Cervical Epidural Steroid Injections Improves Cervicalgia Greater than Radiculopathy: Efficacy and Safety of Epidural Steroids in a Single-Center Retrospective Study

Abstract Background: Epidural steroid injections are widely used in the lumbar and to a lesser extent in the cervical region despite concerns about their efficacy and safety. Objectives: Safety and Efficacy of cervical epidural steroid injections (CESI) were evaluated. Study Design: A single-centre retrospective study was designed to evaluate CESI safety and efficacy. Patients suffering from chronic, resistant cervical radiculopathy and treated with interlaminar (IL) CESI were included. Results were compared to published data. Setting: Patients were treated at the pain centre of the Hôtel-Dieu de France hospital in Beirut-Lebanon between 2005 and 2022. These patients received one or more CESI using the IL approach. Methods: The medical records of included patients were reviewed. Patients were contacted by phone between May and June 2023 to evaluate improvements in their symptoms after CESI. Data on pain numeric rating scale (NRS) before and after the injections and Odom's criteria defined as patient satisfaction were collected. A multivariate analysis of covariance (MANCOVA) was used to compare the mean pain numeric rating scale value before and after the procedure, for cervicalgia and cervical radiculopathy respectively. Complications and the need for referral to surgical management were noted. Results: A total of 60 CESI using the IL approach were performed for the 45 included patients, the majority of whom (84.4%) were suffering from chronic resistant cervicalgia and cervical radiculopathy. Minor complications (n=6, 10%) were noted during and after the injections, including vasovagal episodes (6.67%), a dural puncture (1.67%) and a halt of the procedure following a bloody tap (1.67%). Complications rate was similar to that found in the literature. A significant statistical reduction in pain scores was found when comparing pain numeric ratings for cervicalgia (p=0.030), but not for cervical radiculopathy (p=0.115) despite a clinically significant improvement in pain scores from 8/10 to 4/10. The Odom's criteria classified patients between « completely satisfied » (31%), « partially satisfied » (56%) and « dissatisfied » (13%), all the latter were offered surgical management. Limitations: The retrospective aspect, the lack of comparison with the transforaminal approach and the limited number of patients are limitations of this study. Conclusion: CESI is a safe and efficient technique for the treatment of cervical radiculopathy secondary to cervical disc herniation. Around 9 patients out of 10 are satisfied, with a lasting improvement in symptoms after undergoing the procedure. Minor complications could be seen, but clinically significant ones are very rare, involving mostly the transforaminal (TF) approach. Following IL CESI, cervicalgia was found to be significantly improved compared to cervical radiculopathy. However, prospective randomized studies comparing both symptoms are needed.