Early Outcomes of Cervical Interlaminar Epidural Steroid Injection Under Mild-to-Moderate Sedation: A Retrospective Cohort Study
DOI:
https://doi.org/10.58600/eurjther3089Keywords:
anesthesiology, cervical radiculopathy, epidural injection, mild-to-moderate sedation, painAbstract
Objective: The role of sedation during cervical interlaminar epidural steroid injections remains controversial in terms of patient comfort and procedural safety. This study aimed to present the early clinical outcomes of cervical interlaminar epidural steroid injections performed under sedation in patients with cervical radiculopathy.
Methods: This retrospective observational study included 44 patients who underwent cervical interlaminar epidural steroid injections under sedation. Pain intensity was assessed before the procedure and at 4 hours after the procedure using the NRS-11, and post-procedural patient satisfaction was evaluated using a Likert scale. Cumulative radiation dose, fluoroscopy time, and intra-procedural complications were analyzed. Mild-to-moderate sedation was targeted, and the Modified Observer’s Assessment of Alertness/Sedation Scale (MOAA/S) was used to assess the level of sedation.
Results: At 4 hours post-procedure, a significant decrease in NRS-11 scores was observed compared with pre-procedure scores. Most patients reported high post-procedure satisfaction. No major complications were observed during the study period, and the minor side effects were transient. However, due to the retrospective nature of the study and the absence of a comparison group without sedation, the findings cannot be considered to definitively reflect the effect of sedation.
Conclusion: Cervical interlaminar epidural steroid injections administered with mild-to-moderate sedation were associated with early pain reduction and high patient satisfaction. However, given the limitations of the present study, these findings should be interpreted with caution, and prospective, controlled studies are required to determine the true contribution of sedation.
References
[1] Bono CM, Ghiselli G, Gilbert TJ, Kreiner DS, Reitman C, Summers JT, Baisden JL, Easa JE, Fernand R, Lamer T, Matz PG, Mazanec DJ, Resnick DK, Shaffer WO, Sharma AK, Timmons RB, Toton JF (2011) An evidence-based clinical guideline for the diagnosis and treatment of cervical radiculopathy from degenerative disorders. Spine J. 11(1):64–72. https://doi.org/10.1016/j.spinee.2010.10.023
[2] Mansfield M, Smith T, Spahr N, Thacker M (2020) Cervical spine radiculopathy epidemiology: a systematic review. Musculoskelet Care. 18(4):555–567. https://doi.org/10.1002/msc.1498
[3] Roth D, Mukai A, Thomas P, Hudgins TH, Alleva JT (2009) Cervical radiculopathy. Dis Mon. 55(12):737–756. https://doi.org/10.1016/j.disamonth.2009.06.004
[4] Woods BI, Hilibrand AS (2015) Cervical radiculopathy: epidemiology, etiology, diagnosis, and treatment. J Spinal Disord Tech. 28(5):E251–E259. https://doi.org/10.1097/BSD.0000000000000284
[5] Peene L, Cohen SP, Brouwer B, James R, Wolff A, Van Boxem K, Van Zundert J (2023) Cervical radicular pain. Pain Pract. 23(7):800–817. https://doi.org/10.1111/papr.13252
[6] Conway A, Rolley J, Sutherland JR (2016) Midazolam for sedation before procedures. Cochrane Database Syst Rev. 2016(5):CD009491. https://doi.org/10.1002/14651858.CD009491.pub2
[7] Wisconsin Physician Services Insurance Corporation (2015) Local coverage determination (LCD): epidural and transforaminal epidural injections (L34622). Available from: https://www.wpsgha.com/guides-resources/view/798. Accessed February 4, 2026.
[8] American Society of Anesthesiologists (2015) Standards for basic anesthetic monitoring. Available from: https://www.asahq.org/standards-and-guidelines/standards-for-basic-anesthetic-monitoring. Accessed February 4, 2026.
