What is the efficacy of cervical epidural steroid injections (ESIs)?

Updated: Aug 06, 2018
  • Author: Boqing Chen, MD, PhD; Chief Editor: Stephen Kishner, MD, MHA  more...
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Answer

Answer

No randomized, controlled trials have been performed to date on the efficacy of ESIs for the cervical spine and treatment of upper limb radicular pain. A prospective study by Rowlingson and Kirschenbaum described significant reduction in upper limb pain after cervical ESIs, and other studies (retrospective and prospective) identified radicular pain relief via interlaminar and transforaminal approaches. [18]

Given the similar mechanisms of radicular pain postulated for the lumbar and cervical regions, compelling evidence regarding the efficacy of lumbar ESIs might be applicable to treatment of upper lumbar interlaminar ESIs. A systematic review included fluoroscopically guided 15 randomized trials and 11 nonrandomized studies. The evidence is good for radiculitis secondary to disk herniation with local anesthetics and steroids and fair with local anesthetic only, whereas it is fair for radiculitis secondary to spinal stenosis with local anesthetic and steroids and fair for axial pain without disk herniation with local anesthetic with or without steroids. [9]

In terms of potential efficacy, transforaminal cervical ESIs are preferred over the interlaminar approach by several authors, because the transforaminal cervical injections allow for the delivery of higher concentrations of medications to isolated nerve roots and neuroforamina where stenosis may be present. [19]

A systematic review of cervical interlaminar epidural injections concluded that such injections are effective for relief of cervical radicular pain in the upper limbs; the report strongly recommended the procedure. However, there were no randomized trials identified in this review.


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