Korean J Radiol.  2015 Jun;16(3):604-612. 10.3348/kjr.2015.16.3.604.

Cervical Interlaminar Epidural Steroid Injection for Unilateral Cervical Radiculopathy: Comparison of Midline and Paramedian Approaches for Efficacy

• Yoon JY
• Kwon JW
• Yoon YC
• Lee J

• KMID: 2155530
• DOI: http://doi.org/10.3348/kjr.2015.16.3.604

Abstract

OBJECTIVE
The objective of this study was to compare the clinical outcomes of the cervical interlaminar epidural steroid injection (CIESI) for unilateral radiculopathy by the midline or paramedian approaches and to determine the prognostic factors of CIESI.
MATERIALS AND METHODS
We retrospectively analyzed 182 patients who underwent CIESI from January 2009 to December 2012. Inclusion criteria were no previous spinal steroid injection, presence of a cross-sectional image, and presence of follow-up records. Exclusion criteria were patients with bilateral cervical radiculopathy and/or dominant cervical axial pain, combined peripheral neuropathy, and previous cervical spine surgery. Short-term clinical outcomes were evaluated at the first follow-up after CIESI. We compared the clinical outcomes between the midline and paramedian approaches. Possible prognostic factors for the outcome, such as age, gender, duration of radiculopathy, and cause of radiculopathy were also analyzed.
RESULTS
Cervical interlaminar epidural steroid injections were effective in 124 of 182 patients (68.1%) at the first follow-up. There was no significant difference in the clinical outcomes of CIESI, between midline (69.6%) and paramedian (63.7%) approaches (p = 0.723). Cause of radiculopathy was the only significant factor affecting the efficacy of CIESI. Patients with disc herniation had significantly better results than patients with neural foraminal stenosis (82.9% vs. 56.0%) (p < 0.001).
CONCLUSION
There is no significant difference in treatment efficacy between the midline and paramedian approaches in CIESI, for unilateral radiculopathy. The cause of the radiculopathy is significantly associated with the treatment efficacy; patients with disc herniation experience better pain relief than those with neural foraminal stenosis.

Keyword

Cervical spine; Epidural steroid injection; Radiculopathy; Spinal stenosis; Intervertebral disc

MeSH Terms

Adrenal Cortex Hormones/*therapeutic use
Adult
Aged
Cervical Cord/physiopathology
Cross-Sectional Studies
Female
Humans
Injections, Epidural
Intervertebral Disc Displacement/*drug therapy/radiography
Male
Middle Aged
Radiculopathy/*drug therapy/radiography
Retrospective Studies
Treatment Outcome
Adrenal Cortex Hormones

Figure

• 

  Fig. 1 68-year-old woman with pain in left shoulder and upper arm for duration of 5 months, due to neural foraminal stenosis. Anteroposterior (A) and lateral (B) epidurogram showing midline approach at C5-6 level, and symmetric spreading of contrast media. One month after cervical interlaminar epidural steroid injection, patient's symptom was much improved with mild residual pain in left shoulder.

• 

  Fig. 2 41-year-old man with left shoulder pain for duration of 3 months, due to neural foraminal stenosis. Anteroposterior (A) and lateral (B) epidurogram showing left paramedian approach at C6-7 level, and asymmetric spreading of contrast media. This patient had slightly reduced left shoulder pain and tingling sensation, 1 month after cervical interlaminar epidural steroid injection.

• 

  Fig. 3 60-year-old woman with right shoulder pain for duration of 4 months, due to neural foraminal stenosis. Anteroposterior (A) and lateral (B) epidurogram showing right paramedian approach at C6-7 level, and asymmetric spreading of contrast media. Needle tip is located more ventrally beyond spinolaminar line.

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