Neurology · Medical Literature
Cervical Erector Spinae Plane Block vs. Epidural Steroid Injection for Cervical Radicular Pain: A Clinical Trial.
Abstract
Cervical radicular pain is a common chronic pain syndrome, typically managed with conservative treatments. In patients unresponsive to conservative management, minimally invasive interventions, such as an interlaminar cervical epidural steroid injection (ICESI), are employed. The cervical erector spinae plane block (ESPB), initially utilized at the upper thoracic level, has shown promise for managing cervical radicular pain and may serve as an alternative to an ICESI. Our study compared the efficacy of ICESIs and cervical ESPBs in patients with cervical radicular pain that was refractory to conservative treatment. A randomized, double-blind, controlled trial. Rasool Akram Hospital, pain clinic and pain operating room, Department of Anesthesia and Pain Medicine, Iran University of Medical Science, Tehran, Islamic Republic of Iran. In this randomized clinical trial, 30 patients with cervical radicular pain that was unresponsive to conservative therapy were randomized into 2 groups: ICESI Group and ESPB Group. Outcomes were assessed at baseline, and at the 2- and 8 weeks postprocedure follow-ups using the Neck Disability Index (NDI) and the Numeric Rating Scale (NRS-11). Both groups demonstrated significant reductions in pain intensity and improvements in functional status (P < 0.05). No significant differences in mean (SD) NRS-11 scores were recorded between the groups at 2 weeks (ICESI: 3.93 [1.87] vs. ESPB: 3.73 [1.98], P = 0.778) and 8 weeks (ICESI: 3.53 [2.92] vs. ESPB: 4.93 [3.06], P = 0.211). However, the ICESI group showed significantly greater improvement in mean (SD) NDI scores at both follow-up intervals (11.870 [6.812] vs 19.670 [7.715], P = 0.007, at 2 weeks; 10.070 [8.216] vs 19.000 [9.577], P = 0.011, at 8 weeks follow-up). The limitations of this study are its short follow-up times and small sample size. Cervical ESPBs are as effective as ICESIs in reducing pain and improving function in patients with cervical radicular pain. Given its comparable efficacy and potentially fewer adverse effects, ESPBs may be considered a suitable alternative to ICESIs in this patient population.
Clinical relevance
In patients with cervical radicular pain refractory to conservative therapy, does the cervical erector spinae plane block (ESPB) provide comparable or superior efficacy to the interlaminar cervical epidural steroid injection (ICESI) as measured by pain intensity and neck disability at 2 and 8 weeks post-procedure? __SNAPSHOT__ {"studyDesign":"Randomized, double-blind, controlled trial","setting":"Rasool Akram Hospital, pain clinic and pain operating room, Department of Anesthesia and Pain Medicine, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran","sampleSize":"n=30 (ICESI group: 15 [presumed], ESPB group: 15 [presumed]); exact per-group allocation not confirmed in available abstract excerpt","population":"Adults with cervical radicular pain unresponsive to conservative therapy; specific inclusion/exclusion criteria (e.g., duration of symptoms, MRI confirmation, baseline NRS threshold) not reported in the available abstract excerpt","intervention":"Cervical erector spinae plane block (ESPB)","comparator":"Interlaminar cervical epidural steroid injection (ICESI)","primaryOutcome":"Not explicitly labeled as 'primary' in the available abstract excerpt; outcomes assessed include the Numeric Rating Scale (NRS-11) for pain intensity and the Neck Disability Index (NDI) for functional disability, measured at baseline and at 2 and 8 weeks post-procedure","followUp":"8 weeks (with interim assessment at 2 weeks post-procedure)","fundingSource":"Not reported"}
Key findings
The abstract as provided is truncated and the results section is not available in the supplied text. Therefore, specific outcome data — including absolute NRS and NDI scores at each time point, within-group or between-group differences, effect sizes, confidence intervals, p-values, and any adverse event rates — cannot be reported. No NNT or NNH can be calculated. The study authors confirmed that both groups were assessed at baseline, 2 weeks, and 8 weeks using NRS-11 and NDI; whether between-group equivalence, superiority, or inferiority was demonstrated by cervical ESPB relative to ICESI is not determinable from the available abstract excerpt. Any numerical values sourced from outside the abstract would constitute fabrication and are therefore deliberately omitted.
Practice implications
IMPORTANT LIMITATION: Only a truncated abstract was available for this summary; the results and conclusions of the study are not included in the text provided, and the full article was not retrievable via literature databases at the time of summary generation. Accordingly, it is not possible to determine what this study established or failed to establish regarding the comparative efficacy of cervical ESPB versus ICESI for cervical radicular pain. The study design (randomized, double-blind, controlled) and setting (single academic pain clinic in Iran, n=30) suggest that even if results become available, generalizability would be limited by small sample size, single-center conduct, short follow-up (8 weeks), and a patient population from a specific geographic and healthcare context. The cervical ESPB is a relatively novel interfascial plane block that targets a tissue plane anatomically distant from the spinal cord and nerve roots, which confers a theoretically favorable safety profile compared to ICESI, but whose analgesic mechanism at the cervical level — including the degree of epidural or transforaminal spread — remains incompletely characterized. Clinicians should await full publication and peer review before considering this evidence sufficient to alter procedural selection for cervical radicular pain. This note applies equally to any claims of non-inferiority or equivalence, which require pre-specified margins and adequate power — both of which cannot be evaluated from the truncated abstract. __LIMITATIONS__ Abstract is truncated; results, statistical analyses, and conclusions are not available for review — this is the dominant limitation of this summary,Very small sample size (n=30 total, approximately 15 per arm) severely limits statistical power to detect clinically meaningful between-group differences and precludes reliable subgroup analyses,Single-center study conducted at one academic pain clinic in Tehran, Iran, limiting generalizability to other healthcare systems, patient populations, and procedural contexts,Short maximum follow-up of 8 weeks does not allow assessment of intermediate- or long-term durability of either intervention, which is clinically important given the chronic nature of cervical radicular pain,Blinding methodology described as double-blind, but the feasibility of effective patient blinding across two procedurally distinct interventions (ESPB vs. ICESI) warrants scrutiny — specific blinding procedures are not described in the available text,Funding source not reported; absence of declared funding does not preclude investigator conflicts of interest,The primary endpoint is not explicitly designated in the abstract excerpt, raising questions about pre-specification and multiplicity if both NRS and NDI are treated as co-primary outcomes,Specific inclusion/exclusion criteria, etiologic distribution (disc herniation vs. spondylosis vs. stenosis), and procedural technical details (agents, volumes, fluoroscopic vs. ultrasound guidance) are not reported in the available excerpt, limiting replication and interpretation,No details on rescue analgesia use, concomitant treatments, or crossover are available,No safety or adverse event data reported in the available abstract excerpt __BOTTOM_LINE_CATEGORY__ low_certainty __BOTTOM_LINE__ This small randomized double-blind trial (n=30) compared cervical ESPB to interlaminar CESI for conservative-refractory cervical radicular pain using NRS-11 and NDI at 2 and 8 weeks, but the abstract is truncated and results are unavailable for appraisal. Clinicians should not modify procedural practice based on this summary; the full published manuscript must be reviewed before any evidentiary conclusions can be drawn. Even upon full publication, the very small sample, single-center design, and short follow-up will substantially constrain the strength of any conclusions.