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Randomized Controlled Trial
. 2012;9(6):424-34.
doi: 10.7150/ijms.4444. Epub 2012 Jul 23.

Management of chronic pain of cervical disc herniation and radiculitis with fluoroscopic cervical interlaminar epidural injections

Laxmaiah Manchikanti  1 , Kimberly A Cash, Vidyasagar Pampati, Bradley W Wargo, Yogesh Malla
Affiliations
Randomized Controlled Trial

Management of chronic pain of cervical disc herniation and radiculitis with fluoroscopic cervical interlaminar epidural injections

Laxmaiah Manchikanti et al. Int J Med Sci. 2012.

Abstract

Study design: A randomized, double-blind, active controlled trial.

Objective: To evaluate the effectiveness of cervical interlaminar epidural injections of local anesthetic with or without steroids in the management of chronic neck pain and upper extremity pain in patients with disc herniation and radiculitis.

Summary of background data: Epidural injections in managing chronic neck and upper extremity pain are commonly employed interventions. However, their long-term effectiveness, indications, and medical necessity, of their use and their role in various pathologies responsible for persistent neck and upper extremity pain continue to be debated, even though, neck and upper extremity pain secondary to disc herniation and radiculitis, is described as the common indication. There is also paucity of high quality literature.

Methods: One-hundred twenty patients were randomly assigned to one of 2 groups: Group I patients received cervical interlaminar epidural injections of local anesthetic (lidocaine 0.5%, 5 mL); Group II patients received 0.5% lidocaine, 4 mL, mixed with 1 mL of nonparticulate betamethasone. Primary outcome measure was ≥ 50 improvement in pain and function. Outcome assessments included Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), opioid intake, employment, and changes in weight.

Results: Significant pain relief and functional status improvement (≥ 50%) was demonstrated in 72% of patients who received local anesthetic only and 68% who received local anesthetic and steroids. In the successful group of participants, significant improvement was illustrated in 77% in local anesthetic group and 82% in local anesthetic with steroid group.

Conclusions: Cervical interlaminar epidural injections with or without steroids may provide significant improvement in pain and function for patients with cervical disc herniation and radiculitis.

Keywords: Chronic neck pain; cervical disc herniation; cervical epidural injections; epidural steroids; local anesthetics; upper extremity pain.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

Figures

Fig 1
Fig 1
Schematic presentation of patients flow at one-year follow-up of 120 patients.
Fig 2
Fig 2
Proportion of patients with significant reduction in Numeric Rating Scale and Neck Disability Index (≥ 50% reduction from baseline).
See this image and copyright information in PMC

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