scholarly journals A Randomized Comparative Trial of Targeted Steroid Injection via Epidural Catheter vs Standard Transforaminal Epidural Injection for the Treatment of Unilateral Cervical Radicular Pain: Six-Month Results

Pain Medicine ◽  
2020 ◽  
Vol 21 (10) ◽  
pp. 2077-2089 ◽  
Author(s):  
Zachary L McCormick ◽  
Aaron Conger ◽  
Beau P Sperry ◽  
Masaru Teramoto ◽  
Russell Petersen ◽  
...  
Keyword(s):  
Rating Scale ◽  
Steroid Injection ◽  
Neck Disability Index ◽  
Comparative Trial ◽  
Epidural Injection ◽  
Cervical Radiculopathy ◽  
Numeric Rating Scale ◽  
Radicular Pain ◽  
Interlaminar Epidural Steroid Injection ◽  
Neck Disability

Abstract Objectives Compare the effectiveness of catheter-directed cervical interlaminar epidural steroid injection (C-CIESI) with triamcinolone to cervical transforaminal steroid injection (CTFESI) with dexamethasone for the treatment of refractory unilateral radicular pain. Design Prospective, randomized, comparative trial. Methods Primary outcome: proportion of participants with ≥50% numeric rating scale pain score reduction from baseline “dominant pain” (the greater of arm vs neck) at one month postinjection. Secondary outcomes: ≥30% Neck Disability Index (NDI-5) reduction and Patient Global Impression of Change (PGIC) response indicating “much improved” or “very much improved.” Results One hundred twenty participants (55.6% females, 52.3 ± 12.5 years of age, BMI 28.2 ± 6.5 kg/m2), were enrolled. The proportions of participants who experienced ≥50% pain reduction at one, three, and six months were 68.5% (95% CI = 54.9–79.5%), 59.3% (95% CI = 45.7–71.6%), and 60.8% (95% CI = 46.7–73.2%), respectively, in the C-CIESI group compared with 49.1% (95% CI = 36.4–62.0%), 46.4% (95% CI = 33.8–59.6%), and 51.9% (95% CI = 38.4–65.2%), respectively, in the CTFESI group. The between-group difference at one month was significant (P = 0.038). The proportions of participants who experienced a ≥30% NDI-5 score improvement were 64.0% (95% CI = 49.8–76.1%) and 54.9% (95% CI = 41.1–68.0%) in the C-CIESI and CTFESI groups (P = 0.352). Participants reported similar PGIC improvement in both groups: At six months, 53.2% (95% CI 38.9–67.1%) and 54.5% (95% CI = 39.7–68.7%) of the C-CIESI and CTFESI groups reported being “much improved” or “very much improved,” respectively (P = 0.897). Conclusions Both C-CIESI with triamcinolone and CTFESI with dexamethasone are effective in reducing pain and disability associated with refractory unilateral cervical radiculopathy in a substantial proportion of participants for at least six months.

One-year results from a randomized comparative trial of targeted steroid injection via epidural catheter versus standard transforaminal epidural injection for the treatment of unilateral cervical radicular pain

2021 ◽  
pp. rapm-2021-102514
Author(s):  
Aaron Conger ◽  
Richard W Kendall ◽  
Beau P Sperry ◽  
Russell Petersen ◽  
Fabio Salazar ◽  
...  
Keyword(s):  
Rating Scale ◽  
Steroid Injection ◽  
Neck Disability Index ◽  
Comparative Trial ◽  
Epidural Injection ◽  
Pain Reduction ◽  
Radicular Pain ◽  
Patient Global Impression ◽  
Neck Disability ◽  
Global Impression Of Change

