Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

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

  • Yoon, Ji Young (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kwon, Jong Won (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yoon, Young Cheol (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Jongseok (School of Business Administration, Hallym University)
  • Received : 2014.09.22
  • Accepted : 2015.02.23
  • Published : 2015.06.01
⟨ Previous Next ⟩

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.

Keywords

References

  1. Benyamin RM, Singh V, Parr AT, Conn A, Diwan S, Abdi S. Systematic review of the effectiveness of cervical epidurals in the management of chronic neck pain. Pain Physician 2009;12:137-157
  2. 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:E405-E434
  3. Hogan QH. Epidural anatomy examined by cryomicrotome section. Influence of age, vertebral level, and disease. Reg Anesth 1996;21:395-406
  4. Lirk P, Kolbitsch C, Putz G, Colvin J, Colvin HP, Lorenz I, et al. Cervical and high thoracic ligamentum flavum frequently fails to fuse in the midline. Anesthesiology 2003;99:1387-1390 https://doi.org/10.1097/00000542-200312000-00023
  5. Abbed KM, Coumans JV. Cervical radiculopathy: pathophysiology, presentation, and clinical evaluation. Neurosurgery 2007;60(1 Supp1 1):S28-S34
  6. Fardon DF, Milette PC; Combined Task Forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology. 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:E93-E113 https://doi.org/10.1097/00007632-200103010-00006
  7. Czervionke LF, Fenton DS. Imaging painful spine disorders, 1st ed. Philadelphia: Saunders, 2011:180-187
  8. Castagnera L, Maurette P, Pointillart V, Vital JM, Erny P, Senegas J. Long-term results of cervical epidural steroid injection with and without morphine in chronic cervical radicular pain. Pain 1994;58:239-243 https://doi.org/10.1016/0304-3959(94)90204-6
  9. Lin EL, Lieu V, Halevi L, Shamie AN, Wang JC. Cervical epidural steroid injections for symptomatic disc herniations. J Spinal Disord Tech 2006;19:183-186 https://doi.org/10.1097/01.bsd.0000190558.13248.e1
  10. 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;36:431-436 https://doi.org/10.1007/s00256-006-0258-2
  11. Strub WM, Brown TA, Ying J, Hoffmann M, Ernst RJ, Bulas RV. Translaminar cervical epidural steroid injection: short-term results and factors influencing outcome. J Vasc Interv Radiol 2007;18:1151-1155 https://doi.org/10.1016/j.jvir.2007.06.011
  12. 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;13:223-236
  13. Manchikanti L, Cash KA, Pampati V, Wargo BW, Malla Y. Management of chronic pain of cervical disc herniation and radiculitis with fluoroscopic cervical interlaminar epidural injections. Int J Med Sci 2012;9:424-434 https://doi.org/10.7150/ijms.4444
  14. Manchikanti L, Malla Y, Cash KA, McManus CD, Pampati V. Fluoroscopic cervical interlaminar epidural injections in managing chronic pain of cervical postsurgery syndrome: preliminary results of a randomized, double-blind, active control trial. Pain Physician 2012;15:13-25
  15. Douglas S, Leo FC. Image-guided spine intervention, 1st ed. Philadelphia: Saunders, 2002:99-126
  16. Huston CW. Cervical epidural steroid injections in the management of cervical radiculitis: interlaminar versus transforaminal. A review. Curr Rev Musculoskelet Med 2009;2:30-42 https://doi.org/10.1007/s12178-008-9041-4
  17. Abbasi A, Malhotra G, Malanga G, Elovic EP, Kahn S. Complications of interlaminar cervical epidural steroid injections: a review of the literature. Spine (Phila Pa 1976) 2007;32:2144-2151 https://doi.org/10.1097/BRS.0b013e318145a360
  18. Rivest C, Katz JN, Ferrante FM, Jamison RN. Effects of epidural steroid injection on pain due to lumbar spinal stenosis or herniated disks: a prospective study. Arthritis Care Res 1998;11:291-297 https://doi.org/10.1002/art.1790110410
  19. Fish DE, Kobayashi HW, Chang TL, Pham Q. MRI prediction of therapeutic response to epidural steroid injection in patients with cervical radiculopathy. Am J Phys Med Rehabil 2009;88:239-246 https://doi.org/10.1097/PHM.0b013e3181951890
  20. Ferrante FM, Wilson SP, Iacobo C, Orav EJ, Rocco AG, Lipson S. Clinical classification as a predictor of therapeutic outcome after cervical epidural steroid injection. Spine (Phila Pa 1976) 1993;18:730-736 https://doi.org/10.1097/00007632-199305000-00010
  21. Lee JW, Hwang SY, Lee GY, Lee E, Kang HS. Fluoroscopic cervical paramidline interlaminar epidural steroid injections for cervical radiculopathy: effectiveness and outcome predictors. Skeletal Radiol 2014;43:933-938 https://doi.org/10.1007/s00256-014-1866-x
  22. Goupille P, Jayson MI, Valat JP, Freemont AJ. The role of inflammation in disk herniation-associated radiculopathy. Semin Arthritis Rheum 1998;28:60-71 https://doi.org/10.1016/S0049-0172(98)80029-2
  23. Flower RJ, Blackwell GJ. Anti-inflammatory steroids induce biosynthesis of a phospholipase A2 inhibitor which prevents prostaglandin generation. Nature 1979;278:456-459 https://doi.org/10.1038/278456a0
  24. Cassuto J, Sinclair R, Bonderovic M. Anti-inflammatory properties of local anesthetics and their present and potential clinical implications. Acta Anaesthesiol Scand 2006;50:265-282 https://doi.org/10.1111/j.1399-6576.2006.00936.x
  25. 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;38:1077-1082 https://doi.org/10.1007/s00256-009-0735-5
  26. Lee SH, Kim KT, Kim DH, Lee BJ, Son ES, Kwack YH. Clinical outcomes of cervical radiculopathy following epidural steroid injection: a prospective study with follow-up for more than 2 years. Spine (Phila Pa 1976) 2012;37:1041-1047 https://doi.org/10.1097/BRS.0b013e31823b4d1f

Cited by

  1. RE: Efficacy of Cervical Interlaminar Epidural Steroid Injections vol.16, pp.5, 2015, https://doi.org/10.3348/kjr.2015.16.5.1171
  2. A Prospective Randomized Comparative Trial of Targeted Steroid Injection Via Epidural Catheter Versus Standard C7-T1 Interlaminar Approach for the Treatment of Unilateral Cervical Radicular Pain : vol.42, pp.1, 2015, https://doi.org/10.1097/aap.0000000000000521
  3. Response to Letter to the Editor by Dr. Landers vol.20, pp.9, 2015, https://doi.org/10.1093/pm/pnz166
  4. Evaluation of Contrast Flow Patterns with Cervical Interlaminar Epidural Injection: Comparison of Midline and Paramedian Approaches vol.57, pp.1, 2015, https://doi.org/10.3390/medicina57010008