C7-T1 Epidural Steroid Injections Versus Targeted Injection for Treatment of Cervical Radicular Pain
Condition: Radicular; Neuropathic, Cervical; Neck Pain
MeSH terms: Radiculopathy; Neck Pain
Intervention: Triamcinolone 80mg
Intervention description: C7-T1 Cervical interlaminar epidural steroid injection with Triamcinolone 80mg and 1 mL 1% lidocaine. Total volume is 2 cc.
Intervention MeSH terms: Triamcinolone
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Enrollment: 79.0
Sex: All
Minimum age: 18 Years
Maximum age: 75 Years
Healthy volunteers: No

Summary:

      Cervical radicular pain is a common, disabling problem, occurs in 83:100,000 individuals per
      year. Symptoms are most often caused by intervertebral disc herniation (21.9%) or central or
      foraminal stenosis from spondylosis (68.4%). Patients complain of pain in the head, neck,
      scapula or arm. The diagnosis of radicular pain is made clinically by history and physical
      examination, supported by imaging studies and electrodiagnostic tests. No study has compared
      the differences in pain, medication utilization, functional outcomes, or patient satisfaction
      between interlaminar and targeted epidural injections in the cervical spine. In theory, the
      technique of targeted epidural steroid delivery with a catheter has a lower risk of
      accidental vascular trespass or disc penetration during the procedure, and far less risk of
      dural penetration or spinal cord injury at rostral levels of the cervical spinal cord as
      compared with the interlaminar technique. The investigators hypothesize that this technique
      results in superior pain control, decreased medication use, improved function and fewer
      repeat injections. This data could improve patient safety and affect the evolving treatment
      guidelines for cervical epidural injections.
    

Eligibility criteria:

        Inclusion Criteria:

          -  All patients ages 18-75 with C2-6 unilateral radicular pain who are scheduled to
             undergo cervical epidural steroid injection treatment.

          -  Pain lasting greater than 2 weeks.

          -  Pain resistant to a trial of conservative therapy (i.e. oral steroids,nonsteroidal
             anti-inflammatory drugs, opioids, muscle relaxants, physical therapy or chiropractic
             care)

        Exclusion Criteria:

          -  Patient refusal.

          -  Lack of consent.

          -  Systemic infection or local infection over planned injection site in posterior
             cervical spine.

          -  Bleeding disorder, current use of anticoagulants or anti-platelet medications.

          -  Intrinsic spinal cord lesions in the cervical region.

          -  History of central neurologic, cerebrovascular, demyelinating or muscular disease.

          -  Concomitant use of oral or injected steroids.

          -  Allergy to medications being used for injection procedures.

          -  Inability to communicate with staff or to participate in follow up.

          -  Pregnancy.

          -  Inability to perform handgrip or arm strength testing.

          -  Cognitive deficit or motor neuron disease.

          -  Daily opiate use that preceded the onset of cervical radicular symptoms or daily
             opiate use exceeding 3 months prior to study inclusion