Cervical Interlaminar Epidural Injections In The
Treatment Of Cervical Disc Herniation, Post
Surgery Syndrome, Or Discogenic Pain: Cost
Utility Analysis From Randomized Trials
Authors: Manchikanti Laxmaiah 
Published: February 2021

Background: Neck pain is one of the major conditions attributing to overall disability in the United
States. There have been multiple publications assessing clinical and cost effectiveness of multiple
modalities of interventions in managing chronic neck pain. Even then, the literature has been considered
sparse in relation to cervical interlaminar epidural injections in managing chronic neck pain.
In contrast, cost utility studies of lumbar interlaminar injections, caudal epidural injections, cervical
and lumbar facet joint nerve blocks, percutaneous adhesiolysis demonstrated costs of less than
$3,500 for quality-adjusted life year (QALY).
Objectives: To assess the cost utility of cervical interlaminar epidural injections in managing
chronic neck and/or upper extremity pain secondary to cervical disc herniation, post-surgery
syndrome in neck, and axial or discogenic neck pain.
Study Design: Analysis based on 3 previously published randomized trials of the effectiveness of
cervical interlaminar epidural injections assessing their role in disc herniation, cervical post-surgery
syndrome, and axial or discogenic pain.
Setting: A contemporary, private, specialty referral interventional pain management center in
the United States.
Methods: Cost utility of cervical interlaminar epidural injections with or without steroids in managing
cervical disc herniation, cervical post-surgery syndrome, and cervical discogenic or axial neck back pain
was conducted with data derived from 3 randomized controlled trials (RCTs) that included a 2-year
follow-up, with inclusion of 356 patients. The primary outcome was significant improvement defined as
at least 50% in pain reduction and disability status. Direct payment data from all carriers from 2018 was
utilized for the assessment of procedural costs. Overall costs, including drug costs, were determined
by multiplication of direct procedural payment data by a factor of 1.67 to accommodate for indirect
payments respectively for disc herniation, discogenic pain, and cervical post-surgery syndrome.
Results: The results of the 3 RCTs showed direct cost utility for one year of QALY of $2,412.31 for
axial or discogenic pain without disc herniation, $2,081.07 for disc herniation, and $2,309.20 for post
surgery syndrome, with an average cost per one year QALY of $2,267.57, with total estimated overall
costs with addition of indirect costs of $3,475.38, $4,028.55, $3,856.36, and $3,785.89 respectively.
Limitations: The limitation of this cost utility analysis includes that it is a single center evaluation.
Indirect costs were extrapolated.
Conclusion: This cost utility analysis of cervical interlaminar epidural injections in patients
nonresponsive to conservative management in the treatment of disc herniation, post surgery
syndrome and axial or discogenic neck pain shows $2,267.57 for direct costs with a total cost of
$3,785.89 per QALY.
Key words: Cervical interlaminar epidural injections, chronic neck pain, cervical disc herniation,
cervical discogenic pain, post surgery syndrome, cost utility analysis, cost effectiveness analysis,
quality-adjusted life years