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Safety outcomes and improvement in pain scores after radiologist-performed fluoroscopy-guided interlaminar cervical epidural steroid injection

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Abstract

Introduction

Image-guided spine injections are an important tool in the management of patients with a variety of spinal pathologies. Our practice offers radiologist-performed fluoroscopy-guided interlaminar cervical epidural steroid injection (ESI) routinely performed in the outpatient setting. The purpose of this study was to evaluate clinical outcomes and improvement in pain scores after radiologist-performed cervical ESI.

Methods

An institutional database was used to retrospectively identify cervical injections performed between October 2016 and October 2022. All injections were performed at the C7-T1 level utilizing 1.0 mL of 10 mg/mL dexamethasone without epidural anesthetic. The Numerical Rating Scale (NRS) was used to assess pain improvement. Cervical MRI was reviewed to assess pre-injection cervical disease severity. Patient charts were reviewed for any post-injection complications.

Results

A total of 251 cervical injections in 186 patients met our inclusion criteria with mean clinical follow up of 28.5 months (range 0.2 – 73.0 months). No patients experienced any major complications after injection. Post-injection pain scores were available for 218 of 251 injections (86.9%) with mean follow-up of 11.8 days (range 6 – 57 days). There was a significant improvement in pain scores from a mean pre-injection NRS score of 5.2/10 to 3.0/10 (p < .0001). 117 patients (53.7%) reported ≥ 50% improvement after injection. Patients who had prior injection were more likely to report ≥ 50% pain improvement after subsequent injection (p = .012).

Conclusion

Radiologist-performed fluoroscopy-guided interlaminar cervical ESI at the C7-T1 level is a safe and effective tool in the management of patients with cervical pathology.

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Data availability

Due to the nature of research protected by HIPAA standards and IRB restrictions, data is only available to the authors approved on the IRB and thus supporting data is not available.

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All authors did not receive grant support or research funding related to this article and do not have any proprietary interests in the materials described in this article.

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  1. Northwestern Memorial Hospital, Northwestern University, 676 N St Clair St, Suite 800, Chicago, IL, 60611, USA

    Jonathan Guntin, Luis Regalado, Ali Serhal, Imran M. Omar, Wellington K. Hsu & Ankur Garg

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  1. Jonathan Guntin
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  2. Luis Regalado
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  3. Ali Serhal
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Correspondence to Jonathan Guntin.

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Guntin, J., Regalado, L., Serhal, A. et al. Safety outcomes and improvement in pain scores after radiologist-performed fluoroscopy-guided interlaminar cervical epidural steroid injection. Skeletal Radiol 53, 1145–1152 (2024). https://doi.org/10.1007/s00256-023-04548-5

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