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Randomized Controlled Study of Percutaneous Epidural Neuroplasty Using Racz Catheter and Epidural Steroid Injection in Cervical Disc Disease

 Guy Yeul Ji  ;  Chang Hyun Oh  ;  Keun Su Won  ;  In Bo Han  ;  Yoon Ha  ;  Dong Ah Shin  ;  Keung Nyun Kim 
 PAIN PHYSICIAN, Vol.19(2) : 39-48, 2016 
Journal Title
Issue Date
Adult ; Aged ; Aged, 80 and over ; Analgesia, Epidural/methods* ; Catheter Ablation/methods* ; Cervical Vertebrae/diagnostic imaging ; Cervical Vertebrae/surgery ; Female ; Follow-Up Studies ; Humans ; Injections, Spinal ; Intervertebral Disc Degeneration/diagnostic imaging ; Intervertebral Disc Degeneration/drug therapy* ; Intervertebral Disc Degeneration/surgery* ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures/methods* ; Neck Pain/diagnostic imaging ; Neck Pain/drug therapy ; Neck Pain/surgery ; Pain Measurement/methods ; Radiculopathy/diagnostic imaging ; Radiculopathy/drug therapy ; Radiculopathy/surgery ; Radiography ; Single-Blind Method ; Steroids/administration & dosage* ; Treatment Outcome
Cervical ; cervical disc disease ; pain management ; percutaneous epidural neuroplasty ; percutaneous adhesiolysis ; epidural steroid injection
BACKGROUND: The efficacy of lumbar percutaneous epidural neuroplasty (PEN) as a minimally invasive technique has been relatively well investigated, but the clinical effectiveness of cervical PEN (C-PEN) has yet to be established. OBJECTIVE: The purpose of this study was to compare clinical outcomes between C-PEN and cervical epidural steroid injection (C-ESI). STUDY DESIGN: Randomized control study. SETTING: University hospital center. METHODS: Eighty patients with neck pain from single level cervical disease with and without radiculopathy were included in this study. Patients were randomly assigned into 2 groups: C-PEN or C-ESI. Clinical outcomes were assessed according to Neck Disability Index (NDI) score and Visual Analog Scale (VAS) score for arm pain until 12 months after treatment. RESULTS: All C-PEN and C-ESI groups showed better NDI recovery and greater reduction in VAS score at postoperative 6 months (P < 0.001). The C-PEN group demonstrated better NDI score at postoperative 6 months than the C-ESI group (P = 0.014), while there were no differences at 2, 4, and 12 months. Additionally, the C-PEN group showed lower VAS scores at all follow-up intervals compared to the C-ESI group (P < 0.050). Symptom relief was sustained for a significantly longer duration in the C-PEN group than in the C-ESI group (23.4 vs. 20.5 weeks, P < 0.001). LIMITATIONS: The follow-up period was relatively short with a small sample size, and the grade of cervical disc disease, root compression, and disc degeneration grade were could not considered in this study. CONCLUSIONS: C-PEN was superior to C-ESI in terms of better NDI recovery (at 6 months) and greater reduction in VAS score (until 12 months) in treating single level cervical disc herniation. Better outcomes with C-PEN may have been achieved via a more localized selective block in the epidural space closer to the dorsal root ganglion and ventral aspect of the nerve root.
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1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Keung Nyun(김긍년)
Shin, Dong Ah(신동아) ORCID logo https://orcid.org/0000-0002-5225-4083
Ha, Yoon(하윤)
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