{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T16:58:39Z","timestamp":1785257919716,"version":"3.55.0"},"reference-count":36,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Cervical radiculopathy is a common and disabling condition with both nociceptive and neuropathic pain components. Epidural steroid injections (ESIs) are widely used as an interventional treatment modality; however, the optimal cervicothoracic interlaminar access level and injectate volume remain subjects of ongoing debate. Because injection level and injectate volume have historically been varied together in routine practice rather than independently, prospectively designed comparative data are lacking. Methods: In this retrospective, multicenter cohort study, 166 patients with MRI-confirmed cervical radiculopathy treated between January 2022 and December 2025 at three participating institutions received fluoroscopy-guided cervicothoracic interlaminar epidural steroid injections with dexamethasone and bupivacaine at either C7\/T1 (6 mL; n = 87) or T1\/T2 (8 mL; n = 79), with protocol determined by the treating institution rather than randomization. The prespecified primary outcome was the baseline-adjusted between-group difference in arm-pain Numeric Rating Scale (NRS) score at 3 months, analyzed by analysis of covariance (ANCOVA) adjusted for a directed acyclic graph-informed covariate set (age, symptom duration, baseline pain severity, number of stenotic levels, DN4 score, and treatment center); the same covariates were used in a generalized estimating equation (GEE) model with a group-by-time interaction and in a multivariable logistic regression for treatment response. Secondary outcomes\u2014neck-pain NRS and VAS, neuropathic pain (DN4), functional disability (NDI), quality of life (SF-36, EQ-5D), Patient Global Impression of Change (PGIC), analgesic consumption, and cardiovascular\/metabolic safety outcomes\u2014were assessed at baseline, 3 months, and 6 months. Results: Both groups showed significant within-group reductions in arm-pain NRS (C7\/T1: 8.7 \u00b1 0.4 to 3.5 \u00b1 0.4 at 3 months and 4.1 \u00b1 0.6 at 6 months; T1\/T2: 9.2 \u00b1 0.7 to 3.9 \u00b1 0.5 at 3 months and 4.9 \u00b1 0.7 at 6 months; both p &lt; 0.001). Baseline pain scores and symptom duration were not balanced between groups (baseline-adjusted analysis was therefore used). After adjustment for baseline severity, age, symptom duration, and center, the T1\/T2\u20138 mL protocol was associated with higher (worse) adjusted arm-pain NRS than the C7\/T1\u20136 mL protocol at 3 months (adjusted difference 0.41 points, 95% CI 0.21\u20130.61) and 6 months (0.66 points, 95% CI 0.35\u20130.97); a multivariable-adjusted logistic regression model likewise showed lower odds of achieving a \u226550% arm-pain reduction at 3 months with the T1\/T2\u20138 mL protocol (adjusted OR 0.18, 95% CI 0.04\u20130.82). NDI decreased from a mean of 48.1 points at baseline to 28.1 points at 3 months (pooled cohort, score capped at the 0\u201350 scale maximum; the majority of baseline NDI source records could not be individually verified and this is reported as a limitation), and analgesic consumption decreased over follow-up. Among hypertensive patients (45\/166, 27.1%), 78% experienced transient blood pressure elevation and 40% required temporary antihypertensive adjustment; among diabetic patients (13\/166, 7.8%), 92% developed transient hyperglycemia. Because injection level, injectate volume, and treatment center were confounded by design, these findings should be interpreted as a comparison of two center-specific treatment protocols rather than an isolated effect of anatomical level or volume. Conclusions: Both center-specific cervicothoracic interlaminar epidural steroid injection protocols were associated with improvements in pain and function over six months, with no catastrophic procedural complications documented; however, near-complete confounding of injection level with injectate volume and treatment center, together with imbalanced baseline pain severity, precludes conclusions about the comparative effectiveness of C7\/T1 versus T1\/T2 access. Transient cardiovascular and metabolic effects were common and support consideration of post-procedural monitoring in patients with pre-existing hypertension or diabetes.