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Cervical RadiculopathyPhase 4NCT03382821

Comparative Trial Via Tranforaminal Approach Versus Epidural Catheter Via Interlaminar Approach

A Phase 4 study testing Transforaminal ESI with dexamethasone, Transforaminal catheter-targeted ESI with triamcinolone and Dexamethasone Sodium Phosphate 10 MG/ML in people with Cervical Radiculopathy, run by University of Utah at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Do cervical epidural steroid injections done by transforaminal catheter targeted approach improve pain and function in patients with cervical radicular pain? Read more about this study

Who is it for?
Ages 18 to 80 years
Conditions the study is for
Cervical Radiculopathy
What is being tested?
Transforaminal ESI with dexamethasone, Transforaminal catheter-targeted ESI with triamcinolone and Dexamethasone Sodium Phosphate 10 MG/ML
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
120 participants
Where
1 siteUnited States
Study dates
15 Sep 2017to 19 Aug 2020
Phase
Phase 4
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 80 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age 18-80.
  • Clinical diagnosis of unilateral C4-C8 radicular pain.
  • Magnetic resonance imaging pathology consistent with clinical symptoms/signs.
  • Numerical Rating Scale (NRS) pain score of 4 or higher.
  • Pain duration of more than 6 weeks despite trial of conservative therapy (medications, physical therapy, or chiropractic care).

Who cannot join

  • Refusal to participate, provide consent, or provide follow-up information for the 6-month duration of the study.
  • Contraindications to Cervical Epidural Steroid Iinjection (CESI) (active infection, bleeding disorders, current anticoagulant or antiplatelet medication use, allergy to medications used for Cervical epidural steroid injection (CESI), and pregnancy).
  • Cervical spinal cord lesions; cerebrovascular, demyelinating, or other neuro-muscular muscular disease.
  • Current glucocorticoid use or Epidural Steroid Injection (ESI) within past 6 months.
  • Prior cervical spine surgery.
  • Patient request for or requirement of conscious sedation for the injection procedure.

Trial locations and contacts

1 site in 1 country.

United States1 site
  • University of Utah Orthopaedic Center

    Salt Lake City, Utah, 84108

Other trials in United States

About this study

Official title: A Prospective Randomized Comparative Trial of Targeted Injection Via a Transforaminal Approach With Dexamethasone Versus an Epidural Catheter Via an Interlaminar Approach With Particulate Steroid for the Treatment of Cervical Radicular Pain

Do cervical epidural steroid injections done by transforaminal catheter targeted approach improve pain and function in patients with cervical radicular pain?

Read the detailed description

Two distinct techniques used to administer epidural steroids specifically to the nerve root affected in a radicular pain syndrome, which include transforaminal access at the level of pathology and interlaminar interlaminar access at the C7-T1 level with subsequent advancement of an epidural cathether to the level of pathology. Use of an epidural catheter is necessary in order to achieve a targeted injection via an interlaminar approach in order to prevent dural puncture or direct spinal cord trauma. Anatomic studies confirm the distance between the ligamentum flavum and dura is on average, 4 mm at the C7-T1 or C6-C7 levels, but 1mm or smaller at C5-C6 and more rostral levels. Therefore, there is likely greater risk of dural puncture and spinal cord injury when "targeting" steroid delivery using only the interlaminar technique directly at the level where pathology is located (C4-C5, or C5-C6, for example). Thus, the interlaminar placement of a needle rostral to the C6-C7 level has been strongly discouraged.

Both the transforaminal injection approach and the targeted catheter approach demonstrate effectiveness. Studies have demonstrated the effectiveness of transforaminal epidural steroid injection for the treatment of cervical radicular pain. Our own recent work demonstrates the clinical effectiveness of the catheter-based targeted approach. However, these two approaches have never been directly compared. Thus, we aim to compare the differences in pain reduction, medication utilization, functional outcomes, patient satisfaction, and surgical rate reduction between these two approaches to the treatment of cervical radicular pain.

Cervical radicular pain is a common syndrome, often treated with epidural steroid injection (ESI). An approach that targets the therapeutic agent, corticosteroid, at the site of spinal pathology can be performed via a transforaminal approach or via a interlaminar approach at C7-T1 with subsequent epidural catheter advancement to the symptomatic level. There are no universal guidelines that recommend the use of one technique over the other. We will directly compare the clinical effectiveness of these two approaches as measured by pain reduction, medication utilization, functional outcomes, patient satisfaction, and surgical rate reduction. The results of this study will potentially influence clinical practice recommendations regarding the treatment of cervical radicular pain. If one technique proves superior, instating this technique will have implications potentially for reducing opioid use, surgery and other healthcare utilization, and general healthcare cost related to the treatment of cervical radicular pain.

