title: Fluoroscopic epidural injections in cervical spinal stenosis: preliminary results of a randomized, double-blind, active control trial.
abstract: BACKGROUND
  Cervical spinal stenosis is a common disease that results in considerable morbidity and disability. There are multiple modalities of treatments, including surgical interventions and multiple interventional techniques including epidural injections. The literature on the effectiveness of cervical epidural steroids is sporadic. Emerging evidence for cervical interlaminar epidurals for various conditions in the cervical spine is positive; however, the effect of fluoroscopic epidural injections in cervical spinal stenosis has not been studied.
  
  
  METHODS
  A randomized, double-blind, active control trial.
  
  
  METHODS
  A private interventional pain management practice, a specialty referral center in the United States.
  
  
  OBJECTIVE
  To evaluate the effectiveness of cervical interlaminar epidural injections with local anesthetic with or without steroids in the management of chronic neck pain with upper extremity pain in patients with cervical central spinal stenosis.
  
  
  METHODS
  Patients with cervical central spinal stenosis were randomly assigned to one of 2 groups: injection of local anesthetic only or local anesthetic mixed with non-particulate betamethasone. Sixty patients were included in this analysis. Randomization was performed by computer-generated random allocation sequence by simple randomization.
  
  
  METHODS
  Multiple outcome measures were utilized including the Numeric Rating Scale (NRS), the Neck Disability Index (NDI), employment status, and opioid intake with assessment at 3, 6, and 12 months post-treatment. Significant pain relief or functional status was defined as a 50% or more reduction of NRS or NDI scores.
  
  
  RESULTS
  Significant pain relief was seen in 73% in Group I and 70% in Group II, in Group II showing both significat pain releif and functional status improvements. Group I's average relief per procedures was 11.3 ± 5.8 weeks; for Group II it was 8.6 ± 3.6 weeks, whereas after initial 2 procedures, average relief was 13.7 ± 8.7 weeks in Group I, and 13.6 ± 4.7 weeks in Group II. In the successful group, the average total relief in a one-year period was 42.2 ± 14.7 weeks in Group I and 34.3 ± 13.4 weeks in Group II, with 76% in Group I and 77% in Group II.
  
  
  CONCLUSIONS
  Study limitations include the lack of a placebo group and that this is a preliminary report of only 60 patients, 30 in each group.
  
  
  CONCLUSIONS
  Patients who have chronic function-limiting pain that is secondary to cervical central stenosis might receive relief with cervical interlaminar epidurals of local anesthetic, whether with or without steroids.
  
  
  BACKGROUND
  NCT01071369.
authors.affiliation: Pain Management Center of Paducah, Paducah, KY, USA. drlm@thepainmd.com
authors.forename: Laxmaiah
authors.initials: L
authors.lastname: Manchikanti
authors.forename: Yogesh
authors.initials: Y
authors.lastname: Malla
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Cash
authors.forename: Carla D
authors.initials: CD
authors.lastname: McManus
authors.forename: Vidyasagar
authors.initials: V
authors.lastname: Pampati
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001623:Betamethasone / Q000627:therapeutic use*; D002574:Cervical Vertebrae; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007268:Injections, Epidural; D008012:Lidocaine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000188:drug therapy* / Q000209:etiology*; D010147:Pain Measurement; D012720:Severity of Illness Index; D013130:Spinal Stenosis / Q000150:complications*; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D001623:Betamethasone; D008012:Lidocaine