Top

Skeletal Radiology

Published in:

01-07-2014 | Scientific Article

Fluoroscopic cervical paramidline interlaminar epidural steroid injections for cervical radiculopathy: effectiveness and outcome predictors

Authors: Joon Woo Lee, Su Yeon Hwang, Guen Young Lee, Eugene Lee, Heung Sik Kang

Published in: Skeletal Radiology | Issue 7/2014

Abstract

Objective

The purpose of this study is to analyze the effectiveness of fluoroscopic cervical paramidline interlaminar epidural steroid injection (ESI) as well as to assess outcome predictors.

Methods

One hundred forty-three patients (M:F = 89:54, mean age = 53.1 years old) who received cervical paramidline interlaminar ESIs in 2011 were included in this study. Initial improvements at 2 weeks were assessed. For possible outcome predictors, clinical and MR variables were statistically analyzed using the Mann–Whitney U, Chi-square, and Fisher’s exact tests.

Results

Initial improvements after cervical paramidline interlaminar ESIs at 2 weeks were reported in 115 of 143 patients (80.8 %). Patients with paresthesia only and no pain showed significantly fewer improvements after ESIs (11/19, 57.9 %) than patients with pain (104/124, 83.9 %) (p = 0.013). Other variables were not statistically significant outcome predictors.

Conclusions

Fluoroscopic paramidline interlaminar cervical ESIs effectively managed cervical radiculopathy, irrespective of the cause or zone of nerve root compression, and patients with paresthesia only experienced fewer improvements.

Manchikanti L, Cash KA, Pampati V, Wargo BW, Malla Y. The effectiveness of fluoroscopic cervical interlaminar epidural injections in managing chronic cervical disc herniation and radiculitis: preliminary results of a randomized, double-blind, controlled trial. Pain Physician. 2010;13(3):223–36.PubMed

Diwan S, Manchikanti L, Benyamin RM, Bryce DA, Geffert S, Hameed H, et al. Effectiveness of cervical epidural injections in the management of chronic neck and upper extremity pain. Pain Physician. 2012;15(4):E405–34.PubMed

Manchikanti L, Boswell MV, Datta S, Fellows B, Abdi S, Singh V, et al. Comprehensive review of therapeutic interventions in managing chronic spinal pain. Pain Physician. 2009;12(4):E123–98.PubMed

Razzaq AA, O'Brien D, Mathew B, Bartlett R, Taylor D. Efficacy and durability of fluoroscopically guided cervical nerve root block. Br J Neurosurg. 2007;21(4):365–9.PubMedCrossRef

Smuck M, Rosenberg JM, Akuthota V. The use of epidural corticosteroids for cervical radiculopathy: an interlaminar versus transforaminal approach. PM R. 2009;1(2):178–84.PubMedCrossRef

Stout A. Epidural steroid injections for cervical radiculopathy. Phys Med Rehabil Clin N Am. 2011;22(1):149–59.PubMedCrossRef

Kim KS, Shin SS, Kim TS, Jeong CY, Yoon MH, Choi JI. Fluoroscopically guided cervical interlaminar epidural injections using the midline approach: an analysis of epidurography contrast patterns. Anesth Analg. 2009;108(5):1658–61.PubMedCrossRef

Kwon JW, Lee JW, Kim SH, Choi JY, Yeom JS, Kim HJ, et al. Cervical interlaminar epidural steroid injection for neck pain and cervical radiculopathy: effect and prognostic factors. Skeletal Radiol. 2007;36(5):431–6.PubMedCrossRef

Lee JW, Park KW, Chung SK, Yeom JS, Kim KJ, Kim HJ, et al. Cervical transforaminal epidural steroid injection for the management of cervical radiculopathy: a comparative study of particulate versus non-particulate steroids. Skeletal Radiol. 2009;38(11):1077–82.PubMedCrossRef

10.

Huntoon MA. Anatomy of the cervical intervertebral foramina: vulnerable arteries and ischemic neurologic injuries after transforaminal epidural injections. Pain. 2005;117(1–2):104–11.PubMedCrossRef

11.

Scanlon GC, Moeller-Bertram T, Romanowsky SM, Wallace MS. Cervical transforaminal epidural steroid injections: more dangerous than we think? Spine. 2007;32(11):1249–56.PubMedCrossRef

12.

Kloth DS. Risk of cervical transforaminal epidural injections by anterior approach. Pain Physician. 2003;6(3):392–3.PubMed

13.

Lee JH, Lee JK, Seo BR, Moon SJ, Kim JH, Kim SH. Spinal cord injury produced by direct damage during cervical transforaminal epidural injection. Reg Anesth Pain Med. 2008;33(4):377–9.PubMedCrossRef

14.

Fardon DF, Milette PC. Nomenclature and classification of lumbar disc pathology. Recommendations of the Combined task Forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology. Spine (Phila Pa 1976). 2001;26(5):E93–113.CrossRef

15.

Stojanovic MP, Vu TN, Caneris O, Slezak J, Cohen SP, Sang CN. The role of fluoroscopy in cervical epidural steroid injections: an analysis of contrast dispersal patterns. Spine (Phila Pa 1976). 2002;27(5):509–14.CrossRef

16.

Van Zundert J, Huntoon MA, van Kleef M. Complications of transforaminal cervical epidural steroid injections. Spine (Phila Pa 1976). 2009;34(22):2477. author reply 2477–2478.CrossRef

17.

Suresh S, Berman J, Connell DA. Cerebellar and brainstem infarction as a complication of CT-guided transforaminal cervical nerve root block. Skeletal Radiol. 2007;36(5):449–52.PubMedCrossRef

18.

Dreyfuss P, Baker R, Bogduk N. Comparative effectiveness of cervical transforaminal injections with particulate and nonparticulate corticosteroid preparations for cervical radicular pain. Pain Med. 2006;7(3):237–42.PubMedCrossRef

Title: Fluoroscopic cervical paramidline interlaminar epidural steroid injections for cervical radiculopathy: effectiveness and outcome predictors
Authors: Joon Woo Lee
Su Yeon Hwang
Guen Young Lee
Eugene Lee
Heung Sik Kang
Publication date: 01-07-2014
Publisher: Springer Berlin Heidelberg
Published in: Skeletal Radiology / Issue 7/2014
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI: https://doi.org/10.1007/s00256-014-1866-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Fluoroscopic cervical paramidline interlaminar epidural steroid injections for cervical radiculopathy: effectiveness and outcome predictors

Abstract

Objective

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 7/2014

Bursal synovial chondromatosis formation following osteochondroma resection

Exploring cartilage damage in gout using 3-T MRI: distribution and associations with joint inflammation and tophus deposition

An in vitro comparative study of T2 and T2* mappings of human articular cartilage at 3-Tesla MRI using histology as the standard of reference

Diffusion-weighted imaging of skeletal muscle lymphoma

Browser’s notes

Atypical vertebral Paget’s disease