Do Cervical Epidural Injections Provide Long-Term Relief in Neck And Upper Extremity Pain? A Systematic Review

Abstract

of Background Data: The high prevalence of chronic persistent neck pain not only leads to disability but also has a significant economic, societal, and health impact. Among multiple modalities of treatments prescribed in the management of neck and upper extremity pain, surgical, interventional and conservative modalities have been described. Cervical epidural injections are also common modalities of treatments provided in managing neck and upper extremity pain. They are administered by either an interlaminar approach or transforaminal approach.Objectives: To determine the long-term efficacy of cervical interlaminar and transforaminal epidural injections in the treatment of cervical disc herniation, spinal stenosis, discogenic pain without facet joint pain, and post-surgery syndrome. Materials and Methods:The literature search was performed from 1966 to April 2014 utilizing data from PubMed, Cochrane Library, US National Guideline Clearinghouse, previous systematic reviews, and crossreferences. The evidence was assessed based on best evidence synthesis with Level I to Level V.Results: There were 7 manuscripts meeting inclusion criteria. Of these, 4 assessed the role of interlaminar epidural injections for managing disc herniation or radiculitis, and 3 assessed these injections for managing central spinal stenosis, discogenic pain without facet joint pain, and post surgery syndrome. There were 4 high quality manuscripts. A qualitative synthesis of evidence showed there is Level II evidence for each etiology category. The evidence is based on one relevant, high quality trial supporting the efficacy of cervical interlaminar epidural injections for each particular etiology. There were no randomized trials available assessing the efficacy of cervical transforaminal epidural injections. Conclusion:This systematic review with qualitative best evidence synthesis shows Level II evidence for the efficacy of cervical interlaminar epidural injections with local anesthetic with or without steroids, based on at least one high-quality relevant randomized control trial in each category for disc herniation, discogenic pain without facet joint pain, central spinal stenosis, and post-surgery syndrome.

Shoulder and Neck Pain: Interdisciplinary Aspects of Treatment

“…При объективном обследовании выявлен дефицит чувствительности без двигательных нарушений, сохранявшийся 35-40 мин. Следовательно, блокады фасеточных суставов должны проводиться толь-ко при наличии готового к работе реанимационного обо-рудования и персонал, проводящий интервенционные процедуры, должен быть обучен реанимационным меро-приятиям [50].…”

“…Систематический обзор информации по эпидурально-му введению местных анестетиков с/без ГКС позволил определить II уровень доказательности для эффективно-сти и безопасности интерламинарных манипуляций при дискогенной боли без фасеточной артропатии, грыжах дисков шейного отдела позвоночника [50].…”

Cervical Radiculopathy: Focused on Primary Care

“…Physical therapy interventions focus usually on strength and stretch training of the neck and chest muscles, also it should include postural and ergonomic training, and is recommended to be initiated with gentle range motion exercises and work from light through heavier and more demanding exercises as symptoms subside [3,16,17]. Non-surgical treatment has been reported to have a good outcome in up to 90% of patients, however this benefits tend to disappear in the next 6 months to a year [3,17,18].…”

Optimal volume of injectate for fluoroscopy-guided cervical interlaminar epidural injection in patients with neck and upper extremity pain

“…[ 2–5 7 ] Despite the ongoing debate regarding long-term efficacy, cervical interlaminar epidural injections (CIEIs) of steroids have been shown to be effective for treating chronic neck and upper-extremity pain, as demonstrated by randomized clinical trials and systematic reviews. [ 3 8 ] Cervical transforaminal epidural injections (CTFEIs) may be more effective than CIEIs.…”