Can CT-guided cervical nerve root injections delay or prevent the need for surgical intervention in cervical radiculopathy?

Abstract

To evaluate the effectiveness of computed tomography (CT)-guided cervical nerve root injections (CNRI) for cervical radiculopathy, identify predictors of favourable pain response, and assess their impact on subsequent surgical intervention rates. Retrospective observational study included 148 patients undergoing CT-guided CNRI for cervical radiculopathy between October 2021 and April 2024 at a regional neuroscience centre in the Northwest of England providing a tertiary-level specialist care. Data on demographics, clinical presentation, radiological findings, procedural details, patient-reported outcomes, and subsequent surgery were collected. Univariate and multivariate logistic regression analyses were performed to identify predictors of pain improvement. Overall, 66.2% (98/148) of patients reported improvement in radicular pain following CT-guided CNRI (55.1% substantial, 44.9% partial), with a mean symptom relief duration of 20.2 weeks (SD 22.8). Multivariate analysis identified unilateral symptoms as a significant positive predictor of improvement (OR = 7.0, 95% CI 2.01-24.08, p = 0.002), while multilevel disease (OR = 0.40, 95% CI 0.15-0.98, p = 0.047) and prior cervical surgery (0.31, 95% CI 0.11-0.82, p = 0.018) were significant negative predictors. During the study period, 24.3% (36/148) of patients proceeded to or were listed for cervical spinal surgery. No major neurovascular complications were reported. CT-guided CNRI provides effective short- to medium-term pain relief for a majority of patients with cervical radiculopathy and can reduce the need for subsequent surgery in approximately three-quarters of cases. Treatment success is more likely in patients with unilateral symptoms and without multilevel disease or prior cervical surgery. These findings can aid in patient selection and counselling.