In comparison with computed tomography-guided transforaminal steroid injection, ultrasound offers a non-inferior injectate spread pattern and comparable improvement of functional status and radicular pain.

A randomized, single-blind, controlled noninferiority trial compared the safety and effectiveness of ultrasound (US)-guided and computed tomography (CT)-guided transforaminal steroid injection (TFSI) for the management of cervical radicular pain.

Overall, 430 subjects with cervical radicular pain from cervical spondylosis or cervical herniated disc were included. The TFSI for one affected cervical nerve was randomly given to the patients as either a US-guided procedure or a CT-guided procedure. Using CT, the contrast dispersion pattern was monitored during TFSI in both groups.

At baseline, one and three months following the treatment, subjects had their functional impairment and pain severity measured with the aid of neck disability index (NDI) and numeric rating scale (NRS), respectively. Recording of complications was also done.

In the US group and the CT group, the good rate of contrast dispersion was 92.1% and 95.8%, respectively. During follow-up, both groups illustrated betterment in functional status and pain. There was no clinically meaningful difference in the reduction in NRS pain scores and NDI scores between both the groups with F =1.050 at 1 month and F =0.103 at 3 months following the treatment. There were no severe or long-lasting complications reported.

When compared to CT-guided TFSI, the US-guided TFSI provided a comparable betterment in radicular pain and functional status, and a non-inferior injectate spread pattern. Since US-guided TFSI prevents radiation exposure and provides visualization of critical vessels, it may be helpful during this treatment.