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

OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.