Background: Chronic neck pain is a common problem in the adult population with a typical 12-
month prevalence of 30% to 50%. Cervical disc herniation and radiculitis is one of the common
conditions described responsible for chronic neck and upper extremity pain.
Cervical epidural injections for managing chronic neck pain with disc herniation are one of the
commonly performed non-surgical interventions in the United States. However, the literature
supporting cervical interlaminar epidural steroids in managing chronic neck pain is scant.
Study Design: A randomized, double-blind, controlled trial.
Setting: A private interventional pain management practice and specialty referral center in the
United States.
Objectives: To evaluate the effectiveness of cervical interlaminar epidural injections of local
anesthetic with or without steroids in providing effective and long-lasting relief in the management
of chronic neck pain and upper extremity pain in patients with disc herniation and radiculitis, and to
evaluate the differences between local anesthetic with or without steroids.
Methods: Patients were randomly assigned to one of 2 groups: Group I patients received cervical
interlaminar epidural injections of local anesthetic (lidocaine 0.5%, 5 mL); Group II patients received
cervical interlaminar epidural injections with 0.5% lidocaine, 4 mL, mixed with 1 mL of nonparticulate betamethasone.
Outcomes Assessment: Multiple outcome measures were utilized. They included the Numeric
Rating Scale (NRS), the Neck Disability Index (NDI), employment status, and opioid intake. Assessments
were done at baseline and 3, 6, and 12 months post-treatment.
Significant pain relief was defined as 50% or more; significant improvement in disability score was
defined as a reduction of 50% or more.
Results: Significant pain relief (≥ 50%) was demonstrated in 77% of patients in both groups. Functional
status improvement was demonstrated by a reduction (> 50%) in the NDI scores in 74% of Group I and
71% of Group II at 12 months. The overall average procedures per year were 3.7 ± 1.1 in Group I and
4.0 ± 0.91 in Group II; the average total relief per year was 39.45 ± 11.59 weeks in Group I and 41.06 ±
11.56 weeks in Group II over the 52 week study period in the patients defined as successful.
The initial therapy was considered to be successful if a patient obtained consistent relief with 2 initial
injections lasting at least 4 weeks. All others were considered failures.
Limitations: The study results are limited by the lack of a placebo group and a preliminary report
of 70 patients, 35 in each group.
Conclusion: Cervical interlaminar epidural injections with local anesthetic with or without steroids
might be effective in 77% of patients with chronic function-limiting neck pain and upper extremity
pain secondary to cervical disc herniation and radiculitis.
Key words: Chronic neck pain, cervical disc herniation, upper extremity pain, cervical epidural
injections, epidural steroids, local anesthetics
Systematic Review of the Effectiveness of
Cervical Epidurals in the Management of
Chronic Neck Pain