Being tested
Transforaminal ESI with dexamethasone, Transforaminal catheter-targeted ESI with triamcinolone, Dexamethasone Sodium Phosphate 10 MG/ML, Lidocaine, Triamcinolone Acetonide 40mg/mL
Keywords
cervical epidural steroid injection, transforaminal approach, epidural catheter targeted, interlaminar approach, cervical radicular pain
Medical subject headings
Radiculopathy

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Transforaminal ESI with dexamethasoneProcedure or surgery

    Catheter-targeted ESI via interlaminar access at the C7-T1 level with dexamethasone sodium phosphate 1.5 mL (10 mg/mL) and 1 ml 1% lidocaine (total volume 2.5 mL).

  • Transforaminal catheter-targeted ESI with triamcinoloneProcedure or surgery

    Catheter-targeted ESI via interlaminar access at the C7-T1 level with triamcinolone acetonide 2 mL (40mg/mL) and 1 ml 1% lidocaine (total volume 3 mL).

  • Dexamethasone Sodium Phosphate 10 MG/MLDrug

    Transforaminal ESI with dexamethasone 1.5 mL of dexamethasone sodium phosphate in group #1

  • LidocaineDrug

    Also called Xylocaine

    1 mL of 1% lidocaine as diluent for the steroid in both group #1 and group #2

  • Triamcinolone Acetonide 40mg/mLDrug

    Also called Kenalog

    Transforaminal catheter-targeted ESI with triamcinolone acetonide 2 mL in group #2

Study groups in NCT03382821
Study groupRoleWhat they receive
Transforaminal ESI with dexamethasoneActive comparatorGroup 1: Transforaminal cervical ESI with dexamethasone sodium phosphate
Receives: Procedure: Transforaminal ESI with dexamethasone; Drug: Dexamethasone Sodium Phosphate 10 MG/ML; Drug: Lidocaine
Transforaminal catheter-targeted ESI with triamcinoloneActive comparatorGroup 2: Catheter-targeted cervical ESI with triamcinolone acetonide
Receives: Procedure: Transforaminal catheter-targeted ESI with triamcinolone; Drug: Lidocaine; Drug: Triamcinolone Acetonide 40mg/mL

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. The Percentage of Participants With Reduction of 50% or More of Neck and Arm Pain NRS Score

    The Percentage of Participants with Reduction of 50% or More of Neck and Arm Pain NRS score

    Measured: 1 month follow up

Secondary outcomes (3)
  1. Neck Disability Index-5

    Percentage of patients with >30% improvement in Neck Disability Index-5 score.

    Measured: 1 month, 3 month, 6 month, and 1 year follow up

  2. Percentage of Participants Reporting >6.8 Reduction on the Medication Quantification Scale III

    The Medication Quantification Scale (MQS) is an instrument used for clinical and research applications for quantifying medication regimen use in chronic pain populations. A 6.8 point reduction is considered equivalent to 10 morphine eqivalents.

    Measured: 1 month, 3 month, 6 month, and 1 year follow up

  3. The Percentage of Participants Reporting Patient Global Impression of Change Score of 6-7 (Indicating "Much Improved" and "Very Much Improved")

    Patient Global Impression of Change is a scale which measures participant reported satisfaction after an intervention. The outcome was measured as the percent of patients reporting a PGIC score of 6-7 (indicating "much improved" and "very much improved")

    Measured: 1 month, 3 month, 6 month, and 1 year follow up

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted26 Dec 2017
  2. Study start15 Sep 2017
  3. Primary completion15 Apr 2020
  4. Study completion19 Aug 2020

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Prospective, randomized, comparative trial
Masking
Single blind
Who is masked
Participant
Enrolment
120 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03382821
Sponsor's protocol ID
105766
Status last verified
Nov 2022
First submitted
4 Dec 2017
Last updated
25 Nov 2022
Data monitoring committee
No
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
Undecided

Publications

  • Radhakrishnan K, Litchy WJ, O'Fallon WM, Kurland LT. Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976 through 1990. Brain. 1994 Apr;117 ( Pt 2):325-35. doi: 10.1093/brain/117.2.325.

    PubMed 8186959
  • Carette S, Fehlings MG. Clinical practice. Cervical radiculopathy. N Engl J Med. 2005 Jul 28;353(4):392-9. doi: 10.1056/NEJMcp043887. No abstract available.

