Efficacy of combined dorsal root ganglion pulsed radiofrequency and cervical epidural steroid injection on radicular neck pain

2022 ◽  
Author(s):  
Ayse Kinci ◽  
Sinem Sari ◽  
Esra Ertilav ◽  
Osman Nuri Aydin
Keyword(s):  
Dorsal Root Ganglion ◽  
Neck Pain ◽  
Dorsal Root ◽  
Steroid Injection ◽  
Epidural Steroid Injection ◽  
Pulsed Radiofrequency ◽  
Epidural Steroid

Does the Contrast Dispersion Pattern During Fluoroscopically Guided Cervical Transforaminal Epidural Steroid Injection Predict Short-Term Pain and Functional Outcomes? An Exploratory Analysis of Prospective Cohort Data

Pain Medicine ◽  
2020 ◽  
Vol 21 (12) ◽  
pp. 3350-3359
Author(s):  
Aaron Conger ◽  
Beau P Sperry ◽  
Cole W Cheney ◽  
Keith Kuo ◽  
Russel Petersen ◽  
...  
Keyword(s):  
Neck Pain ◽  
Epidural Space ◽  
Functional Outcomes ◽  
Steroid Injection ◽  
Epidural Steroid Injection ◽  
Dispersion Pattern ◽  
Arm Pain ◽  
Dispersion Patterns ◽  
Transforaminal Epidural Steroid Injection ◽  
Epidural Steroid

Abstract Summary of Background Data No study has evaluated the relationship between contrast dispersion patterns and outcomes after fluoroscopically guided cervical transforaminal epidural steroid injection (CTFESI). Objectives Determine whether contrast dispersion patterns predict pain and functional outcomes after CTFESI. Methods Secondary analysis of data collected during two prospective studies of CTFESI for the treatment of refractory radicular pain. Contrast dispersion patterns visualized by true anteroposterior (AP) projections during CTFESIs were categorized by flow: 1) completely external to the lateral border of the neuroforamen (zone 1); 2) within the neuroforamen but without entry into the lateral epidural space (zone 2); and 3) with extension into the lateral epidural space (zone 3). At baseline and at 1 month post-CTFESI, neck pain, arm pain, and “dominant index pain” (the greater of arm or neck pain) were evaluated using a numeric rating scale (NRS); physical function was assessed using the Five-Item Version of the Neck Disability Index (NDI-5). Results One-month post-CTFESI, neck pain, arm pain, and “dominant index pain” reductions of ≥50% were observed in 39.4% (95% confidence interval [CI], 28.2–51.8), 55.6% (95% CI, 43.0–67.5), and 44.1% (95% CI, 32.7–56.2) of participants, respectively. Regarding “dominant index pain,” 72.7% (95% CI, 40.8–91.2), 39.4% (95% CI, 24.2–57.0), and 37.5% (95% CI, 20.5–58.2) of participants reported ≥50% pain reduction when zone 1, zone 2, and zone 3 contrast flow patterns were observed. Contrast dispersion zone was not significantly associated with subgroup differences in neck pain, arm pain, or NDI-5 scores (P>0.05). Conclusion Improvements in pain and function 1 month after treatment with CTFESI did not differ significantly based on the contrast dispersion pattern. Future study is needed to confirm or refute these findings in other procedural settings, in broader patient populations, and with longer-term outcome assessment.

scholarly journals The Effect of Pulsed Radiofrequency Combined with a Transforaminal Epidural Steroid Injection on Chronic Lumbar Radicular Pain: A Randomized Controlled Trial

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Sithapan Munjupong ◽  
Nuj Tontisirin ◽  
Roderick J. Finlayson
Keyword(s):  
Treatment Group ◽  
Pain Intensity ◽  
Steroid Injection ◽  
Radicular Pain ◽  
Epidural Steroid Injection ◽  
Secondary Outcome ◽  
Pulsed Radiofrequency ◽  
Transforaminal Epidural Steroid Injection ◽  
Epidural Steroid

Background. Pulsed radiofrequency lesioning (PRFL) of the dorsal root ganglion (DRG) can modulate neural pathways and provide prolonged relief of neuropathic pain, with limited evidence for chronic lumbosacral radicular pain (CLRP). Objective. This study compared the effect of PRFL combined with transforaminal epidural steroid injection (TFESI) to TFESI alone on CLRP. Methods. Forty adults with chronic radicular pain of at least six-month duration were randomly allocated to undergo either a PRFL of the affected DRG followed by a TFESI (treatment group) or a TFESI alone (control group). Participants and assessors were blinded to the allocation and outcomes were assessed at 1, 2, 3, and 4 months. Outcomes. Pain intensity (visual analog score, VAS) was the primary outcome and quality of life (QOL) as measured by the SF-36 was a secondary outcome. Results. There was no difference in baseline characteristics between groups. VAS was significantly lower in the treatment group at 2-month and 3-month but not 4-month follow-up. QOL measurements did not differ between groups. Conclusions. PRFL of the lumbosacral DRG combined with TFESI showed a modest advantage over TFESI alone in reducing pain intensity; however, this did not persist beyond the 3-month follow-up. There was no effect on QOL.

