1451 - Contrast Dispersion Patterns and Needle Tip Depth in Cervical Transforaminal Epidural Steroid Injections: Progression to Cervical Spine Surgery

Cervical radiculopathy can cause neck and arm pain, and cervical transforaminal epidural steroid injections (TFESIs) can be used to treat patients who have failed conservative treatments. Technique in performing TFESI including needle depth and contrast dispersion patterns may influence treatment efficacy. A study by Conger (2020) introduced a zone-based classification system of contrast spread, however the relationship between needle tip placement, flow zones, and pain relief have not fully been studied. Our objective was to determine whether technical factors such as needle depth and contrast dispersion zone during cervical TFESI are associated with patients progressing to spine surgery.

Design: We reviewed 261 cervical TFESIs performed between 2013 and 2020. Needle depth was recorded both as both percentage depth within the foramen as well as in thirds (lateral, middle, and medial thirds). Contrast spread was classified into flow zones (1-3) as defined by Conger. We then documented whether the patient proceeded to undergo cervical spine surgery including the number of days between their last cervical TFESI and their surgery.

Results: Among 261 cervical TFESI, (mean age 51.86 years, 51% female, 49% male), needle placement distribution was: lateral third 48.3%, middle third 47.9%, medial third 3.9%; mean depth 36.93% (SD 16.17). Contrast distribution: Zone 1 8.1%, Zone 2 33.6%, Zone 3 58.3%. Overall, 29.9% underwent surgery within a mean of 205.24 days from the injection.

Conclusions: In this cohort, 29.9% of patients underwent surgery following cervical TFESI. Although patterns of needle placement were characterized, and contrast dispersion categorized into zones, further studies are needed to determine whether technical variation influences surgical conversion rates and patient outcomes.