title: Do cervical epidural injections provide long-term relief in neck and upper extremity pain? A systematic review.
abstract: BACKGROUND
  The high prevalence of chronic persistent neck pain not only leads to disability but also has a significant economic, societal, and health impact. Among multiple modalities of treatments prescribed in the management of neck and upper extremity pain, surgical, interventional and conservative modalities have been described. Cervical epidural injections are also common modalities of treatments provided in managing neck and upper extremity pain. They are administered by either an interlaminar approach or transforaminal approach.
  
  
  OBJECTIVE
  To determine the long-term efficacy of cervical interlaminar and transforaminal epidural injections in the treatment of cervical disc herniation, spinal stenosis, discogenic pain without facet joint pain, and post surgery syndrome.
  
  
  METHODS
  The literature search was performed from 1966 to October 2014 utilizing data from PubMed, Cochrane Library, US National Guideline Clearinghouse, previous systematic reviews, 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 role of interlaminar epidural injections for managing disc herniation or radiculitis, and 3 assessed these 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 of evidence showed there is Level II evidence for each etiology category. The evidence is based on one relevant, high quality trial supporting the efficacy of cervical interlaminar epidural injections for each particular etiology. There were no randomized trials available assessing the efficacy of cervical transforaminal epidural injections.
  
  
  CONCLUSIONS
  Paucity of available literature, specifically conditions other than disc herniation.
  
  
  CONCLUSIONS
  This systematic review with qualitative best evidence synthesis shows Level II evidence for the efficacy of cervical interlaminar epidural injections with local anesthetic with or without steroids, based on at least one high-quality relevant randomized control trial in each category for disc herniation, discogenic pain without facet joint pain, central spinal stenosis, and post surgery syndrome.
authors: Pain Management Center of Paducah, Paducah, KY, and University of Louisville, Louisville, KY; New York University School of Medicine, New York, NY.
authors: Laxmaiah
authors: L
authors: Manchikanti
authors: Devi E
authors: DE
authors: Nampiaparampil
authors: Kenneth D
authors: KD
authors: Candido
authors: Sanjay
authors: S
authors: Bakshi
authors: Jay S
authors: JS
authors: Grider
authors: Frank J E
authors: FJ
authors: Falco
authors: Nalini
authors: N
authors: Sehgal
authors: Joshua A
authors: JA
authors: Hirsch
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000627:therapeutic use*; D001132:Arm; D002574:Cervical Vertebrae; D059350:Chronic Pain; D006801:Humans; D007268:Injections, Epidural; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000188:drug therapy*; D019547:Neck Pain / Q000188:drug therapy* / Q000209:etiology; D059408:Pain Management; D011843:Radiculopathy / Q000150:complications / Q000188:drug therapy*; D013130:Spinal Stenosis / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000779:Anesthetics, Local