title: Two-year follow-up results of fluoroscopic cervical epidural injections in chronic axial or discogenic neck pain: a randomized, double-blind, controlled trial.
abstract: METHODS
  A randomized, double-blind, active-controlled trial.
  
  
  OBJECTIVE
  To assess the effectiveness of cervical interlaminar epidural injections of local anesthetic with or without steroids for the management of axial or discogenic pain in patients without disc herniation, radiculitis, or facet joint pain.
  
  
  BACKGROUND
  Cervical discogenic pain without disc herniation is a common cause of suffering and disability in the adult population. Once conservative management has failed and facet joint pain has been excluded, cervical epidural injections may be considered as a management tool. Despite a paucity of evidence, cervical epidural injections are one of the most commonly performed nonsurgical interventions in the management of chronic axial or disc-related neck pain.
  
  
  METHODS
  One hundred and twenty patients without disc herniation or radiculitis and negative for facet joint pain as determined by means of controlled diagnostic medial branch blocks were randomly assigned to one of the 2 treatment groups. Group I patients received cervical interlaminar epidural injections of local anesthetic (lidocaine 0.5%, 5 mL), whereas Group II patients received 0.5% lidocaine, 4 mL, mixed with 1 mL or 6 mg of nonparticulate betamethasone. The primary outcome measure was ≥ 50% improvement in pain and function. Outcome assessments included numeric rating scale (NRS), Neck Disability Index (NDI), opioid intake, employment, and changes in weight.
  
  
  RESULTS
  Significant pain relief and functional improvement (≥ 50%) was present at the end of 2 years in 73% of patients receiving local anesthetic only and 70% receiving local anesthetic with steroids. In the successful group of patients, however, defined as consistent relief with 2 initial injections of at least 3 weeks, significant improvement was illustrated in 78% in the local anesthetic group and 75% in the local anesthetic with steroid group at the end of 2 years. The results reported at the one-year follow-up were sustained at the 2-year follow-up.
  
  
  CONCLUSIONS
  Cervical interlaminar epidural injections with or without steroids may provide significant improvement in pain and functioning in patients with chronic discogenic or axial pain that is function-limiting and not related to facet joint pain.
authors.affiliation: 1. Pain Management Center of Paducah, Paducah, KY, USA; ; 2. Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, USA.
authors.forename: Laxmaiah
authors.initials: L
authors.lastname: Manchikanti
authors.affiliation: 1. Pain Management Center of Paducah, Paducah, KY, USA;
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Cash
authors.affiliation: 1. Pain Management Center of Paducah, Paducah, KY, USA;
authors.forename: Vidyasagar
authors.initials: V
authors.lastname: Pampati
authors.affiliation: 1. Pain Management Center of Paducah, Paducah, KY, USA;
authors.forename: Yogesh
authors.initials: Y
authors.lastname: Malla
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007268:Injections, Epidural; D008012:Lidocaine / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine
keywords: Chronic neck pain; cervical axial pain; cervical disc herniation; cervical discogenic pain; cervical epidural injections; epidural steroids; local anesthetics.