Predictors of Clinical Response After Interlaminar Cervical Epidural Steroid Injection for Cervical Radiculopathy (M-DICER)

Predictors of Clinical Response After Interlaminar Cervical Epidural Steroid Injection for Cervical Radiculopathy: A Retrospective Cohort Study

Cervical epidural steroid injection is a commonly used treatment option for patients with cervical radicular pain who do not improve adequately with conservative treatment. Cervical radicular pain typically radiates from the neck to the shoulder, arm, or hand and may be accompanied by numbness, weakness or changes in reflexes. The most common causes are cervical disc herniation and cervical spondylosis. By reducing inflammation around the affected nerve root, epidural steroid injection may help relieve pain and improve function. Among available techniques, the interlaminar approach is frequently preferred in the cervical region because of its technical feasibility and safety profile.

Although interlaminar cervical epidural steroid injection is widely used, treatment response varies among patients, and not all individuals experience the same degree of benefit. Identifying the factors associated with better or poorer clinical response may help improve patient selection and reduce unnecessary procedures.

This retrospective cohort study aims to evaluate clinical outcomes after interlaminar cervical epidural steroid injection in patients with cervical radiculopathy and to investigate demographic, clinical, and procedure-related variables which may predict treatment response. By analyzing pain scores before and after the procedure, this study seeks to better define the predictors of clinical outcome following this intervention.

Study Overview

• Status: Completed
• Conditions: Neck Pain; Disc Disease; Radicular Pain; Radiculopathy, Cervical Region

Detailed Description

This retrospective cohort study will review the medical records of patients who presented to the Pain Clinic of Mersin University Faculty of Medicine Hospital between January 1, 2018, and October 1, 2025, with neck pain related to cervical disc herniation and underwent interlaminar cervical epidural steroid injection.

The study population will consist of adult patients who were diagnosed and/or followed by physicians in the research team, had neck pain associated with cervical disc herniation for at least 1 month and provided written informed consent for the procedure. Patients will be excluded if they had an active infection at the time of injection, a history of allergy to local anesthetic or contrast agents or a bleeding diathesis.

Data will be collected from existing medical records using a standardized data collection form. Variables of interest will include age, sex, duration of pain, clinical diagnosis, type of corticosteroid used, presence of fibromyalgia, use of transcutaneous electrical nerve stimulation (TENS), history of trigger point injection, electromyography findings and Numeric Rating Scale (NRS-11) pain scores recorded before the procedure and at 1-month and 6-month follow-up.

The primary aim of the study is to identify demographic, clinical, and procedure-related factors associated with clinical response after interlaminar cervical epidural steroid injection in patients with cervical radiculopathy related to cervical disc herniation.

• Study Type: Observational
• Enrollment (Actual): 107

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Ciftlikkoy
    • Mersin, Ciftlikkoy, Turkey (Türkiye), 33110
      • Department of Pain Medicine, Mersin University Faculty of Medicine

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

The study population consists of adult patients with cervical radiculopathy related to cervical disc herniation who underwent interlaminar cervical epidural steroid injection at the Mersin University Faculty of Medicine, Pain Clinic between January 1, 2018, and October 1, 2025. Only patients who met the predefined inclusion and exclusion criteria and had available pre-procedural, procedural, and post-procedural follow-up data, including Numeric Rating Scale (NRS-11) pain scores, were included in the analysis.

Description

Inclusion Criteria:

• Age ≥ 18 years.
• Presence of neck and upper extremity pain consistent with cervical radiculopathy
• Persistence of symptoms for at least 1 month despite conservative treatment
• Documented baseline NRS-11 pain score prior to the procedure and follow-up NRS-11 data available through at least 6 months after treatment.

Exclusion Criteria:

• Active infection during the time of injection
• Allergie to local anesthetics or contrast agents
• History of bleeding diathesis.
• Insufficient follow-up data (less than 6 months of follow-up NRS-11 documentation).

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Patients Undergoing Cervical Interlaminar Epidural Steroid Injection; This cohort includes eligible patients with cervical radiculopathy due to cervical disc herniation who received interlaminar cervical epidural steroid injection during the study period. In patients who received more than one procedure, only the first injection was analyzed. Clinical response was evaluated retrospectively based on pain scores documented before the procedure and during follow-up.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Treatment response at 6 months (IMMPACT-defined responder rate)	Responder defined as ≥50% reduction or ≥4-point decrease in NRS-11 compared with baseline.	6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in NRS-11 pain score from baseline	NRS-11 ranges from 0 (no pain) to 10 (worst imaginable pain).	Baseline, 1 months, and 6 months

Collaborators and Investigators

• Sponsor: Mersin University

Publications and helpful links

General Publications

• Yolcu G, Toprak CS, Sencan S, Gunduz OH. Dry Needling Plus Cervical Interlaminar Epidural Steroid Injections: Do We Have More Favorable Results in Cervical Disc Herniation? A Randomized Sham-Controlled Clinical Study. Am J Phys Med Rehabil. 2024 Dec 1;103(12):1081-1087. doi: 10.1097/PHM.0000000000002509.
• Yildiz G, Perdecioglu GRG, Akkaya OT, Can E, Yuruk D. Comparison of Selective Nerve Root Pulsed Radiofrequency Vs Paramedian Interlaminar Epidural Steroid Injection for the Treatment of Painful Cervical Radiculopathy. Pain Physician. 2024 Feb;27(2):E221-E229.
• Sacaklidir R, Sanal-Toprak C, Yucel FN, Gunduz OH, Sencan S. The Effect of Central Sensitization on Interlaminar Epidural Steroid Injection Treatment Outcomes in Patients with Cervical Disc Herniation: An Observational Study. Pain Physician. 2022 Sep;25(6):E823-E829.

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2018
• Primary Completion (Actual): April 1, 2026
• Study Completion (Actual): April 10, 2026

Study Registration Dates

• First Submitted: April 10, 2026
• First Submitted That Met QC Criteria: April 10, 2026
• First Posted (Actual): April 17, 2026

Study Record Updates

• Last Update Posted (Actual): April 17, 2026
• Last Update Submitted That Met QC Criteria: April 10, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Treatment Outcome; Injections, Spinal; Interventional Pain Management; Injection, Epidural
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Nervous System Diseases; Neuromuscular Diseases; Peripheral Nervous System Diseases; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Radiculopathy; Neck Pain
• Other Study ID Numbers: MERSINALG-CESI -2026

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be made available because the study is based on retrospectively collected medical record data from a single center, and sharing such data may raise confidentiality and privacy concerns.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No