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Cervical Epidural Injections

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.

Keywords

  • Neck pain
  • Upper extremity pain
  • Cervical radicular pain
  • Cervical disc displacement
  • Cervical spinal stenosis
  • Cervical post-surgery syndrome
  • Cervical discogenic pain
  • Cervical interlaminar epidural injection
  • Cervical transforaminal epidural injections

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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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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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