Image-Guided Treatment Reduces Neck Pain without Significant Risk of Paralysis

In addition to being an effective treatment, the translaminar approach was found to be safer than an alternative method or surgery, as no major complications were seen.

In the alternative approach, steroids are injected in close proximity to nerve bundles and small blood vessels in the spine, which can result in nerve damage or paralysis. The translaminar technique in the study avoids this risk by injecting the steroids into the epidural space in the neck, allowing the drug to move up and down the spine to reduce the inflammation and subsequently reduce pain. This safer translaminar application is an outpatient treatment, requiring only a small amount of local anesthesia. Although the injection does not treat the underlying cause of the pain, such as arthritis or herniated disc, it does treat the immediate pain flare-up, allowing patients to get back to their normal routines. The study was presented March 5, 2007, at the Society of Interventional Radiology's 32nd Annual Scientific Meeting held in Seattle, WA, USA.

"Although the other approach offers pain relief, there is increased risk of major complications such as paralysis. This study shows the translaminar approach is just as effective, but without the risk,” explained lead researcher William M. Strub, M.D., from the University of Cincinnati (OH, USA), who completed the study with interventional radiologists based at the Christ Hospital, also in Cincinnati.

During the procedure, an interventional radiologist utilizes real-time, continuous x-ray imaging to guide a small needle into the base of the neck between the C7 and T1 vertebrae, the largest epidural space in the neck, and injects a small amount of medication. The medication then spreads up and down the spine to reduce the inflammation in the spine, reducing pain. The patient is kept awake to enable communication with the physician, but the skin is numbed.

The study's patient population consisted of 161 patients, 69 males and 92 females, with an average age of 53. Patients experienced pain, on average, for four months before undergoing their first injection. One hundred and nineteen patients had multiple injections, 87 had two and 32 had three. The average length between procedures was four weeks. There were no major complications. Of those treated, only 5% had minor complications, mostly side effects from steroids such as weight gain and hot flashes. The treatment resulted in pain relief in 83% of patients. Moreover, the study's findings showed that patients with radiating pain to the hands and fingers, as opposed to more localized pain, had higher probability of improved pain relief.



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