ObjectivesThe objective of this study was to evaluate the long-term effectiveness of catheter-directed cervical interlaminar epidural steroid injection with triamcinolone compared with cervical transforaminal steroid injection with dexamethasone for the treatment of refractory unilateral radicular pain.DesignProspective, randomized, comparative trial.MethodsThe primary outcome was the proportion of participants with ≥50% Numeric Rating Scale ‘dominant pain’ (the greater of arm vs neck) reduction from baseline. Secondary outcomes included ≥30% Neck Disability Index reduction and Patient Global Impression of Change response indicating ‘much improved’ or ‘very much improved’.ResultsData from 117 participants (55.6% women; 52.3±12.5 years of age; body mass index, 28.2±6.5 kg/m2) were analyzed. The proportion of participants who experienced ≥50% pain reduction at 1 month, 3 months, and 6 months has been previously reported. At 1 year, 61.2% (95% CI, 46.9% to 73.9%) of the catheter group compared with 51.9% (95% CI, 38.4% to 65.2%) of the transforaminal group reported ≥50% ‘dominant’ pain reduction (p=0.35). The proportion of participants who experienced ≥30% improvement in Neck Disability Index score was 60.4% (95% CI, 45.9% to 73.3%) and 47.1% (95% CI, 33.7% to 60.8%) in the catheter and transforaminal groups (p=0.18). Patient Global Impression of Change improvement was similar in both groups: 60.5% (95% CI, 44.2% to 74.8%) and 57.5% (95% CI, 41.7% to 71.9%) of the catheter and transforaminal groups reported being ‘much improved’ or ‘very much improved’, respectively (p=0.79).ConclusionBoth cervical catheter-directed interlaminar epidural injection and cervical transforaminal steroid injection were effective in reducing pain and disability in the majority of participants with refractory unilateral cervical radiculopathy for up to 1 year.

Does Neck Disability Index Correlate With 12-Month Satisfaction After Elective Surgery for Cervical Radiculopathy? Results From a National Spine Registry

Neurosurgery ◽  
2019 ◽  
Vol 86 (5) ◽  
pp. 736-741 ◽  
Author(s):  
Inamullah Khan ◽  
Ahilan Sivaganesan ◽  
Kristin R Archer ◽  
Mohamad Bydon ◽  
Matthew J McGirt ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Rating Scale ◽  
Elective Surgery ◽  
Multivariable Analysis ◽  
Neck Disability Index ◽  
Cervical Radiculopathy ◽  
Numeric Rating Scale ◽  
Arm Pain ◽  
Patient Reported ◽  
Neck Disability

Abstract BACKGROUND Modern healthcare reforms focus on identifying and measuring the quality and value of care. Patient satisfaction is particularly important in the management of degenerative cervical radiculopathy (DCR) since it leads to significant neck pain and disability primarily affecting the patients’ quality of life. OBJECTIVE To determine the association of baseline and 12-mo Neck Disability Index (NDI) with patient satisfaction after elective surgery for DCR. METHODS The Quality Outcomes Database cervical module was queried for patients who underwent elective surgery for DCR. A multivariable proportional odds regression model was fitted with 12-mo satisfaction as the outcome. The covariates for this model included patients’ demographics, surgical characteristics, and baseline and 12-mo patient reported outcomes (PROs). Wald-statistics were calculated to determine the relative importance of each independent variable for 12-mo patient satisfaction. RESULTS The analysis included 2206 patients who underwent elective surgery for DCR. In multivariable analysis, after adjusting for baseline and surgery specific variables, the 12-mo NDI score showed the highest association with 12-mo satisfaction (Waldχ2-df = 99.17, 58.1% of total χ2). The level of satisfaction increases with decrease in 12-mo NDI score regardless of the baseline NDI score. CONCLUSION Our study identifies 12-mo NDI score as a very influential driver of 12-mo patient satisfaction after surgery for DCR. In addition, there are lesser contributions from other 12-mo PROs, baseline Numeric Rating Scale for arm pain and American Society of Anesthesiologists (ASA) grade. The baseline level of disability was found to be irrelevant to patients. They seemed to only value their current level of disability, compared to baseline, in rating satisfaction with surgical outcome.

