Contralateral Oblique vs Lateral fluoroscopic approaches to cervical epidural: A comparative study for symptomatic cervical disc herniation

Abstract

Aims: This study was to compare contralateral oblique (CLO) and the classic lateral (CL) fluoroscopic approach to interlaminar cervical epidural steroid injection in terms of pain relief in patients with unilateral upper extremity radicular pain. Methods: This was a randomized clinical trial being conducted in one pain center in Hyderabad india. Fifty patients were allocated into two groups of 25 each. After confirmation of radiocontrast spread in the epidural space by fluoroscopic guidance, dexamethasone 8 mg and bupivacaine 0.125% in a volume of 4 ml were delivered to the epidural space. Evaluation of pain intensity before and 2 month after the procedure was accomplished using the numeric rating scale (NRS) respectively. Results: Demographic and baseline characteristics of the cases showed significant statistical difference. Improvements in the NRS were observed in both groups; meanwhile, improvements were more pronounced in the CLO-CESI group as compared to the CL-CESI group (P<0.01). With the CLO approach the ventral spread of radiocontrast was significantly higher (25%) than with the CL approach (4%) (P<0.01). All patients in CLO group showed radiocontrast spread ipsilateral to the painful side and all patients in the CL group showed a midline distribution of radiocontrast. Conclusion: CLO-CESI provides superior pain relief and improvement of functional disability in patients with unilateral upper extremity radicular pain in comparison to the classic CL-CESI