    PubMed 16049211
  • Heckmann JG, Lang CJ, Zobelein I, Laumer R, Druschky A, Neundorfer B. Herniated cervical intervertebral discs with radiculopathy: an outcome study of conservatively or surgically treated patients. J Spinal Disord. 1999 Oct;12(5):396-401.

    PubMed 10549703
  • Johnston MM, Jordan SE, Charles AC. Pain referral patterns of the C1 to C3 nerves: implications for headache disorders. Ann Neurol. 2013 Jul;74(1):145-8. doi: 10.1002/ana.23869. Epub 2013 Jun 17.

    PubMed 23424170
  • Mizutamari M, Sei A, Tokiyoshi A, Fujimoto T, Taniwaki T, Togami W, Mizuta H. Corresponding scapular pain with the nerve root involved in cervical radiculopathy. J Orthop Surg (Hong Kong). 2010 Dec;18(3):356-60. doi: 10.1177/230949901001800320.

    PubMed 21187551
  • Rhee JM, Yoon T, Riew KD. Cervical radiculopathy. J Am Acad Orthop Surg. 2007 Aug;15(8):486-94. doi: 10.5435/00124635-200708000-00005.

    PubMed 17664368
  • Malanga GA. The diagnosis and treatment of cervical radiculopathy. Med Sci Sports Exerc. 1997 Jul;29(7 Suppl):S236-45. doi: 10.1097/00005768-199707001-00006.

    PubMed 9247921
  • Renfrew DL, Moore TE, Kathol MH, el-Khoury GY, Lemke JH, Walker CW. Correct placement of epidural steroid injections: fluoroscopic guidance and contrast administration. AJNR Am J Neuroradiol. 1991 Sep-Oct;12(5):1003-7.

    PubMed 1719788
  • Mehta M, Salmon N. Extradural block. Confirmation of the injection site by X-ray monitoring. Anaesthesia. 1985 Oct;40(10):1009-12. doi: 10.1111/j.1365-2044.1985.tb10558.x.

    PubMed 4061788
  • Stojanovic MP, Vu TN, Caneris O, Slezak J, Cohen SP, Sang CN. The role of fluoroscopy in cervical epidural steroid injections: an analysis of contrast dispersal patterns. Spine (Phila Pa 1976). 2002 Mar 1;27(5):509-14. doi: 10.1097/00007632-200203010-00011.

    PubMed 11880836
  • Van Zundert J, Huntoon M, Patijn J, Lataster A, Mekhail N, van Kleef M; Pain Practice. 4. Cervical radicular pain. Pain Pract. 2010 Jan-Feb;10(1):1-17. doi: 10.1111/j.1533-2500.2009.00319.x. Epub 2009 Oct 5.

    PubMed 19807874
  • Johansson A, Hao J, Sjolund B. Local corticosteroid application blocks transmission in normal nociceptive C-fibres. Acta Anaesthesiol Scand. 1990 Jul;34(5):335-8. doi: 10.1111/j.1399-6576.1990.tb03097.x.

    PubMed 2167604
  • Benyamin RM, Singh V, Parr AT, Conn A, Diwan S, Abdi S. Systematic review of the effectiveness of cervical epidurals in the management of chronic neck pain. Pain Physician. 2009 Jan-Feb;12(1):137-57.

    PubMed 19165300
  • Stav A, Ovadia L, Sternberg A, Kaadan M, Weksler N. Cervical epidural steroid injection for cervicobrachialgia. Acta Anaesthesiol Scand. 1993 Aug;37(6):562-6. doi: 10.1111/j.1399-6576.1993.tb03765.x.

    PubMed 8213020
  • Castagnera L, Maurette P, Pointillart V, Vital JM, Erny P, Senegas J. Long-term results of cervical epidural steroid injection with and without morphine in chronic cervical radicular pain. Pain. 1994 Aug;58(2):239-243. doi: 10.1016/0304-3959(94)90204-6.

    PubMed 7816491

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Transforaminal ESI with dexamethasone, Transforaminal catheter-targeted ESI with triamcinolone and Dexamethasone Sodium Phosphate 10 MG/ML in people with Cervical Radiculopathy, run by University of Utah at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 25 Nov 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 22 Mar 2021). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

The Percentage of Participants With Reduction of 50% or More of Neck and Arm Pain NRS Score (time frame: 1 month follow up). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03382821, which also lists 29 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 25 Nov 2022.

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