Effectiveness of Neural Mobilization on Pain, Range of motion, and Disability in Cervical Radiculopathy: a Randomized Controlled Trial

2021 ◽  
Author(s):  
Shazia Rafiq ◽  
Hamayun Zafar ◽  
Prof. Dr. Syed Amir Gillani ◽  
Muhammad Sharif Waqas ◽  
Amna Zia ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Pain Intensity ◽  
Range Of Motion ◽  
Conventional Treatment ◽  
Rating Scale ◽  
Controlled Trial ◽  
Neck Disability Index ◽  
Sampling Technique ◽  
Cervical Radiculopathy ◽  
Neck Disability

Abstract Background: Cervical Radiculopathy (CR) is a disorder of the spinal nerve roots that is largely caused by space occupying lesion which can lead to nerve root inflammation and patient usually presents with radiating pain in his/her upper extremity known as cervical radiculopathy. The objective of the study was to compare the effectiveness of neural mobilization technique with conservative treatment on pain intensity, range of motion and disability.Methods: It was a double blinded randomized clinical trial; data was collected from Mayo Hospital, Lahore through convenience sampling technique. After taking consent from the patients, the patients fulfilling the inclusion and exclusion criteria were selected and randomized blindly and assigned through computer generated random number into two groups i.e. group 1 (neural mobilization), group 2 (conventional treatment). Pain intensity was measured on Numeric pain rating scale, range of motion measured with inclinometer and functional status with neck disability index (NDI). Data was analyzed using SPSS and difference in improvement before, after 02 and 04 weeks was noted and compared. Results: There was significant improvement in pain relief, neck disability and cervical ranges after the treatment in both groups compared to the pre-treatment status (p < 0.00) and when neural mobilization was compared , it was more effective technique than conventional treatment in reducing pain and neck disability (p < 0.00). But there was not statistical difference in mean score of cervical range of motion (p>0.05)Conclusions: The present study concluded that both neural mobilization and conservative treatment were effective as an exercise program for patient with cervical radiculopathy, however neural mobilization was more effective in reducing pain and neck disability in cervical radiculopathy.Trial registration: RCT20190325043109N1

Neck Pain and Disability: Are They Related to Dysfunctional Breathing and Stress?

2021 ◽  
Author(s):  
Sarah Stephen ◽  
Corlia Brandt ◽  
Benita Olivier
Keyword(s):  
Neck Pain ◽  
Rating Scale ◽  
Hold Time ◽  
Neck Disability Index ◽  
Numeric Rating Scale ◽  
Cross Sectional Study ◽  
Breath Hold ◽  
Cross Sectional ◽  
Dysfunctional Breathing ◽  
Neck Disability

Purpose: People with neck pain are likely to have negative respiratory findings. The purpose of this study was to investigate the relationship between neck pain and dysfunctional breathing and to examine their relationship to stress. Method: This cross-sectional study included 49 participants with neck pain and 49 age- and sex-matched controls. We measured neck pain using the numeric rating scale (NRS); neck disability using the Neck Disability Index (NDI); dysfunctional breathing using the Nijmegen Questionnaire (NQ), Self-Evaluation of Breathing Questionnaire (SEBQ), breath hold time, and respiratory rate (RR); and stress using the Perceived Stress Scale (PSS). Results:Participants with neck pain scored higher on the NQ ( p < 0.001) and the SEBQ ( p < 0.001) than controls. NQ and SEBQ scores correlated moderately with NDI scores ( r > 0.50; 95% CI: 0.25, 0.68 and 0.33, 0.73, respectively) and PSS scores ( r > 0.50; 95% CI: 0.29, 0.78 and 0.31, 0.73, respectively). SEBQ scores showed a fair correlation with NRS scores and RR a fair correlation with NDI scores. Conclusions: Participants with neck pain had more dysfunctional breathing symptoms than participants without neck pain, and dysfunctional breathing was correlated with increased neck disability and increased stress. The NQ and SEBQ can be useful in assessing dysfunctional breathing in patients with neck pain.

