TY - JOUR
T1 - 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
AU - McCormick, Zachary L.
AU - Nelson, Ariana
AU - Bhave, Meghan
AU - Zhukalin, Mikhail
AU - Kendall, Mark
AU - McCarthy, Robert J.
AU - Khan, Dost
AU - Nagpal, Geeta
AU - Walega, David R.
N1 - Publisher Copyright:
Copyright © 2016 by American Society of Regional Anesthesia and Pain Medicine.
PY - 2017
Y1 - 2017
N2 - Background and Objectives: 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. Methods: Prospective, randomized, single-blinded trial. Primary outcome: Numerical Rating Scale (NRS) pain at 1 month. Secondary outcomes: 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. Results: 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, orMQSIII scores (P > 0.05). Intergroup differenceswere not observed at any follow-up interval. Conclusions: 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).
AB - Background and Objectives: 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. Methods: Prospective, randomized, single-blinded trial. Primary outcome: Numerical Rating Scale (NRS) pain at 1 month. Secondary outcomes: 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. Results: 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, orMQSIII scores (P > 0.05). Intergroup differenceswere not observed at any follow-up interval. Conclusions: 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).
UR - http://www.scopus.com/inward/record.url?scp=85007429377&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85007429377&partnerID=8YFLogxK
U2 - 10.1097/AAP.0000000000000521
DO - 10.1097/AAP.0000000000000521
M3 - Article
C2 - 27922950
AN - SCOPUS:85007429377
SN - 1098-7339
VL - 42
SP - 82
EP - 89
JO - Regional anesthesia and pain medicine
JF - Regional anesthesia and pain medicine
IS - 1
ER -