Korean J Pain.  2016 Apr;29(2):96-102. 10.3344/kjp.2016.29.2.96.

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

• Choi JW
• Lim HW
• Lee JY
• Lee WI
• Lee EK
• Chang CH
• Yang JY
• Sim WS

• KMID: 2365351
• DOI: http://doi.org/10.3344/kjp.2016.29.2.96

Abstract

BACKGROUND
It 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.
METHODS
The 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.
RESULTS
Eighty-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).
CONCLUSIONS
We 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.

Keyword

Axial neck pain; Cervical epidural steroid injection; Herniated intervertebral disc; Magnetic resonance imaging; Radicular pain; Spinal stenosis

MeSH Terms

Constriction, Pathologic
Fluoroscopy
Humans
Intervertebral Disc
Magnetic Resonance Imaging*
Medical Records
Neck Pain*
Neck*
Retrospective Studies
Spinal Stenosis
Visual Analog Scale

Figure

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  Fig. 1 All pain pattern groups show significant pain reduction after cervical interlaminar steroid injection, but there was no significant difference between groups. The number in parenthesis means actual number of patients. *P < 0.05.

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  Fig. 2 Comparison of response rate of cervical interlaminar steroid injection according to pain patterns shows no significant difference between groups. The number in parenthesis means the actual number of patients.

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  Fig. 3 According to pain patterns and MRI findings, the response rate of cervical interlaminar steroid injection in the acute radicular pain patients with HIVD was better than the chronic neck pain patients with spinal stenosis. The number in parenthesis means actual number of patients. *P < 0.05.

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