Abstract

Summary of Background Data: The high prevalence of chronic persistent neck pain not only leads to disability but also has a significant economic, societal, and health impact. Among multiple modalities of treatments prescribed in the management of neck and upper extremity pain, surgical, interventional and conservative modalities have been described. Cervical epidural injections are also common modalities of treatments provided in managing neck and upper extremity pain. They are administered by either an interlaminar approach or transforaminal approach. Objectives: To determine the long-term efficacy of cervical interlaminar and transforaminal epidural injections in the treatment of cervical disc herniation, spinal stenosis, discogenic pain without facet joint pain, and post-surgery syndrome. Materials and Methods: The literature search was performed from 1966 to April 2014 utilizing data from PubMed, Cochrane Library, US National Guideline Clearinghouse, previous systematic reviews, and crossreferences. The evidence was assessed based on best evidence synthesis with Level I to Level V. Results: There were 7 manuscripts meeting inclusion criteria. Of these, 4 assessed the role of interlaminar epidural injections for managing disc herniation or radiculitis, and 3 assessed these injections for managing central spinal stenosis, discogenic pain without facet joint pain, and post surgery syndrome. There were 4 high quality manuscripts. A qualitative synthesis of evidence showed there is Level II evidence for each etiology category. The evidence is based on one relevant, high quality trial supporting the efficacy of cervical interlaminar epidural injections for each particular etiology. There were no randomized trials available assessing the efficacy of cervical transforaminal epidural injections. Conclusion: This systematic review with qualitative best evidence synthesis shows Level II evidence for the efficacy of cervical interlaminar epidural injections with local anesthetic with or without steroids, based on at least one high-quality relevant randomized control trial in each category for disc herniation, discogenic pain without facet joint pain, central spinal stenosis, and post-surgery syndrome.

Highlights

  • Annual estimates of the prevalence of chronic neck pain in the general population of adults ranges from 12.1% to 71.5% with most estimates showing an annual prevalence between 30% and 50% with or without sprain or injury [1,2,3,4,5,6,7]

  • The evidence is based on one relevant, high quality trial supporting the efficacy of cervical interlaminar epidural injections for each particular etiology

  • There were no randomized trials available assessing the efficacy of cervical transforaminal epidural injections

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Summary

Introduction

Annual estimates of the prevalence of chronic neck pain in the general population of adults ranges from 12.1% to 71.5% with most estimates showing an annual prevalence between 30% and 50% with or without sprain or injury [1,2,3,4,5,6,7]. Côté et al [7] described various grades of chronic neck pain with 5% of patients suffering from Grades III and IV neck pain, both of which are associated with high pain intensity and disability Overall, they showed the prevalence and impact of neck pain on general health involving 15% of patients reporting Grade II-IV neck pain. A report on the state of U.S health from 1990-2010 describing the burden of diseases, injuries, and risk factors, showed low back pain as the number one disease leading to disability in 1990 and again in 2010, whereas neck pain ranked number 4 during the

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