Open AccessDo Cervical Epidural Injections Provide LongTerm Relief in Neck and Upper Extremity Pain? A Systematic Review
Author(s) -
Laxmaiah Manchikanti,
Devi E. Nampiaparampil,
Kenneth D. Candido,
Sanjay Bakshi,
Jay S. Grider,
Frank J E Falco,
Nalini Sehgal,
Joshua A Hirsch
Publication year - 2015
Publication title -
pain physician
Language(s) - English
Resource type - Journals
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj/2015.18.39
Subject(s) - medicine , neck pain , interventional pain management , facet joint , modalities , systematic review , evidence based medicine , guideline , cochrane library , etiology , surgery , radicular pain , randomized controlled trial , physical therapy , medline , chronic pain , alternative medicine , lumbar , social science , pathology , sociology , political science , law
Background: The high prevalence of chronic persistent neck pain not only leads to disabilitybut also has a significant economic, societal, and health impact. Among multiple modalitiesof treatments prescribed in the management of neck and upper extremity pain, surgical,interventional and conservative modalities have been described. Cervical epidural injections arealso common modalities of treatments provided in managing neck and upper extremity pain.They are administered by either an interlaminar approach or transforaminal approach.Objectives: To determine the long-term efficacy of cervical interlaminar and transforaminalepidural injections in the treatment of cervical disc herniation, spinal stenosis, discogenic painwithout facet joint pain, and post surgery syndrome.Methods: The literature search was performed from 1966 to October 2014 utilizing datafrom PubMed, Cochrane Library, US National Guideline Clearinghouse, previous systematicreviews, and cross-references.The evidence was assessed based on best evidence synthesis with Level I to Level V.Results: There were 7 manuscripts meeting inclusion criteria. Of these, 4 assessed the roleof interlaminar epidural injections for managing disc herniation or radiculitis, and 3 assessedthese 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 ofevidence showed there is Level II evidence for each etiology category. The evidence is basedon one relevant, high quality trial supporting the efficacy of cervical interlaminar epiduralinjections for each particular etiology.There were no randomized trials available assessing the efficacy of cervical transforaminalepidural injections.Limitations: Paucity of available literature, specifically conditions other than disc herniation.Conclusion: This systematic review with qualitative best evidence synthesis shows Level IIevidence for the efficacy of cervical interlaminar epidural injections with local anesthetic withor without steroids, based on at least one high-quality relevant randomized control trial in eachcategory for disc herniation, discogenic pain without facet joint pain, central spinal stenosis,and post surgery syndrome.Key words: Chronic neck pain, cervical disc herniation, cervical spinal stenosis, cervical postsurgery syndrome, cervical discogenic pain, cervical epidural injections, interlaminar epiduralinjections, transforaminal epidural injections, steroids, local anesthetic