Fluoroscopic cervical epidural injections in chronic axial or disc-related neck pain without disc herniation, facet joint pain, or radiculitis

Manchikanti, Laxmaiah; Cash, Kimberly A; Pampati, Vidyasagar; Malla, Yogesh

doi:10.2147/jpr.s32692

Cited by 36 publications

(47 citation statements)

References 63 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This report consists of the results of 120 patients with a 2-year follow-up, and is a continuation of a previously published one-year follow-up report 15.…”

Section: Introductionmentioning

confidence: 85%

Two-Year Follow-Up Results of Fluoroscopic Cervical Epidural Injections in Chronic Axial or Discogenic Neck Pain: A Randomized, Double-Blind, Controlled Trial

Manchikanti

Ka²,

Pampati³

et al. 2014

Int. J. Med. Sci.

Self Cite

View full text Add to dashboard Cite

Study Design: A randomized, double-blind, active-controlled trial.Objective: To assess the effectiveness of cervical interlaminar epidural injections of local anesthetic with or without steroids for the management of axial or discogenic pain in patients without disc herniation, radiculitis, or facet joint pain.Summary of Background Data: Cervical discogenic pain without disc herniation is a common cause of suffering and disability in the adult population. Once conservative management has failed and facet joint pain has been excluded, cervical epidural injections may be considered as a management tool. Despite a paucity of evidence, cervical epidural injections are one of the most commonly performed nonsurgical interventions in the management of chronic axial or disc-related neck pain.Methods: One hundred and twenty patients without disc herniation or radiculitis and negative for facet joint pain as determined by means of controlled diagnostic medial branch blocks were randomly assigned to one of the 2 treatment groups. Group I patients received cervical interlaminar epidural injections of local anesthetic (lidocaine 0.5%, 5 mL), whereas Group II patients received 0.5% lidocaine, 4 mL, mixed with 1 mL or 6 mg of nonparticulate betamethasone.The primary outcome measure was ≥ 50% improvement in pain and function. Outcome assessments included numeric rating scale (NRS), Neck Disability Index (NDI), opioid intake, employment, and changes in weight.Results: Significant pain relief and functional improvement (≥ 50%) was present at the end of 2 years in 73% of patients receiving local anesthetic only and 70% receiving local anesthetic with steroids. In the successful group of patients, however, defined as consistent relief with 2 initial injections of at least 3 weeks, significant improvement was illustrated in 78% in the local anesthetic group and 75% in the local anesthetic with steroid group at the end of 2 years. The results reported at the one-year follow-up were sustained at the 2-year follow-up.Conclusions: Cervical interlaminar epidural injections with or without steroids may provide significant improvement in pain and functioning in patients with chronic discogenic or axial pain that is function-limiting and not related to facet joint pain.

show abstract

“…This report consists of the results of 120 patients with a 2-year follow-up, and is a continuation of a previously published one-year follow-up report 15.…”

Section: Introductionmentioning

confidence: 85%

Two-Year Follow-Up Results of Fluoroscopic Cervical Epidural Injections in Chronic Axial or Discogenic Neck Pain: A Randomized, Double-Blind, Controlled Trial

Manchikanti

Ka²,

Pampati³

et al. 2014

Int. J. Med. Sci.

Self Cite

View full text Add to dashboard Cite

show abstract

“…183 Investigators looking for a reduction in opioid intake following ESI have met with mixed results, as both ESI and control injections typically result in a decline in analgesic intake. 86 When controlling for diagnosis, randomized comparativeeffectiveness studies have found that ESIs reduce opioid intake for within-group but not between-group comparisons in patients suffering from HD with radiculitis, 184,185 failed back surgery syndrome, 114,186 discogenic spine pain, 187,188 and lumbosacral spinal stenosis. 189Y191 Studies evaluating the ability of ESI to reduce health care utilization as a secondary outcome measure have also yielded conflicting results.…”

