Korean J Pain.  2018 Oct;31(4):277-288. 10.3344/kjp.2018.31.4.277.

Comparison of effectiveness for fluoroscopic cervical interlaminar epidural injections with or without steroid in cervical post-surgery syndrome

• Manchikanti L
• Malla Y
• Cash KA
• Pampati V
• Hirsch JA

• KMID: 2421519
• DOI: http://doi.org/10.3344/kjp.2018.31.4.277

Abstract

BACKGROUND
Neck and back pain are leading sources of disability placing substantial burden on health care systems. Surgical interventions in managing chronic neck pain secondary to various disorders continue to increase. Even though surgical interventions are effective, a significant proportion of patients continue to have symptomatology and develop cervical post-surgery syndrome. This study was performed to know the effectiveness of cervical interlaminar epidural injections with or without steroids.
METHODS
The effectiveness of fluoroscopic cervical interlaminar epidural injections in post-surgery syndrome was evaluated in a randomized, active controlled trial. The study population included 116 patients assigned to 2 groups. Group 1 received cervical interlaminar epidural injections with local anesthetic alone and Group 2 received injection with local anesthetic and steroids. The main outcomes were defined as significant improvement (greater than 50%) of pain relief using the numeric rating scale and/or functional status improvement using the Neck Disability Index (NDI).
RESULTS
Both groups had similar results with significant improvement (≥ 50% pain relief and functional status improvement) in 69% of the patients in Group I, whereas, in Group II, 71% of the patients showed significant improvement at the end of 2 years. During a 2-year period, the average number of procedures was 5 to 6, with an average of approximately 12 weeks of significant improvement per procedure.
CONCLUSIONS
Fluoroscopic cervical interlaminar epidural injections administered in cervical post-surgery syndrome using local anesthetic, regardless of the use of steroids, may be effective in approximately 70% of the patients at 2-year follow-up.

Keyword

Back pain; Cervical vertebrae; Chronic pain; Epidural injections; Follow-up studies; Local anesthetics; Neck pain; Postoperative complications; Reoperation; Steroids

MeSH Terms

Anesthetics, Local
Back Pain
Cervical Vertebrae
Chronic Pain
Delivery of Health Care
Female
Follow-Up Studies
Humans
Injections, Epidural*
Neck
Neck Pain
Postoperative Complications
Reoperation
Steroids
Anesthetics, Local
Steroids

Figure

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  Fig. 1 Schematic presentation as per CONSORT of patient flow at 2-years follow-up.

• 

  Fig. 2 Proportion of patients with significant reduction in numeric rating score and neck disability index (≥ 50% reduction from baseline).

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