• Guy Yeul Ji, Chang Hyun Oh, Keun Su Won, In Bo Han, Yoon Ha, Dong Ah Shin, and Keung Nyun Kim.
• Department of Neurosurgery, CHA University, Bundang CHA Medical Center, Sungnam, Korea.
• Pain Physician. 2016 Feb 1; 19 (2): 39-48.

BackgroundThe efficacy of lumbar percutaneous epidural neuroplasty (PEN) as a minimally invasive technique has been relatively well investigated, but the clinical effectiveness of cervical PEN (C-PEN) has yet to be established.ObjectiveThe purpose of this study was to compare clinical outcomes between C-PEN and cervical epidural steroid injection (C-ESI).Study DesignRandomized control study.SettingUniversity hospital center.MethodsEighty patients with neck pain from single level cervical disease with and without radiculopathy were included in this study. Patients were randomly assigned into 2 groups: C-PEN or C-ESI. Clinical outcomes were assessed according to Neck Disability Index (NDI) score and Visual Analog Scale (VAS) score for arm pain until 12 months after treatment.ResultsAll C-PEN and C-ESI groups showed better NDI recovery and greater reduction in VAS score at postoperative 6 months (P < 0.001). The C-PEN group demonstrated better NDI score at postoperative 6 months than the C-ESI group (P = 0.014), while there were no differences at 2, 4, and 12 months. Additionally, the C-PEN group showed lower VAS scores at all follow-up intervals compared to the C-ESI group (P < 0.050). Symptom relief was sustained for a significantly longer duration in the C-PEN group than in the C-ESI group (23.4 vs. 20.5 weeks, P < 0.001).LimitationsThe follow-up period was relatively short with a small sample size, and the grade of cervical disc disease, root compression, and disc degeneration grade were could not considered in this study.ConclusionsC-PEN was superior to C-ESI in terms of better NDI recovery (at 6 months) and greater reduction in VAS score (until 12 months) in treating single level cervical disc herniation. Better outcomes with C-PEN may have been achieved via a more localized selective block in the epidural space closer to the dorsal root ganglion and ventral aspect of the nerve root.

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