Cervical interlaminar epidural steroid injection for neck pain and cervical radiculopathy: effect and prognostic factors.
OBJECTIVE
To verify the usefulness of a fluoroscopy guided cervical interlaminar epidural steroid injection (CIESI) in patients with neck pain and cervical radiculopathy and to evaluate outcome predictors.


METHODS
We retrospectively analyzed 91 patients from July 2004 to June 2005 in whom CIESI was initially performed for neck pain and cervical radiculopathy. Therapeutic effects were evaluated 2 weeks after the administration of CIESI, and CIESI effectiveness was graded using a five-point scale, namely, whether the pain had disappeared, was much improved, slightly improved, the same, or aggravated. We also used a visual analog scale (VAS) for the clinical evaluation. According to documentation and follow-up charts, we categorized treatments as effective or ineffective. Possible outcome predictors, namely, diagnosis (spinal stenosis vs herniated disc), primary symptoms (neck pain vs radiculopathy vs both), age, gender, and duration of pain (more or less than 6 months) were also analyzed. Fisher's exact test, the chi-square test, and multiple logistic regression analysis were used for the statistical analysis.


METHODS
After their medical records had been reviewed, 76 patients were included in this study. Inclusion criteria were: the availability of a cross-sectional image, such as a CT scan or an MR image, and a follow-up record after injection.


CONCLUSIONS
The medical records of 76 patients (male:female = 41 : 35) of mean age 53.1 years (range 32 years to 82 years) were reviewed. Two weeks after injection, 55 patients (72.4%) had experienced effective pain relief. Patients with herniated discs had significantly better results than patients with spinal stenosis (86.1% vs 60.0%) (P < 0.05). Other non-significant predictors of an improved outcome included: a symptom duration of <6 months, a young age, and the presence of cervical radiculopathy. Multiple regression analysis showed that the only factor that was significantly associated with outcome was the cause of the pain, i.e., herniated disc or spinal stenosis. Fluoroscopy guided CIESI is a safe and effective means of treating patients with neck pain and cervical radiculopathy. The most important outcome predictor was cause of pain, and patients with herniated disc experienced better pain relief than those with spinal stenosis.
Kwon
Jong Won
JW
Department of Radiology, Seoul National University Bundang Hospital, 300 Gumidong, Bundang-Gu, Seongnam-si, Gyeonggi-do, South Korea.
Lee
Joon Woo
JW
Kim
Sung Hyun
SH
Choi
Ja-Young
JY
Yeom
Jin-Sup
JS
Kim
Hyun-Jib
HJ
Kwack
Kyu-Sung
KS
Moon
Sung Gyu
SG
Jun
Woo Sun
WS
Kang
Heung Sik
HS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D007268:Injections, Epidural / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000517:prevention & control*; D010147:Pain Measurement / Q000187:drug effects*; D011379:Prognosis; D011843:Radiculopathy / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*
D000893:Anti-Inflammatory Agents; D014222:Triamcinolone Acetonide