J Korean Soc Spine Surg.  2020 Dec;27(4):115-124. 10.4184/jkss.2020.27.4.115.

Clinical Outcomes of Cervical Transforaminal Epidural Block Using Local Anesthetics with or without a Steroid for Cervical Spondylotic Radiculopathy

• Park EJ
• Kim SM
• Chung S
• Min WK

• KMID: 2511756
• DOI: http://doi.org/10.4184/jkss.2020.27.4.115

Abstract

Objectives
To evaluate and compare the clinical outcomes of cervical transforaminal epidural block (CTEB) using local anesthetics with or without a steroid for cervical spondylotic radiculopathy (CSR). Summary of Literature Review: The typical mixture for a CTEB is a combination of local anesthetics with a non-particulate steroid. However, there are potential complications related to steroid injections such as steroid-induced osteoporosis, hypothalamus-pituitaryadrenal gland axis suppression, and hyperglycemia.
Materials and Methods
From January 2018 to October 2019, 35 patients who underwent CTEB for CSR were enrolled in this study. Cases with arm pain over 4 on a visual analog scale (VAS) were included. In the first 19 cases, a combination of 1 mL of 1% lidocaine and 1 mL of dexamethasone was used (group A), and in the next 16 cases, 1 mL of 1% lidocaine mixed with 1 mL of normal saline was used (group B). Arm pain VAS and the Neck Disability Index (NDI) were obtained perioperatively.
Results
Baseline characteristics were not significantly different between the two groups. In both groups, the arm pain VAS significantly decreased at 30 minutes, 2 weeks, and 6 weeks post-injection compared to pre-injection values. However, the arm pain aggravated 12 weeks post-injection. The NDI of both groups significantly improved 6 weeks post-injection compared to pre-injection. The clinical outcomes of arm pain VAS and NDI at 30 minutes, 2 weeks, and 6 weeks post-injection, as well as the amounts of change, were not significantly different between both groups.
Conclusions
CTEB for CSR without a steroid improved symptoms by 6 weeks. The degree of improvement was similar to when CTEB was performed with a steroid in terms of VAS and NDI.

Keyword

Nerve block; Cervical vertebrae; Dexamethasone; Lidocaine