Cervical epidural steroid injection for cervicobrachialgia

Abstract

Fifty patients with chronic resistant cervicobrachialgia were randomly divided into two groups. Twenty-five patients (group A) were treated with cervical epidural steroid/lidocaine injections and 17 patients (group B) were treated with steroid/lidocaine injections into the posterior neck muscles. Another eight patients from group B were excluded from the study because they had started the process of litigation of insurance claims and their subjective analysis of pain relief might therefore not be trustworthy. One to three injections were administered at 2-week intervals according to the clinical response. All patients continued their various pre-study treatments: non-steroidal anti-inflammatory drugs, non-opioid analgesics and physiotherapy. Pain relief was evaluated by the visual analogue scale 1 week after the last injection and then 1 year later. One week after the last injection we rated pain relief as very good and good in 76% of the patients in group A, as compared to 35.5% of the patients in group B. One year after the treatment 68% of the group A patients still had very good and good pain relief, whereas only 11.8% of group B patients reported this degree of pain relief. These differences were statistically significant. We failed to achieve significant improvement of tendon reflexes or of sensory loss in both groups, but the increase in the range of motion, the fraction of patients who were able to decrease their daily dose of analgesics, and recovery of the capacity for work were significantly better in group A. We encountered no complications in either group of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Cervical Foraminal Versus Interlaminar Epidurals: Risks, Benefits, and Alternatives

“…This study compared them to intramuscular corticosteroid injections, with superior results observed in the interlaminar injection group [8]. This finding supports the theory that a more target specific and higher concentration of corticosteroids produces better results.…”

“…Surprisingly, this practice has never been shown to benefit patients with cervical radiculopathy. As detailed above, intramuscular corticosteroid administration is inferior to interlaminar epidural injection based on a single randomized trial [8]. Another well-designed placebo controlled randomized trial found that oral corticosteroids were no better than placebo in the treatment of lumbar radiculopathy [94].…”

“…Passage of a catheter provides additional opportunity for trauma to epidural veins and increases hematoma risk, much like continuous epidural access for medication infusions. Plus, multiple prospective studies have demonstrated that the standard interlaminar approach is effective in reducing pain and need for surgeries [8,[79][80][81][82]83 •• ].…”

“…The primary goal of conservative treatment of acute radicular pain is to ameliorate the symptoms and improve function while the favorable natural history runs its course. For this purpose, epidural corticosteroids in various forms have proven beneficial [4][5][6][7][8]. These injections are commonly used to treat radicular pain from disc herniation and degenerative stenosis.…”

Safety and Efficacy of CT-Guided Transforaminal Cervical Epidural Steroid Injections Using a Posterior Approach

“…5,6 Prospective and retrospective studies have been completed with limited patient enrollment, 7,8 widely varying results, and varying time periods of followup. 4,[9][10][11][12][13] Although studies have been completed that attempted to link successful outcomes to findings on cross-sectional imaging, 14 EMG findings, 7 or diagnostic root blocks, 7 most patients are referred for therapeutic cervical epidural injections with a variety of clinical, radiographic, and electrophysiologic data.…”