Effect of Cervical Interlaminar Epidural Steroid Injection: Analysis According to the Neck Pain Patterns and MRI Findings

Abstract

BackgroundIt is widely accepted that cervical interlaminar steroid injection (CIESI) is more effective in treating radicular pain than axial neck pain, but without direct comparison. And the differences of effect after CIESI according to MRI findings are inconsistent. In this retrospective study, we evaluated the therapeutic response of CIESI according to pain sites, durations, MRI findings, and other predictive factors altogether, unlike previous studies, which evaluated them separately.MethodsThe medical records of 128 patients who received fluoroscopy guided CIESI were analyzed. We evaluated the therapeutic response (more than a 50% reduction on the visual analog scale [VAS] by their second visit) after CIESI by (1) pain site; neck pain without radicular pain/radicular pain with or without neck pain, (2) pain duration; acute/chronic (more than 6 month), and (3) findings of MRI; herniated intervertebral disc (HIVD)/spinal stenosis, respectively and altogether.ResultsEighty-eight patients (68%) responded to CIESI, and there were no significant differences in demographic data, initial VAS score, or laboratory findings. And there were no significant differences in the response rate relating to pain site, pain duration, or MRI findings, respectively. In additional analysis, acute radicular pain with HIVD patients showed significantly better response than chronic neck pain with spinal stenosis (P = 0.04).ConclusionsWe cannot find any sole predictive factor of therapeutic response to the CIESI. But the patients having acute radicular pain with HIVD showed the best response, and those having other chronic neck pain showed the worst response to CIESI.

A Prospective Randomized Comparative Trial of Targeted Steroid Injection Via Epidural Catheter Versus Standard C7-T1 Interlaminar Approach for the Treatment of Unilateral Cervical Radicular Pain

“…Prior investigation has shown response rates defined by either 50% or greater NRS pain score reduction or PGIC rating consistent with "improvement" in symptoms of 68% to 80% depending on the duration of followup, [21][22][23][24][25][26] consistent with the observed rates in this study (Fig. 2).…”

Analysis of epidural waveform for cervical epidural steroid injections confirmed with fluoroscopy

“…ESI of the cervical and lumbar area is a common method for the pain physician to manage patients experiencing chronic pain. [ 12 – 14 ] Most pain physicians routinely used fluoroscopy as a guidance tool. ESI using fluoroscopic guidance provides the benefit of accuracy and minimizes the delivery of medication to non-epidural space.…”

Effect of epidural corticosteroid injection on magnetic resonance imaging findings

“…It is an effective treatment method for improving ambulatory and functional limitations and for pain management in patients with spinal diseases [ 12 13 ]. Magnetic resonance imaging is the most sensitive and trustworthy diagnostic technique for spinal diseases; it has become increasingly common in recent years [ 14 15 ]. It is useful for excluding other causes of spinal diseases.…”