Therapeutic efficacy of selective nerve root injections for cervical radiculopathy

Study Design: Retrospective case-series Objective: To assess the clinical effect of single level cervical selective nerve root injection (SNI) on patient outcomes. Methods: A total of 120 injections in 108 patients with at least 1-year follow-up were identified at one institution following a single-level, one-sided SNI that provided >90% relief. Statistical analysis was performed comparing time from symptom onset to injection, pre- and post-injection Neck Disability Index (NDI) and VAS arm pain scores, and injection type. Results: At 1-year follow-up 39.2% of patients had avoided surgical intervention. Both groups were similar in gender and cervical levels affected. Both surgical and non-surgical groups had significant improvement in NDI scores (44.7 to 29.8, p=0.0006 and 33.7 to 16.4, p=0.015 respectively). The surgical group had a statistically significant older patient population (59.5 versus 54.5, p=0.018), a higher pre-injection VAS arm pain score (6.9 versus 6.1, p=0.014), and a higher NDI both pre-injection and at follow-up (44.7 versus 33.7, p=0.0006 and 29.8 versus 16.4, p=0.015 respectively). There was also no difference in preventing surgical intervention (p=0.4299) between the groups receiving lidocaine alone versus lidocaine plus steroid. Conclusions: Based on our retrospective data, a significant percentage of patients may receive therapeutic benefit from cervical selective nerve root injections. There appears to be no benefit to adding steroid to the injection composition. Those who avoided surgical intervention from a SNI had lower pre-injection VAS arm and NDI scores and a lower NDI with at least 1-year follow-up compared to surgical group.