Section: Healthcare Utilizationmentioning

confidence: 99%

Epidural Steroids

Cohen¹,

Bicket

Jamison

et al. 2013

Regional Anesthesia and Pain Medicine

300

114

View full text Add to dashboard Cite

Epidural steroid injections (ESIs) are the most widely utilized pain management procedure in the world, their use supported by more than 45 placebo-controlled studies and dozens of systematic reviews. Despite the extensive literature on the subject, there continues to be considerable controversy surrounding their safety and efficacy. The results of clinical trials and review articles are heavily influenced by specialty, with those done by interventional pain physicians more likely to yield positive findings. Overall, more than half of controlled studies have demonstrated positive findings, suggesting a modest effect size lasting less than 3 months in well-selected individuals. Transforaminal injections are more likely to yield positive results than interlaminar or caudal injections, and subgroup analyses indicate a slightly greater likelihood for a positive response for lumbar herniated disk, compared with spinal stenosis or axial spinal pain. Other factors that may increase the likelihood of a positive outcome in clinical trials include the use of a nonepidural (eg, intramuscular) control group, higher volumes in the treatment group, and the use of depo-steroid. Serious complications are rare following ESIs, provided proper precautions are taken. Although there are no clinical trials comparing different numbers of injections, guidelines suggest that the number of injections should be tailored to individual response, rather than a set series. Most subgroup analyses of controlled studies show no difference in surgical rates between ESI and control patients; however, randomized studies conducted by spine surgeons, in surgically amenable patients with standardized operative criteria, indicate that in some patients the strategic use of ESI may prevent surgery.

show abstract

“…However, to date, no diagnostic standard for cervical discogenic upper back pain has been published. Because upper back pain can potentially originate from thoracic radiculitis or discogenic pain, 21 thoracic facet joint syndrome, 22 scapulothoracic bursitis, 23 cervical radiculitis or discogenic pain, 24 cervical facet joint syndrome, 24 or myofascial pain, 25 , 26 it was difficult to enroll patients with this type of pain in this study. Therefore, to avoid the potential risk of misdiagnosis, all the subjects in this study received thoracic and cervical MRI and a stepper diagnostic and therapeutic procedure.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Coblation Technology in Treating Cervical Discogenic Upper Back Pain

Tang

et al. 2015

Medicine

View full text Add to dashboard Cite

Upper back pain originating from the cervical disk itself is defined as cervical discogenic upper back pain. Coblation procedures can provide therapeutic effects for neck and radicular pain related to contained cervical disk herniation. However, no studies have reported the performance of coblation procedures, particularly for treating cervical discogenic upper back pain. The purpose of this study was to evaluate the efficacy of coblation procedures in treating cervical discogenic upper back pain.In a prospective, clinical, observational study, 28 consecutive patients with discogenic upper back pain underwent coblation procedures on the cervical disk with a percutaneous anterior approach. Pain visual analogue scale (VAS) scores, patient responses stating significant (≥50%) pain relief, significant (≥50%) reduction in pain medicine intake and Modified MacNab criteria were adopted to evaluate the pain intensity, degree of pain relief, and functional status after 12 months of follow-up.The preoperative pain VAS score was 6.5 ± 1.1 (95% confidence interval [CI] 6.085–6.915), and the pain VAS score significantly decreased to 2.4 ± 1.3 (95% CI 1.929–2.928), 2.5 ± 1.5 (95% CI 1.963–3.109), 2.7 ± 1.4 (95% CI 2.157–3.271), 3.1 ± 1.6 (95% CI 2.457–3.686), and 3.1 ± 1.6 (95% CI 2.471–3.743) at 1 week and 1, 3, 6, and 12 months postoperatively, respectively (P < 0.05). Twenty-two (78.6%), 21 (75.0%), 20 (71.4%), 19 (67.9%), and 18 (64.3%) of the patients expressed significant pain relief at 1 week and 1, 3, 6, and 12 months postoperatively, respectively. 24 (85.7%), 23 (82.1%), 23 (82.1%), and 22 (78.6%) reported significant reduction in pain medication intake at 1, 3, 6, and 12 months postoperatively, respectively. According to the Modified MacNab criteria, the numbers of patients with “excellent” or “good” ratings were 22 (78.6%), 21 (75.0%), 20 (71.4%), and 18 (64.3%) at 1, 3, 6, and 12 months postoperatively, respectively. No serious complications were observed.The findings of this study showed that coblation is an effective, safe, minimally invasive, and less uncomfortable procedure for the treatment of discogenic upper back pain.

show abstract

Fluoroscopic cervical epidural injections in chronic axial or disc-related neck pain without disc herniation, facet joint pain, or radiculitis

Cited by 36 publications

References 63 publications

Two-Year Follow-Up Results of Fluoroscopic Cervical Epidural Injections in Chronic Axial or Discogenic Neck Pain: A Randomized, Double-Blind, Controlled Trial

Two-Year Follow-Up Results of Fluoroscopic Cervical Epidural Injections in Chronic Axial or Discogenic Neck Pain: A Randomized, Double-Blind, Controlled Trial

Epidural Steroids

Efficacy of Coblation Technology in Treating Cervical Discogenic Upper Back Pain

Contact Info

Product

Resources

About