Journal Article

Do cervical epidural injections provide long-term relief in neck and upper extremity pain? A systematic review

Bakshi, Sanjay, Sehgal, Nalini, Nampiaparampil, Devi E, Falco, Frank J E, Hirsch, Joshua A, Manchikanti, Laxmaiah, Candido, Kenneth D, Grider, Jay S

2015

Overview

The high prevalence of chronic persistent neck pain not only leads to disability but also has a significant economic, societal, and health impact. Among multiple modalities of treatments prescribed in the management of neck and upper extremity pain, surgical, interventional and conservative modalities have been described. Cervical epidural injections are also common modalities of treatments provided in managing neck and upper extremity pain. They are administered by either an interlaminar approach or transforaminal approach. To determine the long-term efficacy of cervical interlaminar and transforaminal epidural injections in the treatment of cervical disc herniation, spinal stenosis, discogenic pain without facet joint pain, and post surgery syndrome. The literature search was performed from 1966 to October 2014 utilizing data from PubMed, Cochrane Library, US National Guideline Clearinghouse, previous systematic reviews, and cross-references. The evidence was assessed based on best evidence synthesis with Level I to Level V. There were 7 manuscripts meeting inclusion criteria. Of these, 4 assessed the role of interlaminar epidural injections for managing disc herniation or radiculitis, and 3 assessed these injections for managing central spinal stenosis, discogenic pain without facet joint pain, and post surgery syndrome. There were 4 high quality manuscripts. A qualitative synthesis of evidence showed there is Level II evidence for each etiology category. The evidence is based on one relevant, high quality trial supporting the efficacy of cervical interlaminar epidural injections for each particular etiology. There were no randomized trials available assessing the efficacy of cervical transforaminal epidural injections. Paucity of available literature, specifically conditions other than disc herniation. This systematic review with qualitative best evidence synthesis shows Level II evidence for the efficacy of cervical interlaminar epidural injections with local anesthetic with or without steroids, based on at least one high-quality relevant randomized control trial in each category for disc herniation, discogenic pain without facet joint pain, central spinal stenosis, and post surgery syndrome.

• Publisher: American Society of Interventional Pain Physician
• Subject: Adrenal Cortex Hormones - therapeutic use / Anesthetics, Local - therapeutic use / Arm / Cervical Vertebrae / Chronic Pain / Epidural / Humans / Injections, Epidural / Intervertebral Disc Displacement - complications / Intervertebral Disc Displacement - drug therapy / Local anesthesia / Neck / Neck Pain - drug therapy / Neck Pain - etiology / Pain / Pain Management / Radiculopathy - complications / Radiculopathy - drug therapy / Spinal stenosis / Spinal Stenosis - complications / Spinal Stenosis - drug therapy / Surgery / Systematic review / Treatment Outcome