Eur Radiol (2007) 17: 1156–1161 DOI 10.1007/s00330-006-0416-x MUSCULOSKELETAL Fouad Fayad François Rannou Jean Luc Drapé Lamia Rahmani Marie-Martine Lefevre-Colau Alain Nys Serge Poiraudeau Michel Ledoux Alain Chevrot Michel Revel Received: 28 February 2006 Revised: 16 May 2006 Accepted: 31 July 2006 Published online: 12 October 2006 # Springer-Verlag 2006 Intradiscal corticosteroid injections in spondylotic cervical radiculopathy Abstract The purpose of this study was to evaluate treatment outcomes with intradiscal injection of corticosteroids (IDIC) in cervical spondylotic radiculopathy. Twenty consecutive patients were treated with intradiscal injection of 25 mg of acetate of prednisolone under fluoroscopic control. All patients had previously received a nonsurgical treatment for at least 3 months without success. Outcomes were assessed 1, 3 and 6 months after IDIC. Radicular pain reduction as scored on a visual analogue scale (VAS 100-mm length) was statistically significant at 1 month (19.0 ± 28.0 mm; p = 0.008), 3 months (25.2 ± 27.5 mm; p = 0.002), and 6 months (24.6 ± 28.4 mm; p = 0.001). In all, 40% of treated patients de- scribed at least 50% pain improve- ment 6 months after treatment. Four patients had complete relief of radic- ular pain. In conclusion, IDIC should be an alternative in the nonsurgical management of cervical spondylotic radiculopathy. Keywords Cervical radiculopathy . Spinal injection . Corticosteroids . Intradiscal . Discography Introduction Few epidemiological studies have been performed to document the incidence and natural history of cervical radiculopathy, but this dysfunction of cervical roots is very painful, disabling, and difficult to cure [1–4]. In contrast to disorders of the lumbar spine, herniation of the nucleus pulposus is responsible for only 20–25% of cases [1, 2, 5]. The most common cause is cervical spondylosis, and the mechanism generally accepted is foraminal encroachment of the spinal roots between uncovertebral osteophytes anteriorly and degenerative changes of the zygapophyseal joints posteriorly. However, the mechanism underlying the onset of radicular pain is poorly understood. Indeed, if the physiopathologic features are summarized by the com- pression of the roots by osteophytes, it is difficult to explain why many patients have no symptoms but comparable degenerative changes with patients with symptoms and why patients present with sudden radicular pain after a long period of osteoarthritic changes and no pain. Evidence from several studies strongly indicates an inflammatory process in the pathophysiologic process of sciatica, but few data are available on cervical disc herniation and even less on spondylotic cervical radicu- lopathy. However, radicular inflammation is a rationale for treatment with anti-inflammatory agents and local injec- F. Fayad (*) . F. Rannou . L. Rahmani . M.-M. Lefevre-Colau . A. Nys . S. Poiraudeau . M. Ledoux . M. Revel Service de rééducation et de réadaptation de l’appareil locomoteur et des pathologies du rachis, Hôpital Cochin (AP-HP) Université Paris 5, 27 Rue du Faubourg Saint Jacques, 75014 Paris, France e-mail: fouad.fayad@cch.aphp.fr Tel.: +33-1-58412541 Fax: +33-1-58412545 J. L. Drapé . A. Chevrot Department of Radiology B, Hôpital Cochin (AP-HP), 75014 Paris, France