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Epidural Steroid Injections for Cervical Radiculopathy

February 28, 2019

Health Problem: Cervical radiculopathy is a condition that involves nerve root compression in the cervical spine. Causes of cervical radiculopathy include cervical degenerative disc disease, such as herniated disc, as well as spondylosis and cervical spinal stenosis. Few studies have examined the prevalence of cervical radiculopathy, but an oft-cited estimate is 83 patients diagnosed with cervical radiculopathy per 100,000 people per year in the Rochester, MN area, and the most common causes of cervical radiculopathy in this population were herniated disc (21.9%) and spondylosis (68.5%).

Technology Description: Epidural steroid injection (ESI) is a nonsurgical treatment for managing radiculopathy caused by disc herniation or degenerative changes in the vertebrae, such as spondylosis. ESI involves injection of steroid medication directly into the epidural space. Steroids reduce inflammation and decrease pain by inhibition of inflammatory mediators, stabilization of hyperexcitable nerve membranes, and reduction of capillary permeability. Delivery of steroids directly into the epidural space exposes the spinal nerve roots to higher concentrations of the medications for a longer period of time than systemic administration.

Controversy: Although positive reports of pain reduction by ESIs have led to widespread acceptance and use of this treatment for lower back pain, some studies have suggested that steroids do not provide additional pain relief beyond the anesthetic that is typically included in ESIs, and safety concerns have been raised. According to the Radiological Society of North America, inadvertent misplacement of the needle in the cervical region could potentially lead to major complications, such as spinal cord injury, stroke, or death. Furthermore, the Food and Drug Administration has not approved any steroid for epidural injection.

Key Questions:

  • Do ESIs provide pain relief, reduce the need for surgery, and/or reduce disability or improve function in patients with cervical radiculopathy?
  • Are ESIs safe?
  • How do ESIs compare with alternative treatments for cervical radiculopathy (e.g., anesthetic injection alone, autologous conditioned serum, percutaneous epidural neuroplasty, or pulsed radiofrequency?
  • Have definitive patient selection criteria been established for ESIs for cervical radiculopathy?