What is the efficacy of cervical epidural blocks (CEBs) for pain management?

Updated: Jun 19, 2018
  • Author: Anthony H Wheeler, MD; Chief Editor: Meda Raghavendra (Raghu), MD  more...
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Answer

Answer

The transforaminal approach with LAs and corticosteroids, when performed correctly is considered by many physicians to be the most specific for determining the diagnosis and prognosis for the treatment of chronic cervical radicular syndromes due to discal compression, vascular insufficiency, inflammation, noxious biochemical factors, failed surgical disorders, and spondylosis with stenosis; this is especially the case when it is preceded by a selective nerve root block.

Some specialists advocate this approach as being more effective; however, most evidence is moderate for short-term and long-term benefit. Although once considered the treatment of choice for selective cervical radicular pain, a high incidence of major complications suggests more caution when considering CEBs. High cervical and brainstem infarction are presumed to be caused by vertebral artery trauma, vasospasm, and in some cases, to thromboembolic occlusion. Trauma and occlusion of the cervical foraminal radicular artery has been frequently reported as a cause of severe complications of late. The latter complication has been noticed and speculated by some to occur more often with the use of particulate corticosteroids. Other complications of this procedure include high cervical spinal anesthesia, seizures, and death. [19, 20, 21]


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