Are Stabilization Exercises Effective After Epidural Steroid Injection in Patients With Cervical Radiculopathy?

Marmara University

Status

Completed

Conditions

Pain, Neck

Pain, Radiating

Cervical Radiculopathy

Treatments

Other: Neck and Scapular Stabilization Exercises

Procedure: Cervical Interlaminar Epidural Steroid Injection

Other: Neck Stabilization Exercises

Study type

Interventional

Funder types

Other

Identifiers

NCT05307211

04.03.2022.357

Details and patient eligibility

About

Cervical radiculopathy was first described in 1943 by researchers named Semmes and Murphy, years later than lumbosacral radiculopathy. It is a neurological condition caused by dysfunction in the cervical spinal nerves, nerve roots, or both. This compression occurs as a result of disc herniation, spondylosis, trauma, spinal tumors, etc. As the first symptom, it manifests as pain. When pain radiates from the neck to the shoulder and arm and is accompanied by sensory complaints and motor weakness, cervical radiculopathy should be suspected. It is a significant cause of morbidity and disability in both men and women, and it occurs in middle age. As a result, clinicians must quickly diagnose and determine the best treatment method. The majority of the information in the literature on the incidence of cervical radiculopathy is based on the findings of a large population-based study conducted between 1976 and 1990 by the Mayo Clinic in Rochester, Minnesota. The incidence rate of cervical radiculopathy was reported to be 83.2 per 100,000 per year in this study, which included 561 cases. The primary goals of treatment are to alleviate pain, restore neurological function, and prevent a recurrence. According to the literature, cervical radiculopathy recurs at a rate of 31.7%, and 26% of them go to surgery. Treatment options vary depending on whether the symptoms are acute or chronic and their severity. In the treatment of cervical radiculopathy, either conservative (non-operative) or surgical treatments are used. In patients with chronic neck pain with or without radiculopathy, a cervical epidural steroid injection is one of the most frequently used interventional therapeutic options. Chronic neck pain or radicular pain caused by disc herniation, spinal stenosis, or discogenic pain can also be treated with cervical epidural injections. Cervical stability training is an exercise program that is used to strengthen the cervical spine, relieve pain, and improve functionality. Changes in dynamic scapula stabilization are observed in patients with chronic neck pain. The scapula connects the neck and shoulder, so it plays an important role in stabilizing the neck and shoulder complex. Because of the interaction between the neck and the scapula, scapular stability becomes more important in these patients.

Full description

Many studies in the literature separately investigate the effectiveness of Cervical Interlaminar Epidural Steroid Injection (CIESI) in radiculopathy due to cervical disc herniation or the effectiveness of stabilization exercises and physical therapy modalities in these patients. However, there have been no studies on the effectiveness of post-injection exercise training as far as we are aware. Our study aims to investigate the benefit of stabilization exercises after interlaminar epidural steroid injection in patients with radiculopathy caused by cervical disc herniation, add a new study to the literature, and guide future research.

Enrollment

60 patients

Sex

All

Ages

18 to 65 years old

Volunteers

No Healthy Volunteers

Inclusion criteria

Between the ages of 18-65
Cervical radiculopathy has caused neck and arm pain for at least three months.
Sign a consent form and volunteer to take part in the study.

Exclusion criteria

Previous surgical/interventional procedure for the cervical region
Presence of other musculoskeletal disorders (such as lateral epicondylitis, tendinitis, entrapment neuropathy) that may cause diagnostic confusion in terms of pain pattern and localization
Signs of trauma, fracture, malignancy, or active infection
Rheumatological (RA, AS, etc.), endocrinological (such as osteoporosis, Paget's disease), or another systemic disease that may change the anatomical or physiological structure of the relevant regions Presence of coagulopathy
History of whiplash injury, cervical spinal stenosis, cervical spondylosis
Being pregnant and breastfeeding
Presence of mental deterioration or psychiatric/neurological disease that can affect the flow of the study.
Having a history of allergic reactions to the injectables that will be used.
Presence of cardiopulmonary disease that may lead to exercise intolerance (heart failure, chronic obstructive pulmonary disease, etc.)
Failure to implement the exercise program regularly.

Trial design

Primary purpose

Treatment

Allocation

Randomized

Interventional model

Parallel Assignment

Masking

Single Blind

60 participants in 3 patient groups

GROUP 1 (CIESI Only)

Active Comparator group

Description:

Only interlaminar epidural steroid injection will be administered to patients in this arm with the same method as in the other arms (one session, week 0). Staying active will be the only recommendation, and no exercise prescription will be provided.

Treatment:

Procedure: Cervical Interlaminar Epidural Steroid Injection

GROUP 2 (CIESI plus NECK STABILIZATION EXERCISES)

Experimental group

Description:

After the interlaminar epidural steroid injection, the patients will be taken to an exercise program in the physical therapy unit, in the company of a physiotherapist, within 24 hours, within 72 hours at the latest.

Treatment:

Procedure: Cervical Interlaminar Epidural Steroid Injection

Other: Neck Stabilization Exercises

GROUP 3 ( CIESI plus NECK and SCAPULAR STABILIZATION EXERCISES)

Experimental group

Description:

Treatment:

Other: Neck and Scapular Stabilization Exercises

Procedure: Cervical Interlaminar Epidural Steroid Injection