Cervical Epidural Steroid Injection: Parasagittal versus Midline Approach in Patients with Unilateral Cervical Radicular Pain; A Randomized Clinical Trial

Objective: to compare parasagittal interlaminar cervical epidural steroid injection (psil-cesi) and the classic midline interlaminar cervical epidural steroid injection (mil-cesi) in terms of pain relief and functional improvement in patients with unilateral upper extremity radicular pain. methods: this was a randomized clinical trial being conducted in a single pain center in tehran. twenty-six patients were allocated into two groups of 13, undergoing either psil-cesi or mil-cesi. after confirmation of radiocontrast spread in the epidural space by fluoroscopic guidance, dexamethasone 8 mg and bupivacaine 0.125% in a volume of 5 ml were delivered to the epidural space. evaluation of functional state and pain intensity before and 1 month after the procedure was accomplished using the neck disability index (ndi) and the numeric rating scale (nrs) respectively. results: demographic and baseline characteristics of the cases showed no significant statistical difference. improvements in the ndi and the nrs were observed in both groups; meanwhile, improvements were more pronounced in the psil-cesi group as compared to the mil-cesi group (p<0.001). with the psil approach the ventral spread of radiocontrast was significantly higher (38%) than with the mil approach (0.7%) (p<0.001). all patients in psil group showed radiocontrast spread ipsilateral to the painful side and all patients in the mil group showed a midline distribution of radiocontrast. conclusion: psil-cesi provides superior pain relief and improvement of functional disability in patients with unilateral upper extremity radicular pain in comparison to the classic mil-cesi. clinical trial registry: