Paramedian CESI vs Selective Nerve Root PRF for Lower Cervical Radicular Pain
Condition: Neck Pain; Cervical Radiculopathy
MeSH terms: Radiculopathy; Neck Pain
Study type: Interventional

Summary: 
      This study aims to compare the efficacy of ultrasound-guided selective cervical nerve root
      pulsed radiofrequency (PRF) versus fluoroscopy-guided paramedian cervical epidural steroid
      administration (CESI) for the treatment of lower cervical radicular pain refractory to
      conservative treatments. For this evaluation, a numerical rating (NRS), neck disability index
      (NDI), and Leeds Assessment Of Neuropathic Symptoms And Signs (LANSS) scale will be used
      before and after both interventions.
    

Detailed description: 
      Chronic cervical radicular pain is a common condition that affects the quality of life of
      many patients and is caused by compression or irritation of the cervical nerve roots.
      Treatment options for this condition include conservative methods such as medications and
      physical therapy, as well as interventions such as surgery or injections.

      Two commonly used injections for chronic cervical radicular pain are ultrasound-guided
      selective nerve root PRF and fluoroscopy-guided paramedian CESI. PRF involves the application
      of pulsed radiofrequency energy (intermittent current, tissue temperature not exceeding 42
      °C) to the cervical nerve root under ultrasound guidance. PRF is a non-destructive technique
      that modulates the activity of nerve fibers without causing thermal damage. CESI involves
      injecting local anesthetic and steroids into the epidural space between the laminae of the
      vertebrae under fluoroscopic guidance. The aim of both techniques is to reduce inflammation
      and pain transmission from the affected nerve root. The efficacy of both CESI and selective
      nerve root PRF has been demonstrated in clinical trials.

      The primary aim of the investigators in this study is to compare the efficacy of these two
      treatments. A total of at least 60 patients, 30 patients in each group, will be enrolled for
      comparison. NRS, NDI, and LANSS scores before, 3 months, and 6 months after treatment will be
      compared both within and between groups. The secondary aim is to reveal the side effects and
      adverse events in these two treatment modalities.
    

Intervention name(s): Paramedian cervical epidural steroid injection; Selective nerve root pulsed radiofrequency
Intervention type(s): Procedure; Procedure
Intervention description(s): For paramedian cervical epidural steroid injection, the cervical 7 (C7) - thoracic 1 (T1) interval is determined by taking an appropriate angle with C-arm fluoroscopy to determine the interlaminar space from the posterior cervical region. The epidural space is recognized by the negative pressure reflected on the resistance syringe.; For selective nerve root PRF, an 8-12 Hz linear ultrasound probe is first placed posterolateral to the neck. The level of the cervical nerve roots is determined according to the morphology of the anterior and posterior vertebral tubercles. The corresponding nerve root is visualized hypoechoically between the tubercles. The radiofrequency cannula is inserted in the same plane as the ultrasound probe (in plane) and the relevant nerve root is approached. Pulsed radiofrequency current, which has therapeutic properties in chronic pain, is applied to the relevant nerve root for 240 seconds.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Pulsed Radiofrequency Treatment; Fluoroscopy; Steroids