1. 2021;24;117-125Comparative Effectiveness of Parasagittal Interlaminar and Transforaminal Cervical Epidural Steroid Injection in Patients with Cervical Radicular Pain: A Randomized Clinical Trial
   Randomized Controlled Trial
   Ji Hoon Sim, MD, Han Park, MD, Yujin Kim, MD, Jin-Woo Shin, MD, PhD, Jeong-Gil Leem, MD, PhD, Hyun-Seok Cho, MD, and Seong-Soo Choi, MD, PhD.

BACKGROUND: Cervical epidural steroid injections (ESI) are performed either by interlaminar (IL) or transforaminal (TF) approaches; however, there is controversy over which is better for safety and efficacy.

OBJECTIVES: This clinical trial aimed to compare the effectiveness of the parasagittal IL and TF approaches for cervical ESI in patients who were suffering from cervical radicular pain.

STUDY DESIGN: A prospective randomized assessor-blind study.

SETTING: The study took place at a single pain clinic within a tertiary medical center in Seoul, Republic of Korea.

METHODS: This prospective randomized, assessor-blind trial included 80 patients with cervical radicular pain. We randomly assigned patients to the TF or parasagittal IL approach for cervical ESI. The effectiveness of the 2 groups was compared based on pain intensity using the Numeric Rating Scale (NRS-11) at 1 and 3 months. The Neck Disability Index (NDI), Medication Quantification Scale (MQS), and responders at 1 and 3 months between the 2 groups were compared.

RESULTS: The pain intensity of both groups significantly reduced after 1 and 3 months after each procedure (P < 0.001). Two-way repeated measures of analysis of variance showed no significant interaction between group and time for cervical radicular pain (P = 0.266), although NRS-11 pain score was lower in the TF group than the parasagittal IL group after 1 month (P = 0.010). NDI, MQS, and successful responders were not different between the 2 groups at 1 and 3 months after the procedure. We observed 7 cases (18.4%) of vascular visualization in the TF group, although no serious complications were found in either group.

LIMITATIONS: This study had no placebo control group and limited follow-up time.

CONCLUSIONS: Parasagittal IL ESI may be recommended over the TF ESI in reducing cervical radicular pain, considering both clinical effectiveness and safety.

KEY WORDS: Chronic pain, cervical radicular pain, fluoroscopy, epidural steroid injection, parasagittal, interlaminar, transforaminal, pain management