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Patient-Reported Outcomes and Satisfaction after Cervical Epidural Steroid Injection for Cervical Radiculopathy

Masoud Hashemi, Payman Dadkhah, Mehrdad Taheri, Mahshid Ghasemi, Ali Hosseinpoor, Mojtaba Farjam

Background: Cervical radiculopathy caused by disc herniation is a frequent public health issue with economical and socio-professional impacts. The objective of the present study is to evaluate the patient-reported outcomes and satisfaction from cervical epidural steroid injection during a 2-year follow-up. Materials and Methods: Results based on patients’ reports from a previously performed intervention of cervical epidural steroid injection on patients with cervical radiculopathy due to cervical disc herniation are prospectively collected. Outcome measures are Neck Disability Index (NDI), numerical rating scale (NRS) for pain assessment, and 5-scale patient satisfaction questionnaire (PSQ) plus opioid medication for pain relief, additional injections, and progression to surgery. Results: Of total 37 cases, 34 were available for follow-up after 2-year postoperatively. The mean preoperative NDI was 21.17 and improved to 17.38, and the mean NRS was 7.7 and improved to 5.00; both were statistically significant. Mean patient satisfaction after 2 years was 3.17 out of 5. 11 cases needed additional injections, and 4 of patients proceeded to surgery. Conclusion: We showed that transforaminal cervical epidural steroid injection for cervical radiculopathy is an effective non-surgical treatment option, providing significant pain relief and functional improvement during 2-years follow-up along with higher-than-average patient satisfaction in most of our patients. [GMJ.2019;8:e1478] 

Radiculopathy; Neck Pain; Steroids; Injection, Epidural; Pain Management

Iyer S, Kim HJ. Cervical radiculopathy. Curr Rev Musculoskelet Med. 2016;9(3):272-80.

PMid:27250042 PMCid:PMC4958381

Caridi JM, Pumberger M, Hughes AP. Cervical radiculopathy: a review. HSS J. 2011;7(3):265-72.

PMid:23024624 PMCid:PMC3192889

Cohen SP, editor Epidemiology, diagnosis, and treatment of neck pain. Mayo Clin Proc; 2015: Elsevier.


Hashemi SM, Dadkhah P, Taheri M, Abootorabi SMHS. Effects of Percutaneous Laser Disc Decompression (PLDD) on Clinical Outcome of Teared Vs Intact Protruded Intervertebral Discs: A Prospective Cohort Study. Orthopaedic Surgery and Traumatology. 2018;2(1):279-85.

Woods BI, Hilibrand AS. Cervical radiculopathy. J Spinal Disord Tech. 2015;28(5):E251-E9.


Wainner RS, Gill H. Diagnosis and nonoperative management of cervical radiculopathy. J Orthop Sports Phys Ther. 2000;30(12):728-44.


Moghtadaei M, Yeganeh A, Boddouhi B, Alaee A, Farahini H, Otoukesh B. Effect of high tibial osteotomy on hip biomechanics in patients with genu varum: a prospective cohort study. Interv Med Appl Sci. 2017;9(2):94-9.

PMid:28932503 PMCid:PMC5598133

Manchikanti L, Kaye AD, Manchikanti K, Boswell M, Pampati V, Hirsch J. Efficacy of Epidural Injections in the Treatment of Lumbar Central Spinal Stenosis: A Systematic Review. Anesthe Pain Med. 2015;5(1):e23139.

PMid:25789241 PMCid:PMC4350165

Manchikanti L, Pampati V, Benyamin RM, Boswell MV. Analysis of Efficacy Differences between Caudal and Lumbar Interlaminar Epidural Injections in Chronic Lumbar Axial Discogenic Pain: Local Anesthetic Alone vs. Local Combined with Steroids. Int J Med Sci. 2015;12(3):214-22.

PMid:25678838 PMCid:PMC4323359

Pandey RA. Efficacy of Epidural Steroid Injection in Management of Lumbar Prolapsed Intervertebral Disc: A Comparison of Caudal, Transforaminal and Interlaminar Routes. Journal of Clinical and Diagnostic Research : JCDR. 2016;10(7):RC05-RC11.

PMid:27630917 PMCid:PMC5020256

Park EJ, Park SY, Lee SJ, Kim NS, Koh DY. Clinical outcomes of epidural neuroplasty for cervical disc herniation. J Korean Med Sci. 2013;28(3):461-5.

PMid:23487574 PMCid:PMC3594612

Veihelmann A, Devens C, Trouillier H, Birkenmaier C, Gerdesmeyer L, Refior H. Epidural neuroplasty versus physiotherapy to relieve pain in patients with sciatica: a prospective randomized blinded clinical trial. J Orthop Sci. 2006;11(4):365-9.


Buenaventura RM, Datta S, Abdi S, Smith HS. Systematic review of therapeutic lumbar transforaminal epidural steroid injections. Pain Physician. 2009;12(1):233-51.

Haefeli M, Elfering A. Pain assessment. Eur Spine J. 2006;15(1):S17-S24.

PMid:16320034 PMCid:PMC3454549

Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther. 1991;14(7):409-15.

Thayaparan AJ, Mahdi EJ. The Patient Satisfaction Questionnaire Short Form (PSQ-18) as an adaptable, reliable, and validated tool for use in various settings. Med Educ Online. 2013;18.

