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

Zachary L. McCormick, Ariana Nelson, Meghan Bhave, Mikhail Zhukalin, Mark C Kendall, Robert J McCarthy, Dost Mohammad Khan, Geeta Nagpal, David R Walega*

*Corresponding author for this work

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

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).

Original languageEnglish (US)
Pages (from-to)82-89
Number of pages8
JournalRegional anesthesia and pain medicine
Volume42
Issue number1
DOIs
StatePublished - Jan 1 2017

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Epidural Injections
Neck Pain
Catheters
Steroids
Pain
Confidence Intervals
Neck
Pain Measurement
Morphine
Therapeutics
Clinical Trials
Pathology

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

@article{59670c76c9b546d7ba24f2814c25c3a2,
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 = "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).",
author = "McCormick, {Zachary L.} and Ariana Nelson and Meghan Bhave and Mikhail Zhukalin and Kendall, {Mark C} and McCarthy, {Robert J} and Khan, {Dost Mohammad} and Geeta Nagpal and Walega, {David R}",
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language = "English (US)",
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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. / McCormick, Zachary L.; Nelson, Ariana; Bhave, Meghan; Zhukalin, Mikhail; Kendall, Mark C; McCarthy, Robert J; Khan, Dost Mohammad; Nagpal, Geeta; Walega, David R.

In: Regional anesthesia and pain medicine, Vol. 42, No. 1, 01.01.2017, p. 82-89.

Research output: Contribution to journalArticle

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 C

AU - McCarthy, Robert J

AU - Khan, Dost Mohammad

AU - Nagpal, Geeta

AU - Walega, David R

PY - 2017/1/1

Y1 - 2017/1/1

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).

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