The effectiveness of cervical transforaminal epidural steroid injection for the treatment of neck pain due to cervical disc herniation: long-term results

2018 ◽  
Vol 8 (5) ◽  
pp. 321-326 ◽  
Author(s):  
Serdar Kesikburun ◽  
Berke Aras ◽  
Bayram Kelle ◽  
Ferdi Yavuz ◽  
Evren Yaşar ◽  
...  
Keyword(s):  
Neck Pain ◽  
Disc Herniation ◽  
Treatment Effect ◽  
Steroid Injection ◽  
Epidural Steroid Injection ◽  
Cervical Disc Herniation ◽  
Cervical Disc ◽  
Transforaminal Epidural Steroid Injection ◽  
The Mean ◽  
Epidural Steroid

Aim: To investigate the long-term effect of fluoroscopy guided cervical transforaminal epidural steroid injection on neck pain radiating to the arm due to cervical disc herniation. Materials & methods: 64 patients (26 women [40.6%], 38 men [59.4%]; mean age, 44.9 ± 12.1 years) who had received fluoroscopy guided cervical transforaminal epidural steroid injection for neck pain due to cervical disc herniation at least 1 year before were included in the study. The effectiveness of transforaminal epidural steroid injection was assessed using data obtained by medical records and a standardized telephone questionnaire. Multiple linear regression analysis was applied to evaluate the factors affecting the pain reduction after injection and the duration of treatment effect. Results: The mean duration of neck pain symptom was 23.3 ± 23.9 months. Most of the patients received a single injection (50 patients, 78.1%). The mean time since injection at the time of interview was 21.4 ± 9.4 months. There was a significant reduction in mean pain visual analog scale (VAS [10 cm]) score, from 8.6 ± 1.4 at baseline to 3.2 ± 2.5 at check visit two weeks after injection (p < 0.001). 52 patients (81.2%) reported pain relief of more than 50%. The mean duration of treatment effect was 13.3 ± 9.44 months. Greater pain on the VAS was found to predict strongly the higher pain reduction and longer treatment effect (p = 0.042 and 0.011, respectively). Conclusion: The results suggested that cervical transforaminal epidural steroid injections might be an effective treatment for neck back pain radiating to the arm due to cervical disc herniation.

scholarly journals Successful treatment of unilateral neck pain with transforaminal epidural steroid injection on the left C3 nerve root: a case report

2020 ◽  
Vol 48 (11) ◽  
pp. 030006052096953
Author(s):  
Min Cheol Chang ◽  
Mathieu Boudier-Revéret ◽  
Ming-Yen Hsiao ◽  
Shaw-Gang Shyu
Keyword(s):  
Case Report ◽  
Neck Pain ◽  
Nerve Root ◽  
Rating Scale ◽  
Steroid Injection ◽  
Radicular Pain ◽  
Epidural Steroid Injection ◽  
Foraminal Stenosis ◽  
Transforaminal Epidural Steroid Injection ◽  
Epidural Steroid

In clinical practice, neck pain is one of the most common complaints. Although most of the cervical radicular pain is manifested in the neck and upper extremities, C3 or C4 radicular pain only results in neck pain. It does not produce upper extremity radiating pain. This case report describes a 70-year-old male that presented with a numeric rating scale score of 5 out of 10 for the left neck pain that he had been experiencing for the previous 1 month. Hyperalgesia was present on the left C3 dermatome. Foraminal stenosis at the left C2–C3 was observed on cervical magnetic resonance imaging. In order to manage the neck pain on the left side due to the foraminal stenosis at the left C2–C3, a transforaminal epidural steroid injection (TFESI) was undertaken on the left C3 nerve root. Thirty minutes after TFESI, the patient’s neck pain had completely resolved. At the 1-month and 3-month follow-ups, no neck pain was evident. Clinicians should consider the possibility of C3 radicular pain as a cause of neck pain, especially when the neck pain presents as neuropathic pain combined with sensory deficits.

scholarly journals Cardiopulmonary Arrest Following Cervical Epidural Injection

2012 ◽  
Vol 2;15 (2;3) ◽  
pp. 147-152
Author(s):  
Reza Nazari
Keyword(s):  
Neck Pain ◽  
Steroid Injection ◽  
Cardiopulmonary Arrest ◽  
Epidural Injection ◽  
Chronic Neck Pain ◽  
Epidural Steroid Injection ◽  
Life Threatening ◽  
Spinal Region ◽  
Vasovagal Response ◽  
Epidural Steroid

Epidural steroid injection is a common treatment for the management of pain in a wide variety of patients. It is generally well tolerated and perceived to have few side effects, with a low risk of serious complications. Only a handful of reports exist that describe life-threatening complications such as subdural hematoma, respiratory depression, vasovagal response, and pneumocephalus. This is a case report of a 67-year-old woman with a relatively unremarkable past medical history, other than rheumatoid arthritis, osteoarthritis, and hypertension, who suffered from chronic neck pain treated with cervical epidural steroid injection at the C6-C7 level. She went into immediate cardiopulmonary arrest following the injection. She was brought to the emergency department by ambulance and resuscitated, and was found to have pneumocephalus. Ultimately, she made a relatively full recovery over the following weeks. Cardiopulmonary arrest is a rare but potentially deadly side effect of epidural steroid injection. To the best of our knowledge, this is the first report of such an arrest following a steroid injection in the cervical spinal region. There are several possible mechanisms for the immediate arrest, including cardioacceleratory center blockade, severe vasovagal response, iatrogenic pneumocephalus, and involvement of the phrenic nerve followed by apnea. Our conclusion in this case is that the most likely scenario was injection of the C6-C7 level led to a blockade of the cardiac accelerator fibers located just below in the T1-T4 spinal level, causing a sympathetic blockade and profound bradycardia, leading to cardiopulmonary arrest. Key words: Cardiopulmonary arrest, cervical epidural steroid injection, pneumocephalus, cardiac accelerator, vasovagal, chronic neck pain.

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