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One-year results from a randomized comparative trial of targeted steroid injection via epidural catheter versus standard transforaminal epidural injection for the treatment of unilateral cervical radicular pain
  1. Aaron Conger1,
  2. Richard W Kendall1,
  3. Beau P Sperry2,
  4. Russell Petersen3,
  5. Fabio Salazar1,
  6. Shellie Cunningham1,
  7. A Michael Henrie1,
  8. Erica F Bisson4,
  9. Masaru Teramoto1 and
  10. Zachary L McCormick1
  1. 1Division of Physical Medicine and Rehabilitation, Department of Orthopedic Surgery, University of Utah, Salt Lake City, Utah, USA
  2. 2Los Angeles David Geffen School of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
  3. 3Alabama College of Osteopathic Medicine, Dothan, Alabama, USA
  4. 4Department of Neurosurgery, The University of Utah School of Medicine, Salt Lake City, Utah, USA
  1. Correspondence to Dr Aaron Conger, Physical Medicine and Rehab, University of Utah Health, Salt Lake City, Utah, USA; aaron.conger{at}hsc.utah.edu

Abstract

Objectives The objective of this study was to evaluate the long-term effectiveness of catheter-directed cervical interlaminar epidural steroid injection with triamcinolone compared with cervical transforaminal steroid injection with dexamethasone for the treatment of refractory unilateral radicular pain.

Design Prospective, randomized, comparative trial.

Methods The primary outcome was the proportion of participants with ≥50% Numeric Rating Scale ‘dominant pain’ (the greater of arm vs neck) reduction from baseline. Secondary outcomes included ≥30% Neck Disability Index reduction and Patient Global Impression of Change response indicating ‘much improved’ or ‘very much improved’.

Results Data from 117 participants (55.6% women; 52.3±12.5 years of age; body mass index, 28.2±6.5 kg/m2) were analyzed. The proportion of participants who experienced ≥50% pain reduction at 1 month, 3 months, and 6 months has been previously reported. At 1 year, 61.2% (95% CI, 46.9% to 73.9%) of the catheter group compared with 51.9% (95% CI, 38.4% to 65.2%) of the transforaminal group reported ≥50% ‘dominant’ pain reduction (p=0.35). The proportion of participants who experienced ≥30% improvement in Neck Disability Index score was 60.4% (95% CI, 45.9% to 73.3%) and 47.1% (95% CI, 33.7% to 60.8%) in the catheter and transforaminal groups (p=0.18). Patient Global Impression of Change improvement was similar in both groups: 60.5% (95% CI, 44.2% to 74.8%) and 57.5% (95% CI, 41.7% to 71.9%) of the catheter and transforaminal groups reported being ‘much improved’ or ‘very much improved’, respectively (p=0.79).

Conclusion Both cervical catheter-directed interlaminar epidural injection and cervical transforaminal steroid injection were effective in reducing pain and disability in the majority of participants with refractory unilateral cervical radiculopathy for up to 1 year.

  • neck
  • radiculopathy
  • fluoroscopic
  • pain
  • treatment

https://doi.org/10.1136/rapm-2021-102514

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    Footnotes

    • Correction notice This article has been corrected since it published Online First. Table 1 and the methods section have been updated.

    • Contributors RK, ZMcC, EFB, and AM were involved in conception and design of the study. AC, BPS, RP, FWS, SC, RK, ZMcC, EFB, and AMH were involved in acquisition of data. AC, ZMcC, and MT were involved in analysis of data. AC, ZMcC, RK, and MT were involved in interpretation of data. AC, BPS, and ZMcC were involved in drafting of the manuscript. AC, BPS, RP, FW, SC, RK, ZMcC, EFB, AMH, and MT were involved in critical revision of the work for important intellectual content. AC, BPS, RP, FWS, SC, RK, ZMcC, EFB, AMH, and MT provided approval of the version of the manuscript to be published. AC, BPS, RP, FWS, SC, RK, ZMcC, EFB, AMH, and MT provided agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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    • Funding This was an investigator-initiated study supported by a grant from Epimed International. All funds were paid directly to the study investigators’ institution. No investigator salary support was provided by this grant.

    • Competing interests ZMcC serves on the Board of Directors of the Spine Intervention Society. There are no other potential conflicts of interest to disclose on the part of any of the other authors.

    • Provenance and peer review Not commissioned; externally peer reviewed.