Are Stabilization Exercises Effective After Epidural Steroid Injection in Patients With Cervical Radiculopathy?
Condition: Pain, Neck; Cervical Radiculopathy; Pain, Radiating
MeSH terms: Radiculopathy; Neck Pain; Pain
Study type: Interventional

Summary: 
      Cervical radiculopathy was first described in 1943 by researchers named Semmes and Murphy,
      years later than lumbosacral radiculopathy. It is a neurological condition caused by
      dysfunction in the cervical spinal nerves, nerve roots, or both. This compression occurs as a
      result of disc herniation, spondylosis, trauma, spinal tumors, etc. As the first symptom, it
      manifests as pain. When pain radiates from the neck to the shoulder and arm and is
      accompanied by sensory complaints and motor weakness, cervical radiculopathy should be
      suspected. It is a significant cause of morbidity and disability in both men and women, and
      it occurs in middle age. As a result, clinicians must quickly diagnose and determine the best
      treatment method. The majority of the information in the literature on the incidence of
      cervical radiculopathy is based on the findings of a large population-based study conducted
      between 1976 and 1990 by the Mayo Clinic in Rochester, Minnesota. The incidence rate of
      cervical radiculopathy was reported to be 83.2 per 100,000 per year in this study, which
      included 561 cases. The primary goals of treatment are to alleviate pain, restore
      neurological function, and prevent a recurrence. According to the literature, cervical
      radiculopathy recurs at a rate of 31.7%, and 26% of them go to surgery. Treatment options
      vary depending on whether the symptoms are acute or chronic and their severity. In the
      treatment of cervical radiculopathy, either conservative (non-operative) or surgical
      treatments are used. In patients with chronic neck pain with or without radiculopathy, a
      cervical epidural steroid injection is one of the most frequently used interventional
      therapeutic options. Chronic neck pain or radicular pain caused by disc herniation, spinal
      stenosis, or discogenic pain can also be treated with cervical epidural injections. Cervical
      stability training is an exercise program that is used to strengthen the cervical spine,
      relieve pain, and improve functionality. Changes in dynamic scapula stabilization are
      observed in patients with chronic neck pain. The scapula connects the neck and shoulder, so
      it plays an important role in stabilizing the neck and shoulder complex. Because of the
      interaction between the neck and the scapula, scapular stability becomes more important in
      these patients.
    

Detailed description: 
      Many studies in the literature separately investigate the effectiveness of Cervical
      Interlaminar Epidural Steroid Injection (CIESI) in radiculopathy due to cervical disc
      herniation or the effectiveness of stabilization exercises and physical therapy modalities in
      these patients. However, there have been no studies on the effectiveness of post-injection
      exercise training as far as we are aware. Our study aims to investigate the benefit of
      stabilization exercises after interlaminar epidural steroid injection in patients with
      radiculopathy caused by cervical disc herniation, add a new study to the literature, and
      guide future research.
    

Intervention name(s): Cervical Interlaminar Epidural Steroid Injection; Neck Stabilization Exercises; Neck and Scapular Stabilization Exercises
Intervention type(s): Procedure; Other; Other
Intervention description(s): Fluoroscopy-guided cervical interlaminar epidural steroid injection will be administered to patients with chronic neck pain due to cervical disc herniation. The injection area is cleaned 3 times with an antiseptic solution and covered with a sterile cloth. Local anesthesia with 2 ccs 3% prilocaine will be applied to the skin and subcutaneous tissues in the area of interest. Under fluoroscopy guidance, the needle is advanced into the C7-T1 intervertebral disc level. With the help of the loss of resistance technique, it is understood that the needle is in the epidural space, and second control is provided by administering contrast material. After the confirmation of needle place is done, a mixture of 12 mg dexamethasone, 1 cc 2% lidocaine, 1 cc saline is injected. The patient is taken to the restroom after the procedure and followed up for any complications.; The physiotherapist will design an exercise protocol for neck stabilization. Each exercise will be applied three days a week throughout a 4-week program, accompanied by a physiotherapist, and will begin with 7 to 10 repetitions at first, increasing to 10 to 15 repetitions in the following weeks, taking into account the patient's condition. After the physiotherapist-assisted exercises are completed, the protocol will continue as home-based exercises until the assessments are completed.; The physiotherapist will design an exercise protocol for neck and scapular stabilization. Each exercise will be applied three days a week throughout a 4-week program, accompanied by a physiotherapist, and will begin with 7 to 10 repetitions at first, increasing to 10 to 15 repetitions in the following weeks, taking into account the patient's condition. After the physiotherapist-assisted exercises are completed, the protocol will continue as home-based exercises until the assessments are completed.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Pain; cervical radiculopathy; cervical interlaminar epidural steroid injection; stabilization exercises