTEB) using local anesthetics with or without a steroid for cervical spondylotic radiculopathy (CSR). Summary of Literature Review: The typical mixture for a CTEB is a combination of local anesthetics with a non-particulate steroid. However, there are potential complications related to steroid injections such as steroid-induced osteoporosis, hypothalamus-pituitary-adrenal gland axis suppression, and hyperglycemia. Materials and Methods: From January 2018 to October 2019, 35 patients who underwent CTEB for CSR were enrolled in this study. Cases with arm pain over 4 on a visual analog scale (VAS) were included. In the first 19 cases, a combination of 1 mL of 1% lidocaine and 1 mL of dexamethasone was used (group A), and in the next 16 cases, 1 mL of 1% lidocaine mixed with 1 mL of normal saline was used (group B). Arm pain VAS and the Neck Disability Index (NDI) were obtained perioperatively. Results: Baseline characteristics were not significantly different between the two groups. In both groups, the arm pain VAS significantly decreased at 30 minutes, 2 weeks, and 6 weeks post-injection compared to pre-injection values. However, the arm pain aggravated 12 weeks post-injection. The NDI of both groups significantly improved 6 weeks post-injection compared to pre-injection. The clinical outcomes of arm pain VAS and NDI at 30 minutes, 2 weeks, and 6 weeks post-injection, as well as the amounts of change, were not significantly different between both groups. Conclusions: CTEB for CSR without a steroid improved symptoms by 6 weeks. The degree of improvement was similar to when CTEB was performed with a steroid in terms of VAS and NDI.