Effectiveness and Risk Factors of CT-guided Transforaminal Epidural Steroid Injection for Cervical Spondylotic Radiculopathy in the Elderly: A Retrospective Study

Abstract Background Cervical spondylotic radiculopathy (CSR) significantly impacts quality of life in elderly patients. Evidence on transforaminal epidural steroid injection (TFESI) efficacy and predictors of treatment response in this population remains limited. To evaluate the 6-month clinical efficacy of CT-guided TFESI in elderly patients with CSR and to identify factors influencing treatment outcomes. Methods This retrospective study included 148 elderly CSR patients undergoing CT-guided TFESI (July 2019–May 2024). Outcomes were assessed using modified MacNab scale and Numerical Rating Scale (NRS) at 6 months. Multivariate logistic regression with bootstrap resampling identified independent predictors. Results At 6 months, overall efficacy rate was 84.5% (125/148). Median NRS scores decreased from 7.00 (IQR 6.00–8.00) at baseline to 2.00 (IQR 1.00–4.00) at 6 months (P < 0.001). Number of treatment sessions was an independent predictor of treatment outcome (P < 0.05). Patients receiving multiple treatments had 2.74-fold higher risk of ineffectiveness compared to single treatment. No significant associations were found between efficacy and demographic characteristics, symptom duration, or baseline pain. No serious complications occurred. No serious procedure-related complications were observed during follow-up. Conclusion CT-guided TFESI demonstrates favorable 6-month efficacy (84.5%) in elderly CSR patients. Number of treatment sessions independently predicts therapeutic response. These findings support TFESI as an effective intervention for this population. Trial registration: The study was approved by the Human Ethical Committee of West China Hospital of Sichuan University and registered at www.chictr.org.cn (Identifier: ChiCTR2300077491).