Comparison between ultrasound-guided monopolar and bipolar pulsed radiofrequency treatment for refractory chronic cervical radicular pain: A randomized trial

2021 ◽  
pp. 1-6
Author(s):  
Sang Hoon Lee ◽  
Hyun Hee Choi ◽  
Min Cheol Chang
Keyword(s):  
Pain Relief ◽  
Rating Scale ◽  
Cervical Radiculopathy ◽  
Numeric Rating Scale ◽  
Radicular Pain ◽  
Pulsed Radiofrequency ◽  
Epidural Steroid Injections ◽  
Pulsed Radiofrequency Treatment ◽  
Epidural Steroid ◽  
Positive Effect

BACKGROUND: Many patients complain of chronic cervical radicular pain, and pulsed radiofrequency (PRF) is known to have a positive effect for alleviating neuropathic pain. OBJECTIVES: In the present study, we used ultrasound (US) guidance and compared the effects of monopolar PRF with those of bipolar PRF in patients with chronic cervical radicular pain refractory to repeated transforaminal epidural steroid injections. METHODS: Sixty-six patients with chronic cervical radicular pain were included in this study. Patients were randomly assigned to one of the two groups: monopolar or bipolar PRF group (n= 33 per group). Pain intensity was evaluated using a numeric rating scale (NRS) at pretreatment, and at 1 and 3 months after the treatment. Target stimulation site was the extraforaminal nerve root. RESULTS: Compared to the pretreatment NRS scores, patients in both groups showed a significant decrease in NRS scores at 1 and 3 months after the treatment. Reductions in the NRS scores over time were significantly larger in the bipolar PRF group. Three months after the treatment, 18 patients (54.5%) in the monopolar PRF group and 27 (81.8%) in the bipolar PRF group reported successful pain relief (pain relief of ⩾50%). CONCLUSIONS: US-guided PRF can be an effective interventional technique for the management of chronic refractory cervical radiculopathy. Moreover, bipolar PRF has better treatment outcome than monopolar PRF.

scholarly journals Patient-Reported Outcomes and Patient-Reported Satisfaction After Surgical Treatment for Cervical Radiculopathy

2018 ◽  
Vol 8 (7) ◽  
pp. 703-708 ◽  
Author(s):  
Andreas Kiilerich Andresen ◽  
Rune Tendal Paulsen ◽  
Frederik Busch ◽  
Alexander Isenberg-Jørgensen ◽  
Leah Y. Carreon ◽  
...  
Keyword(s):  
Short Form ◽  
Neck Disability Index ◽  
Visual Analogue Score ◽  
Cervical Radiculopathy ◽  
Strongly Correlated ◽  
Anterior Cervical Decompression ◽  
Sf 36 ◽  
Patient Reported ◽  
Neck Disability ◽  
Cervical Degenerative Disease

Study Design: Retrospective cohort study. Objectives: It is estimated that 10 000 patients seek medical care due to cervical radiculopathy every year in Denmark. Although the natural course is usually favorable, around 20% undergo surgery for cervical degenerative disease every year in Denmark. We aim to evaluate the patient-reported results and satisfaction of anterior cervical decompression and fusion over a 5-year period from a single Danish center for spine surgery. Methods: This study is a retrospective study based on prospectively collected data from 318 consecutive patients treated with anterior cervical decompression and fusion over 1 to 3 levels. Data in the DaneSpine registry was collected pre- and postoperatively, and at 1 year after surgery. The outcome measures were Neck Disability Index (NDI), European Quality of Life 5D (EQ-5D), visual analogue score (VAS), and Short Form-36 Physical Component Summary (SF-36 PCS). Results: Of 318 cases enrolled, 272 (85.5%) had follow-up data available at a minimum 1-year postoperatively. The mean preoperative NDI was 40.0 and improved to 22.7. Mean EQ-5D was 0.50 and improved to 0.70, and mean VAS arm was 60.4 improved to 26.4. All improvements were statistically significant. A total of 74.3% were back to work 1 year after surgery. Achieving minimal clinically important difference (MCID) in VAS neck and SF-36 PCS was strongly correlated to patient satisfaction. Conclusion: Patients who undergo anterior cervical discectomy and fusion can expect improvement in their pain and disability, with 74.3% of patients reporting a positive change in health status after surgery.

