Ultrasound-guided cervical retro-laminar block may well be a safer alternative to cervical epidural steroid injections for patients with cervical radicular pain that doesn’t respond to more conservative treatments, a new study finds.
Is a Block Safer Than Epidural Steroid Injections?
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Secondary#cervicalepiduralseroidinjections#cervicalradicularpain#cervicalretrolaminarblock
The study, “Ultrasound-guided Cervical Retro-laminar Block for Cervical Radicular Pain: A Comparative Analysis,” was published online in the journal Spine in the October 1, 2022 issue.
“Cervical radiculopathy is a common clinical condition, often treated with cervical epidural steroid injections. Retro-laminar cervical blocks may be considered safer than cervical epidural steroid injections as they do not require entering the neuroaxis,” the researchers wrote.
The retrospective analysis included medical record data of all patients who underwent retro-laminar cervical block for cervical radicular pain between August 2019 and March 2021. Overall, there were 98 patients and 139 procedures included in the study.
According to the analysis, most patients achieved significant pain reduction after the procedure and at the final follow up (16.9 ± 13.2 weeks). At the time of discharge, the rating scale for the whole cohort changed from 7.21 ± 2.51 to 4.04 ± 2.51 (p < 0.01). Eighty-three percent of patients had a lower post procedural Neck Disability Index than preprocedural Neck Disability Index. And for 80% of the patients, the improvement surpassed the minimal clinically important change by the final evaluation.
The researchers reported that 61% of the patients were discharged after just one retro laminar block while 8 patients eventually needed surgery. No major adverse events were reported. The most common complaint was injection site soreness.
They said that while their findings suggest that retro-laminar block can be a safe alternative to cervical epidural steroid injections and decompressive surgery, more studies are needed to confirm their results.
Study authors included Morsi Khashan, M.D., of the Tel Aviv Medical Center in Israel; Jesus de Santiago, M.D., of Hospital Quirónsalud de Tenerife, Santa Cruz de Tenerife, Spain; Itai Pardo, M.D., of Tel Aviv University; Gilad Regev, M.D., of Tel Aviv Medical Center; Dror Ophir, M.D., of Tel Aviv Medical Center; Khalil Salame, M.D., of Tel Aviv Medical Center; Zvi Lidar, M.D., of Tel Aviv Medical Center; Silviu Brill, M.D., of Tel Aviv University and Uri Hochberg, M.D., of Tel Aviv University.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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