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Abstract
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Background and Aims Cervical radicular pain is a major problem throughout the world. Generally, when conventional treatments such as oral medications and physical therapy have failed, epidural injections are recommended. The controversy regarding the most optimal technique for cervical radicular pain persists due to safety concerns. Recently, there has been a shift from fluoroscopy (FL) to ultrasound (US) to guide interventional procedures.
Methods The trial was registered on ClinicalTrials.gov(NCT:05340179). Patients with unilateral cervical radiuclar pain were randomly divided into two groups (figure 1): FL-guided interlaminar cervical epidural steroid injection (IL-CESI) and the US-guided cervical selective nerve root block (CSNRB) group (figure 2). Severity of pain and disability were assessed with Numeric Rating Scale (NRS-11) and Neck Disability Index at baseline, and 1,3 and 6 months after treatment. Fifty percent or more improvement in NRS-11 was defined as treatment success and an improvement in NRS of at least 2 points was defined as minimally clinically important difference (MCID). Changes in analgesic use was also recorded.
Results Significant improvement in pain and disability scores was observed during 6 months compared to baseline in both groups(P < .001). There was no statistically significant difference between the groups in terms of the proportion of subjects experiencing MCID, achieving a positive treatment outcome, quality of life and analgesic use. The procedure time was longer in the IL-CESI group.
Flowchart of the study
Ultrasound images of the C5 (A), C6 (B) and C7 (C) nerve roots
Conclusions The effectiveness of US-guided CSNRB is comparable to FL-guided IL-CESI for cervical radicular pain. However, US-guided CSNRB offers the advantage of shorter procedure duration and eliminates the need for radiation exposure.