Ultrasound-Guided Cervical Retro-Laminar Block for Cervical Radicular Pain

A Comparative Analysis

Morsi Khashan, MD; Jesus de Santiago, MD; Itai Pardo, MD; Gilad Regev, MD; Dror Ophir, MD; Khalil Salame, MD; Zvi Lidar, MD; Silviu Brill, MD; Uri Hochberg, MD

Disclosures

Spine. 2022;47(19):1351-1356. 

In This Article

Abstract and Introduction

Abstract

Study Design and Objective: Cervical radiculopathy is a common clinical condition, often treated with cervical epidural steroid injections (ESI). Retro-laminar cervical blocks (RLCB) may be considered safer than ESI as they do not require entering the neuroaxis.In this study, we evaluated the outcome of RLCB in patients with cervical radiculopathy who had failed conservative treatment and were candidates for cervical spine decompression surgery.

Background Data: Recently, we reported a clinical pilot study investigating the treatment of cervical radiculopathy with an ultrasound-guided RLCB.

Materials and Methods: A retrospective, comparative analysis of prospectively collected data was carried out on the medical records of all patients who underwent RLCB for cervical radicular pain, between August 2019 and March 2021.

Results: Ninety-eight patients were included in the analysis, with a total of 139 procedures.A significant pain reduction was achieved for most patients immediately after the procedure and at the final follow up (16.9±13.4 wk). The mean numerical rating scale for the whole cohort changed from 7.21±2.51 to 4.04±2.51 (P-value <0.01) at the time of discharge, with similar patterns at the subgroup level. A functional evaluation was carried out by a questionnaire (Neck Disability Index—NDI). Overall, 83% of patients had a lower postprocedural NDI than preprocedural NDI. For 80% of patients, the improvement of NDI surpassed the minimal clinically important change at the final assessment. Most patients (61%) were discharged after just one RLCB. Eight patients (8%) eventually underwent surgery. The most frequent complaint was injection site soreness; however, there were no major adverse events reported.

Conclusions: These findings suggest that RLCB can be performed as an alternative to cervical ESI and decompressive surgery in patients with cervical radicular pain that's refractory to noninvasive treatment. More comparative and prospective studies are needed to confirm our results.

Introduction

Cervical radiculopathy is a common clinical condition with an incidence of 1.79 per 1000 person-year.[1] Most frequently, the nerve root is compressed by a protruding disk or by an osteophyte, with the C6 and C7 roots being the most affected.[2] Conservative treatment of cervical radiculopathy consists of various modalities such as physical therapy, traction, medication, and cervical epidural steroid injections (ESI).

Cervical ESI are used mainly in patients who have inadequate improvement with less invasive conservative therapies.[3] Severe adverse effects and complications, including mortality and catastrophic neurological injury, have been reported after cervical ESI, mostly related to the transforaminal approach with the use of particulate steroids.[4,5] As a result, the use of cervical ESI is avoided in many health centers and institutions worldwide. Ultrasound-guided paraspinal inter-fascial plane blocks (UGPIPB) have been proposed to provide analgesia for patients undergoing shoulder and cervical spine surgeries.[6–9]

The retro-laminar cervical block (RLCB) is a specific type of cervical UGPIPB. We recently reported a clinical pilot study investigating the treatment of cervical radiculopathy with an UGPIPB in the space posterior to the cervical lamina (retro-laminar), in addition to a cadaver study aimed at evaluating the spread of injectate when utilizing this UGPIPB. The report suggested, for the first time, that an ultrasound-guided cervical retrolaminar injection could potentially serve as a modality to manage cervical radicular pain.[10]

In the current study, we retrospectively evaluated the outcome of RLCB in patients with cervical radicular pain who had failed conservative treatment and were candidates for cervical spine decompression surgery. To the best of our knowledge, this is the first series of its kind.

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