Cervical Radicular Pain: The Role of Interlaminar and Transforaminal Epidural Injections
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Chronic neck pain and cervical radicular pain are relatively common in the adult population. Treatment for chronic radicular pain recalcitrant to conservative management includes surgical management as well as interventional techniques with epidural injections utilizing either an interlaminar approach or transforaminal approach. Although there have been multiple systematic reviews and randomized clinical trials of cervical interlaminar epidural injections, the literature is sparse in reference to cervical transforaminal epidural injections. Overall, there is good evidence for the effectiveness of cervical interlaminar epidural injections in managing cervical disc herniation and fair evidence in managing central spinal stenosis and postsurgery syndrome. The evidence is poor, however, for cervical transforaminal epidural injections. Complications with cervical interlaminar epidural injections are rare, but more commonly occur with transforaminal epidural injections and can be fatal. Emerging concepts in pain include further randomized trials; proper placebo design; focus on control design (either active control or placebo control); and appropriate methodologic quality assessment and evidence synthesis.
KeywordsCervical radicular pain Cervical interlaminar epidural injections Cervical transforaminal epidural injections Particulate steroids Local anesthetic
The authors wish to thank Pya Seidner, Alvaro F. Gómez, and Laurie Swick for manuscript review; and Tonie M. Hatton and Diane E. Neihoff, transcriptionists, for their assistance in preparation of this manuscript.
Dr. Howard Smith passed away on May 8, 2013, prior to publication of this manuscript. Dr. Smith contributed significantly to this manuscript with protocol and draft preparation. No major changes were made after his death.
Compliance with Ethics Guidelines
Conflict of Interest
Laxmaiah Manchikanti served as a board member for the American Society of Interventional Pain Physician and is employed by the Pain Management Center of Paducah. Frank J. E. Falco served as a board member for the American Society of Interventional Pain Physicians. Dr. Falco is a consultant for St. Jude Medical Inc. and Joimax Inc. Sudhir Diwan declares that he has no conflict of interest. Joshua A. Hirsch declares that he has no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently have been highlighted as: • Of importance •• Of major importance
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