SIR: Steroid Injections to Cervical Spine Ease Neck Pain

SEATTLE, March 7 -- Translaminar steroid injections into the cervical spine may help relieve chronic neck pain, according to a retrospective study.

Among 161 patients who underwent the translaminar approach, rather than the more commonly used transforaminal approach, 82% reported pain relief at the first injection, which 35% rated "substantial," said William M. Strub, M.D., of the University of Cincinnati.

Those who had the recommended series of three injections reported even better outcomes, he reported at the Society of Interventional Radiology meeting here.

Furthermore, the lack of major complications were reassuring for this underused procedure, said Brian F. Stainken, M.D., of the Roger Williams Medical Center in Providence, R.I., who moderated a press conference during which the study was discussed.

The procedure, which involves using a fine gauge needle to inject steroids into the spinal column at the C7-T1, is more commonly used to treat lower back pain.

Dr. Strub and colleagues retrospectively analyzed outcomes from all 161 patients (69 male, average age 53) who underwent a total of 280 cervical interlaminar epidural steroid injections from December 2003 through April 2006.

On average, the patients' neck symptoms lasted four months prior to the procedure (range 0.25 to 240 months). Fifteen had prior cervical surgery and 44% of patients used narcotic analgesics to control pain. All had a cervical MRI beforehand to exclude fracture or ligament injury.

Injections of the steroid solution containing about 2.0 mL triamcinolone (Kenalog) were performed by five experienced interventional radiologists at three institutions.

Among the findings, Dr. Strub reported:

• 91% of patients who had the recommended series of three injections reported some degree of pain relief, with 47% rating it "substantial,"
• 8% went on to surgery after their second or third injection,
• Patients with more severe, multilevel spinal disc degeneration reported more pain relief than those with single level changes (odds ratio 4.13, P=0.0055),
• Those with pain radiating to the hand were also more likely to have improvement in pain than those with neck pain alone (OR 2.72, P=0.0011), and
• Injections at the C7-T1 level were most likely to improve pain (OR 2.44, P=0.0034).

No major complications were reported though 5.18% had minor complications likely due to steroids, such as hot flashes or weight gain.

One factor contributing to the safety of the procedure may be the translaminar approach, Dr. Strub said. The injection site avoids the vertebral artery and reduces the risk of hematoma, he added.

"Our work is consistent with and extends the work of others showing this is a safe and effective procedure that should be considered in the management of neck pain," he added. "We hope that further studies will help determine the long term benefits of this procedure."

Compared with open surgery for neck pain, the steroid injections are associated with less risk, less pain, and less recovery time, Dr. Strub said.

Many patients who develop neck pain never reach the point of requiring surgery, because about a third of cases resolve within a year.

For those patients who do not get adequate relief from pain medication, steroid injections may offer another option for patients and physicians before considering surgery, he added.

"This offers an excellent intermediate step before surgery," Dr. Strub concluded.

This procedure can help provide pain relief in patients with neck pain from bulging discs, arthritis, and even in patients who continue to have pain after cervical spine surgery.