Cervical Epidural Steroid Drug Injection: Parasagittal approach as an alternative to the midline approach in patients with unilateral cervical radicular pain; a comparative randomized clinical trial

Background and objectives: Cervical epidural steroid injection (CESI) is one of the most commonly performed interventions in management of upper extremity radicular pain. This study was aimed to make a comparison between parasagittal interlaminar CESI (PSIL-CESI) and the classic midline interlaminar CESI (MIL-CESI) in terms of alleviation of pain and reduction of functional disability in patients with unilateral upper extremity radicular pain. Materials and methods: In a parallel randomized double-blind clinical trial with ethic code IR.SBMU.RETECH.REC.1397.163, 26 patients were allocated into two groups of 13 patients undergoing either PSIL-CESI or MIL-CESI. After confirmation of radiocontrast spread in the epidural space by fluoroscopic guidance, dexamethasone 8 mg and bupivacaine 0.125% in a volume of 5 ml were delivered to the epidural space. Evaluation of functional state and pain intensity before and 1 month after the procedure was accomplished using the neck disability index (NDI) and the numeric rating scale (NRS) respectively. Findings: Improvements in the NDI and the NRS were observed in both groups; meanwhile, improvements were more pronounced in the PSIL-CESI group as compared to the MIL-CESI group (P<0.001). With the PSIL approach the ventral spread of radiocontrast was significantly higher (38%) than with the MIL approach (0.7%) (P<0.001). All patients in PSIL group showed radiocontrast spread ipsilateral to the painful side and all patients in the MIL group showed a midline distribution of radiocontrast. Conclusion: PSIL-CESI provides superior pain relief and improvement of functional disability in patients with unilateral upper extremity radicular pain in comparison to the classic MIL-CESI.

Keywords:

Cervical Epidural , Midline , Parasagittal , Ventral Distribution , Radicular Pain , Disc Herniation