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Systemic steroids for cervical radicular pain: A systematic review
Nolan Gall1, Cyrus Ghaffari2, Jyotsna Koduri2
1Department of Anesthesiology and Critical Care, Division of Pain Medicine, Philadelphia, PA, USA.
Objective:
Determine the effectiveness of systemic steroids for the treatment of cervical radicular pain.
Data Sources:
We identified articles from two electronic databases (PubMed and Ovid Medline) and previously known articles.
Study Selection:
We combined (using the Boolean Operator "AND") the following search terms: "Steroid* and Cervical Radic*" or "Steroid* and Cervicobrachialgia". We applied the search to PubMed and Ovid Medline research databases for all studies up February 11, 2022. We included all published articles involving cervical radicular pain treated with systemic steroids among adult users (≥18 years old). We defined systemic steroids as steroid medication administered into the body excluding epidural or intra-articular injections. We excluded reviews and editorials.
Data Extraction:
Information extracted from each study included: (1) study design; (2) characteristics of trial participants; (3) diagnostic criteria; (4) treatment intervention protocol; (5) outcome measure; and (6) follow-up time. Outcomes included the neck disability index (NDI) and patient reported pain.
Data Synthesis:
842 publications were identified, 7 were suitable for inclusion. The only level one study comparing oral steroid to placebo reported greater improvements of NDI (35.7 ± 21.4 versus 12.9 ± 10.2, P < 0.001) and NPRS (4.4 ± 2.7 versus 1.6 ± 1.2, P < 0.001), and higher success rates (76% [95% CI: 60-92%] vs 30% [95% CI: 14-46%]) in the oral steroid group compared to the placebo group. The only level one study comparing paraspinal intramuscular (IM) versus interlaminar (IL) epidural steroids reported worse outcomes in the IM group with a success rate of 35% [95% CI: 13-58%] at 1 week and 12% [95% CI: 0-27%] at one year in the IM group, compared to 76% [95% CI: 60-92%] at 1 week (p = 0.04) and 68% [95% CI: 50-86%] at one year (p = 0.0004) in the IL group (P < 0.0004). The Cochrane Risk of Bias Tool and GRADE system was used to assess bias and rate the overall evidence quality.
Conclusions:
Very limited evidence exists supporting treatment of cervical radicular pain with systemic steroids. Oral steroids can be considered as a reasonable conservative option based on one RCT, whereas IM steroids may be inferior to epidural steroids based on another RCT. Additional higher quality studies are needed.
