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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
  1. Zachary L. McCormick, MD*,
  2. Ariana Nelson, MD,
  3. Meghan Bhave, MD,
  4. Mikhail Zhukalin, DO§,
  5. Mark Kendall, MD,
  6. Robert J. McCarthy, PharmD,
  7. Dost Khan, MD,
  8. Geeta Nagpal, MD and
  9. David R. Walega, MD
  1. *Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA
  2. Department of Anesthesiology, University of California at Irvine, Irvine, CA
  3. Department of Anesthesiology, Northwestern University, Chicago, IL
  4. §Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL
  1. correspondence: David R. Walega, MD, Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, 251 E Huron St, F5-704 Chicago, IL 60611 (e-mail: d-walega{at}


Background and Objectives No study has compared cervical interlaminar epidural steroid injection (CIESI) with epidural catheter advancement to the side and level of pathology versus standard C7-T1 CIESI. This study investigated whether cervical radicular pain is more effectively treated by CIESI with a targeted epidural catheter versus a standard C7-T1 approach.

Methods Prospective, randomized, single-blinded trial. Primary outcome: Numerical Rating Scale (NRS) pain at 1 month. Secondary outcomes: Oswestry Neck Disability Index (ONDI), Pain Disability Index (PDI), McGill Pain Questionnaire (MPQ), Patient Global Impression of Change (PGIC), daily morphine equivalents (DME), and Medication Quantification Scale (MQS) III scores.

Results Seventy-six participants with a median age of 48 years (IQR, 40–56 years), 59% female, with C4 (n = 2), C5 (n = 27), or C6 (n = 47) radicular pain were enrolled. At 1 month in the catheter and no catheter groups, respectively: 26 (72%, 95% confidence interval [CI], 57%–87%) and 23 (60%; 95% CI, 45%–75%) participants reported 50% or greater NRS reduction; 24 (67%; 95% CI, 52%–84%) and 23 (58%; 95% CI, 42%–73%) participants reported 30% or greater ONDI reduction. There were no group differences in median NRS, ONDI, PDI, MPQ, PGIC, DME, or MQSIII scores (P > 0.05). Intergroup differences were not observed at any follow-up interval.

Conclusions This trial showed no significant difference in clinical outcomes with CIESI using a targeted epidural catheter compared to a standard C7-T1 approach for the treatment of unilateral cervical radicular pain at the C5 or C6 level. Both techniques were associated with clinically meaningful improvement across outcome domains of pain, function, disability, and medication use. These effects persisted to 6-month follow-up.

The study was registered at Clinical (NCT02095197).

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  • The authors report no conflict of interest.

    Funding: This study was funded through the 2013 Midwest Pain Society Addison/Blonsky Research Grant.