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Cervical Epidural Injections

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Essentials of Interventional Techniques in Managing Chronic Pain

Abstract

Chronic neck pain with or without upper extremity pain or headaches is relatively common in the adult population secondary to disc herniation, discogenic pain, spinal stenosis, spondylosis, and post-surgery syndrome. Treatments for chronic neck pain, recalcitrant to conservative management resulting in disability, include surgical management as well as interventional techniques with epidural injections utilizing either an interlaminar approach or transforaminal approach. Even though there have been multiple systematic reviews and randomized clinical trials of efficacy of cervical interlaminar epidural injections, the literature is sparse in reference to cervical transforaminal epidural injections. In addition, cervical transforaminal epidural injections have been associated with an inordinate risk.

Overall, there is Level II evidence of efficacy of cervical interlaminar epidurals in managing neck pain with or without upper extremity pain with cervical disc herniation or radiculitis, discogenic pain, central spinal stenosis, and cervical post-surgery syndrome, based on at least one relevant high-quality randomized trial. However, the evidence of efficacy is limited for cervical transforaminal epidural injections in disc herniation, and it is unavailable for other ailments.

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Acknowledgments

This book chapter is modified and updated from previous book chapters, “Cervical Interlaminar Epidural Steroid Injections” by Kenneth Botwin, MD and Robert Guirguis, DO, “Cervical Transforaminal Epidural Steroid Injections” by David M. Schultz, MD, Laxmaiah Manchikanti, MD, and Gabor B. Racz, MD, published by ASIPP Publishing. Permission has been obtained from ASIPP Publishing.

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Authors and Affiliations

  1. ASIPP and SIPMS, Paducah, KY, USA

    Laxmaiah Manchikanti

  2. Pain Management Center of Paducah, Paducah, KY, USA

    Laxmaiah Manchikanti

  3. Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, USA

    Laxmaiah Manchikanti

  4. Medical Advanced Pain Specialists Medical Pain Clinics, Shorewood, MN, USA

    David M. Schultz

  5. Mid Atlantic Spine and Pain Physicians, Newark, DE, USA

    Frank J. E. Falco

  6. Pain Medicine Fellowship Program, Temple University Hospital, Philadelphia, PA, USA

    Frank J. E. Falco

  7. Temple University Medical School, Philadelphia, PA, USA

    Frank J. E. Falco

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  1. Laxmaiah Manchikanti
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  3. Frank J. E. Falco
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Corresponding author

Correspondence to Laxmaiah Manchikanti .

Editor information

Editors and Affiliations

  1. Pain Management Center of Paducah, Paducah, Kentucky

    Laxmaiah Manchikanti

  2. Department of Anesthesia, LSU Health Science Center, New Orleans, Louisiana, USA

    Alan D. Kaye

  3. Mid Atlantic Spine and Pain Physicians, Newark, Delaware

    Frank J.E. Falco

  4. Service Line Chief of Interventional Radiology, Director of Interventional Neuroradiology, Chief of NeuroInterventional Spine Service, Massachusetts General Hospital, Boston, Massachusetts, USA

    Joshua A. Hirsch

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Manchikanti, L., Schultz, D.M., Falco, F.J.E. (2018). Cervical Epidural Injections. In: Manchikanti, L., Kaye, A., Falco, F., Hirsch, J. (eds) Essentials of Interventional Techniques in Managing Chronic Pain. Springer, Cham. https://doi.org/10.1007/978-3-319-60361-2_13

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