title: A Prospective Randomized Comparative Trial of Targeted Steroid Injection Via Epidural Catheter Versus Standard C7-T1 Interlaminar Approach for the Treatment of Unilateral Cervical Radicular Pain.
abstract: No study has compared cervical interlaminar epidural steroid injection (CIESI) with epidural catheter advancement to the side and level of pathology versus standard C7-T1 CIESI. This study investigated whether cervical radicular pain is more effectively treated by CIESI with a targeted epidural catheter versus a standard C7-T1 approach.
  
  
  
  Prospective, randomized, single-blinded trial.
  
  
  
  Numerical Rating Scale (NRS) pain at 1 month.
  
  
  
  Oswestry Neck Disability Index (ONDI), Pain Disability Index (PDI), McGill Pain Questionnaire (MPQ), Patient Global Impression of Change (PGIC), daily morphine equivalents (DME), and Medication Quantification Scale (MQS) III scores.
  
  
  
  Seventy-six participants with a median age of 48 years (IQR, 40-56 years), 59% female, with C4 (n = 2), C5 (n = 27), or C6 (n = 47) radicular pain were enrolled. At 1 month in the catheter and no catheter groups, respectively: 26 (72%, 95% confidence interval [CI], 57%-87%) and 23 (60%; 95% CI, 45%-75%) participants reported 50% or greater NRS reduction; 24 (67%; 95% CI, 52%-84%) and 23 (58%; 95% CI, 42%-73%) participants reported 30% or greater ONDI reduction. There were no group differences in median NRS, ONDI, PDI, MPQ, PGIC, DME, or MQSIII scores (P > 0.05). Intergroup differences were not observed at any follow-up interval.
  
  
  
  This trial showed no significant difference in clinical outcomes with CIESI using a targeted epidural catheter compared to a standard C7-T1 approach for the treatment of unilateral cervical radicular pain at the C5 or C6 level. Both techniques were associated with clinically meaningful improvement across outcome domains of pain, function, disability, and medication use. These effects persisted to 6-month follow-up.The study was registered at Clinical Trials.gov (NCT02095197).
authors.affiliation: From the *Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA; †Department of Anesthesiology, University of California at Irvine, Irvine, CA; ‡Department of Anesthesiology, Northwestern University, Chicago, IL and §Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL.
authors.forename: Zachary L
authors.initials: ZL
authors.lastname: McCormick
authors.forename: Ariana
authors.initials: A
authors.lastname: Nelson
authors.forename: Meghan
authors.initials: M
authors.lastname: Bhave
authors.forename: Mikhail
authors.initials: M
authors.lastname: Zhukalin
authors.forename: Mark
authors.initials: M
authors.lastname: Kendall
authors.forename: Robert J
authors.initials: RJ
authors.lastname: McCarthy
authors.forename: Dost
authors.initials: D
authors.lastname: Khan
authors.forename: Geeta
authors.initials: G
authors.lastname: Nagpal
authors.forename: David R
authors.initials: DR
authors.lastname: Walega
mesh_terms: D000328:Adult; D002408:Catheters, Indwelling; D002574:Cervical Vertebrae; D005260:Female; D006801:Humans; D007268:Injections, Epidural; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000175:diagnosis / Q000188:drug therapy*; D011446:Prospective Studies; D011843:Radiculopathy / Q000175:diagnosis / Q000188:drug therapy*; D016037:Single-Blind Method; D013256:Steroids / Q000008:administration & dosage*; D013904:Thoracic Vertebrae
chemical_list: D013256:Steroids