scholarly journals Clinical Efficacy of Scalene Injection for Thoracic Outlet Syndrome

2021 ◽  
Author(s):  
Samuel Baek ◽  
Seok Kim ◽  
Myung Ho Shin ◽  
Tae Min Kim ◽  
Seoung-Joon Lee ◽  
...  
Keyword(s):  
Side Effects ◽  
Clinical Efficacy ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Neck Disability Index ◽  
Vital Signs ◽  
Treatment Technique ◽  
The Novel ◽  
Numerical Rating ◽  
Neck Disability

Purpose: We introduce the novel treatment technique, scalene injection, and study its clinical efficacy for diagnosis, treatment, and pain control for patients with thoracic outlet syndrome.Methods: Between November 2001 and October 2018, 266 patients were studied retrospectively. To evaluate the efficacy and sustainability, we checked the numerical rating scale (NRS) for pain relief and neck disability index (NDI) for functional improvements, prior to and 1, 12 weeks after the injection. The safety was evaluated by examining side effects for at least 24 hours from the point of injection.Results: NRS was improved from 7.12 to 3.11 at 1 week, and to 3.05 at 12 weeks (p<0.05). NDI was improved from 15.87 to 6.15 at 1 week, and to 6.19 at 12 weeks (p<0.05). There were two cases of convulsion immediately after the injection and were treated with prompt oxygen supply and sedatives. Transient side effects included two cases of dyspnea and one case of nausea and were resolved within 1 hour after. All five cases showed symptoms of side effects on the day of injection and were resolved within a day. A total of 242 patients (91.0%) experienced immediate declines in NRS and 161 patients experienced persistent declines for more than 12 weeks. However, 24 patients (9.0%) showed no improvement and 20 patients (7.5%) experienced increases in NRS.Conclusion: Scalene injection is also effective as a therapeutic method. However, this study suggests that it must be done with monitoring of vital signs in an operating room for any possible complications and side effects.

scholarly journals Effectiveness of Progressive Resisted Exercise along with Conventional Exercise and Conventional Exercise Program alone in Subjects with Text Neck Syndrome

2021 ◽  
pp. 536-542
Author(s):  
Divya Jain ◽  
Swapna Jawade ◽  
Neha Chitale
Keyword(s):  
Neck Pain ◽  
Pain Intensity ◽  
Conventional Therapy ◽  
Rating Scale ◽  
Neck Disability Index ◽  
Exercise Program ◽  
Pain Rating ◽  
Numerical Pain Rating Scale ◽  
Neck Disability ◽  
Pain Rating Scale

Background: "Text neck" is a term coined to describe the posture created by leaning forward for lengthy periods of time, such as when reading and texting on a cellphone which has been linked to stress injuries. Neck pain, upper back discomfort, shoulder pain, frequent headaches, and greater curvature of the spine are all dangerous indications of text neck. According to a survey, 35% of smartphone users suffer from text neck syndrome. People between the ages of 15 and 18 are more likely to have neck pain. This protocol has been created that describes the design of comparative study to evaluate effectiveness of progressive resisted exercise along with conventional exercise and conventional exercise program alone in text neck syndrome. Methods: The participants (n=80) will be recruited in the study suffering from text neck syndrome and meeting the inclusion criteria. Two groups will be formed such that patients in group A will be treated with conventional therapy and group B will be treated with progressive resisted exercise (PRE) along with conventional therapy. The protocol will cover 4 weeks of treatment. In the rehabilitation period, we will evaluate the pain intensity, strength of neck muscles and functional activity. Our outcome measures will be- Numerical pain rating scale (NPRS) and Neck disability index (NDI). Discussion: Efficacy of the intervention will be evaluated by analyzing the pain intensity by using Numerical pain rating scale (NPRS) and level of functional disability by using Neck disability index (NDI). The result of the study will significantly provide affirmation on either using combination therapy of PRE with conventional exercise or conventional exercise alone.

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