Closer is better-interlaminar epidural steroid injection is more effective at C6-C7 than at C7-T1: a case report

The C7-T1 interspace is generally preferred for cervical interlaminar epidural steroid injections (ESIs) because of its relatively wide epidural space, which allows for safer needle access. However, cervical degeneration primarily occurs above the C7-T1 level, suggesting that interlaminar ESIs would be more effective at C6-C7 than at C7-T1. This report presents a case of central cervical spinal stenosis that was refractory to conventional C7-T1 interlaminar ESIs but showed significant pain relief following a targeted injection at C6-C7. A 71-year-old male presented with chronic posterior neck pain and bilateral interscapular pain (numeric rating scale [NRS] 7) associated with multilevel central canal stenosis from C3-C4 to C6-C7. The patient had previously undergone four sessions of interlaminar ESIs at the C7-T1 level, with no pain relief. Subsequently, we performed interlaminar ESI at C6-C7 to achieve better drug delivery to the stenotic segments. Following the C6-C7 injection, the patient's pain decreased from NRS 7 to NRS 3, with sustained relief lasting for at least 2 months. When cervical ESIs at C7-T1 provide insufficient relief, interlaminar ESIs at C6-C7 may be considered an alternative approach to improve clinical outcomes.