[9] Kaye AD, Jones MR, Viswanath O, Candido KD, Boswell MV, Soin A, Sanapati M, Harned ME, Simopoulos TT, Diwan S, Albers SL, Datta S, Falco FJ, Manchikanti L (2019) ASIPP guidelines for sedation and fasting status of patients undergoing interventional pain management procedures. Pain Physician 22(3):201–207. Available from: https://www.painphysicianjournal.com/current/pdf?article=NjMwMQ==&journal=120
[10] Fardon DF, Williams AL, Dohring EJ, Murtagh FR, Rothman SL, Sze GK (2014) Lumbar disc nomenclature: version 2.0. Recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology. Spine J 14(11):2525–2545. https://doi.org/10.1016/j.spinee.2014.04.022
[11] Altun G, Esin A, Ozsahin Y, Arslan S, Erkalp K, Salihoglu Z (2025) Outcomes of rhomboid intercostal plane block on local anaesthesia in cardiac implantable electronic device implantation: a randomized controlled clinical trial. BMC Anesthesiol 25:328. https://doi.org/10.1186/s12871-025-02859-4
[12] Van Haperen M, Preckel B, Eberl S (2019) Indications, contraindications, and safety aspects of procedural sedation. Curr Opin Anaesthesiol. 32(6):769–775. https://doi.org/10.1097/ACO.0000000000000777
[13] Benzoni T, Agarwal A, Cascella M (2025) Procedural sedation. In: StatPearls. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551685/. Accessed February 27, 2026.
[14] Lee E, Lee JW, Kang HS (2023) Interlaminar versus transforaminal epidural steroid injections: a review of efficacy and safety. Skeletal Radiol. 52(10):1825–1840. https://doi.org/10.1007/s00256-023-04339-1
[15] Joshi J, Roytman M, Aiyer R, Mauer E, Chazen JL (2022) Cervical spine ligamentum flavum gaps: MR characterization and implications for interlaminar epidural injection therapy. Reg Anesth Pain Med. 47(8):459–463. https://doi.org/10.1136/rapm-2022-103523
[16] Huston CW (2009) Cervical epidural steroid injections in the management of cervical radiculitis: interlaminar versus transforaminal. Curr Rev Musculoskelet Med. 2(1):1–7. https://doi.org/10.1007/s12178-008-9039-0
[17] Clements N, Vydra D, Cushman DM, Nagpal A, Julia J, Zheng P, McCormick ZL (2019) Trends in steroid agent and diluent choices for epidural steroid injections: a survey of Spine Intervention Society physicians. Reg Anesth Pain Med. 44(8):809–813. https://doi.org/10.1136/rapm-2018-100366
[18] Mehta P, Syrop I, Singh JR, Kirschner J (2017) Systematic review of the efficacy of particulate versus nonparticulate corticosteroids in epidural injections. PM R. 9(5):502–512. https://doi.org/10.1016/j.pmrj.2016.10.010
[19] Yamashita K, Ikuma H, Tokashiki T, Maehara T, Nagamachi A, Takata Y, Sakai T, Higashino K, Sairyo K (2017) Radiation exposure to the hand of a spinal interventionalist during fluoroscopically guided procedures. Asian Spine J. 11(1):75–81. https://doi.org/10.4184/asj.2017.11.1.75
[20] Sacaklidir R, Ozturk EC, Sencan S, Gunduz OH (2022) Radiation doses for different approaches of fluoroscopy-guided epidural injections: an observational clinical study. Pain Physician 25(1):E67–E72. Available from: https://www.painphysicianjournal.com/current/pdf?article=NzI3Mw%3D%3D&journal=136
[21] Levi D, Horn S, Runzo D (2022) Single-center experience on the rate of discontinuation and safety of cervical transforaminal epidural steroid injections using the modified approach in an office setting without sedation. Interv Pain Med. 1(3):100075. https://doi.org/10.1016/j.inpm.2022.100075
Downloads
Published
How to Cite
License
Copyright (c) 2026 Halil İbrahim Altun, Gözde Altun, Fatma Ayşen Eren
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The content of this journal is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
