Cervical Interlaminar Versus Transforaminal Epidural Steroid Injection

This study will compare one route of epidural steroid injection (interlaminar) using a
particulate steroid to another route of epidural steroid injection (transforaminal) using a
different non-particulate steroid dexamethasone. Repeat injections may be allowed.

All injections will be done with image guidance. Patients will be evaluated for improvements
in pain and function.

Inclusion Criteria:

- - aged >18, capable of understanding and providing consent in English, capable of
complying with the outcome instruments used, capable of attending all planned follow
up visits

- unilateral cervical radicular pain as defined by arm pain or shoulder girdle
pain/periscapular pain with or without neck pain of at least 2 weeks.

- 7 day average of numeric pain rating score (NPRS) for arm pain or shoulder
girdle/periscapular pain of at least 5/10 at baseline evaluation

- MRI (or CT if MRI not available) shows one or two level cervical disc herniation(s) or
disc osteophyte complex(es) between levels C4-T1, corresponding in location with
unilateral radicular pain, with or without neurological deficits. MRI or CT may show
degenerative changes at other levels.

- Patient consents to treatment with epidural injection in a shared decision-making
process with the treating physician.

- Pain duration of at least 2 weeks or more.

Exclusion Criteria:

- - Neck pain is greater than arm pain or shoulder girdle/periscapular pain based on 7
day average NPRS

- Those receiving remuneration for their pain treatment (e.g., disability, worker's
compensation).

- Those involved in active litigation relevant to their pain.

- Those unable to read English and complete the assessment instruments.

- Those unable to attend follow up appointments

- The patient is incarcerated.

- Spondylolisthesis at the involved or adjacent segments.

- History of prior cervical surgery

- Progressive motor deficit, and/or clinical signs of myelopathy.

- Prior cervical epidural steroid injections.

- Prior epidural steroid injection within the prior 12 months in any location within the
spine.

- Possible pregnancy or other reason that precludes the use of fluoroscopy.

- Allergy to contrast media or local anesthetics.

- BMI>35.

- Systemic inflammatory arthritis (e.g., rheumatoid arthritis, ankylosing spondylitis,
lupus).

- Active infection or treatment of infection with antibiotics within the past 7 days.

- Medical conditions causing significant functional disability (e.g., stroke, COPD)

- Chronic widespread pain or somatoform disorder (e.g. fibromyalgia).

- Addictive behavior, severe clinical depression, or psychotic features.