PMid:23883565 PMCid:PMC3722414

Babita Ghai M, Dipika Bansal D, Jonan Puni Kay M, Kaivalya Sadashiv Vadaje M. Transforaminal versus parasagittal interlaminar epidural steroid injection in low back pain with radicular pain: a randomized, double-blind, active-control trial. Pain Physician. 2014;17:277-90.

Beyaz SG. Comparison of transforaminal and interlaminar epidural steroid injections for the treatment of chronic lumbar pain. Brazilian Journal of Anesthesiology (English Edition). 2017;67(1):21-7.


Botwin KP, Gruber RD, Bouchlas CG, Torres-Ramos FM, Sanelli JT, Freeman ED, et al. Fluoroscopically Guided Lumbar Transformational Epidural Steroid Injections in Degenerative Lumbar Stenosis: An Outcome Study. Am J Phys Med Rehabil. 2002;81(12):898-905.


Jeong HS, Lee JW, Kim SH, Myung JS, Kim JH, Kang HS. Effectiveness of transforaminal epidural steroid injection by using a preganglionic approach: a prospective randomized controlled study. Radiology. 2007;245(2):584-90.


Benoist M, Boulu P, Hayem G. Epidural steroid injections in the management of low-back pain with radiculopathy: an update of their efficacy and safety. Eur Spine J. 2012;21(2):204-13.

PMid:21922288 PMCid:PMC3265586

Sung MS. Epidural Steroid Injection for Lumbosacral Radiculopathy. Korean J Radiol. 2006;7(2):77-9.

PMid:16799267 PMCid:PMC2667591

Abram SE. Treatment of lumbosacral radiculopathy with epidural steroids. Anesthesiology: The Journal of the American Society of Anesthesiologists. 1999;91(6):1937-.


Lee JH, Lee S-H. Comparison of Clinical Efficacy Between Interlaminar and Transforaminal Epidural Injection in Patients With Axial Pain due to Cervical Disc Herniation. Medicine. 2016;95(4):e2568-e.

PMid:26825899 PMCid:PMC5291569

Manchikanti L, Cash KA, Pampati V, Malla Y. Two-year follow-up results of fluoroscopic cervical epidural injections in chronic axial or discogenic neck pain: a randomized, double-blind, controlled trial. Int J Med Sci. 2014;11(4):309-20.

PMid:24578607 PMCid:PMC3936024

Benditz A, Brunner M, Zeman F, Greimel F, Florian V, Boluki D, et al. Effectiveness of a multimodal pain management concept for patients with cervical radiculopathy with focus on cervical epidural injections. Sci Rep. 2017;7(1):7866-.

PMid:28801567 PMCid:PMC5554143

Bush K, Hillier S. Outcome of cervical radiculopathy treated with periradicular/epidural corticosteroid injections: a prospective study with independent clinical review. Eur Spine J. 1996;5(5):319-25.


Kolstad F, Leivseth G, Nygaard O. Transforaminal steroid injections in the treatment of cervical radiculopathy. A prospective outcome study. Acta Neurochir (Wien). 2005;147(10):1065-70.


Persson L, Anderberg L. Repetitive transforaminal steroid injections in cervical radiculopathy: a prospective outcome study including 140 patients. Evid Based Spine Care J. 2012;3(3):13-20.

PMid:23531493 PMCid:PMC3592766

Anderberg L, Annertz M, Persson L, Brandt L, Säveland H. Transforaminal steroid injections for the treatment of cervical radiculopathy: a prospective and randomised study. Eur Spine J, 2007;16(3):321-8.

PMid:16835737 PMCid:PMC2200696

Zarghooni K, Rashidi A, Siewe J, Röllinghoff M, Bredow J, Eysel P, et al. Single-Shot Epidural Injections in the Management of Radicular Pain. Orthop Rev (Pavia). 2015;7(4):5985-.

PMid:26793292 PMCid:PMC4703910

Delaney TJ, Rowlingson JC, Carron H, Butler A. Epidural steroid effects on nerves and meninges. Anesth Analg. 1980;59(8):610-4.


Rowlingson JC. Epidural steroids: Do they have a place in pain management? APS Journal. 1994;3(1):20-7.

Rowlingson JC, Kirschenbaum LP. Epidural analgesic techniques in the management of cervical pain. Anesth Analg. 1986;65(9):938-42.

Rathmell JP, Aprill C, Bogduk N. Cervical transforaminal injection of steroids. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2004;100(6):1595-600.


Castagnera L, Maurette P, Pointillart V, Vital J, Erny P, Senegas J. Long-term results of cervical epidural steroid injection with and without morphine in chronic cervical radicular pain. Pain. 1994;58(2):239-43.

Sehgal N, Paidin M, Rasmussen D, Tariq A, Hetzel S. Is there a decrease in opioid use after a single epidural steroid injection in LBP: a pilot study. The Journal of Pain. 2013;14(4):S85.

Friedly J, Nishio I, Bishop MJ, Maynard C. The relationship between repeated epidural steroid injections and subsequent opioid use and lumbar surgery. Arch Phys Med Rehabil. 2008;89(6):1011-5.



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