<\/jats:p>","DOI":"10.3390\/jcm15155900","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T15:57:28Z","timestamp":1785254248000},"page":"5900","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Outcomes of Two Institution-Specific Cervicothoracic Interlaminar Epidural Steroid Injection Protocols (C7\/T1\u20136 mL vs. T1\/T2\u20138 mL) in Cervical Radiculopathy: A Multicenter Retrospective Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"given":"Pawe\u0142","family":"Gogol","sequence":"first","affiliation":[{"name":"Neurolocus Pain Management Centre, 04-281 Warsaw, Poland"},{"name":"Pain Treatment Clinic, Our Lady of Perpetual Help Hospital in Wo\u0142omin, 05-200 Wo\u0142omin, Poland"},{"name":"Department of Neurosurgery, Faculty of Medicine, Academy of Silesia, 40-555 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafa\u0142","family":"Pasztaleniec","sequence":"additional","affiliation":[{"name":"Pain Medicine Centre, 64-920 Pi\u0142a, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Szczepaniak","sequence":"additional","affiliation":[{"name":"Neurolocus Pain Management Centre, 04-281 Warsaw, Poland"},{"name":"Pain Treatment Clinic, Our Lady of Perpetual Help Hospital in Wo\u0142omin, 05-200 Wo\u0142omin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafa\u0142","family":"Wi\u015bniewski","sequence":"additional","affiliation":[{"name":"Neurolocus Pain Management Centre, 04-281 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0781-6534","authenticated-orcid":false,"given":"Rafa\u0142","family":"Staszkiewicz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Faculty of Medicine, Academy of Silesia, 40-555 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2684-3757","authenticated-orcid":false,"given":"Micha\u0142","family":"Sobstyl","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Institute of Psychiatry and Neurology, 02-957 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9073-6945","authenticated-orcid":false,"given":"Piotr","family":"W\u0105sik","sequence":"additional","affiliation":[{"name":"Pain Management Clinic, St. Luke\u2019s Hospital in Boles\u0142awiec, 59-700 Boles\u0142awiec, Poland"},{"name":"Pain Management Clinic, District Hospital in Czarnk\u00f3w, 64-700 Czarnk\u00f3w, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1633-7145","authenticated-orcid":false,"given":"Beniamin Oskar","family":"Grabarek","sequence":"additional","affiliation":[{"name":"Collegium Medicum, WSB University, 41-300 D\u0105browa G\u00f3rnicza, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"486","DOI":"10.5435\/00124635-200708000-00005","article-title":"Cervical Radiculopathy","volume":"15","author":"Rhee","year":"2007","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.spinee.2010.10.023","article-title":"An Evidence-Based Clinical Guideline for the Diagnosis and Treatment of Cervical Radiculopathy from Degenerative Disorders","volume":"11","author":"Bono","year":"2011","journal-title":"Spine J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1007\/s11916-009-0032-y","article-title":"The Evaluation of Neuropathic Components in Low Back Pain","volume":"13","author":"Freynhagen","year":"2009","journal-title":"Curr. Pain Headache Rep."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1097\/AAP.0b013e31828ea086","article-title":"Epidural Steroids: A Comprehensive, Evidence-Based Review","volume":"38","author":"Cohen","year":"2013","journal-title":"Reg. Anesth. Pain Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e213361","DOI":"10.1212\/WNL.0000000000213361","article-title":"Epidural Steroids for Cervical and Lumbar Radicular Pain and Spinal Stenosis Systematic Review Summary: Report of the AAN Guidelines Subcommittee","volume":"104","author":"Armon","year":"2025","journal-title":"Neurology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e2568","DOI":"10.1097\/MD.0000000000002568","article-title":"Comparison of Clinical Efficacy Between Interlaminar and Transforaminal Epidural Injection in Patients with Axial Pain Due to Cervical Disc Herniation","volume":"95","author":"Lee","year":"2016","journal-title":"Medicine"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1249","DOI":"10.1097\/BRS.0b013e318053ec50","article-title":"Cervical Transforaminal Epidural Steroid Injections: More Dangerous Than We Think?","volume":"32","author":"Scanlon","year":"2007","journal-title":"Spine"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Misterska, E., Jankowski, R., and Glowacki, M. (2011). Cross-Cultural Adaptation of the Neck Disability Index and Copenhagen Neck Functional Disability Scale for Patients with Neck Pain Due to Degenerative and Discopathic Disorders. Psychometric Properties of the Polish Versions. BMC Musculoskelet. Disord., 12.","DOI":"10.1186\/1471-2474-12-84"},{"key":"ref_9","first-page":"1302","article-title":"The Polish version of the SF-36v2 questionnaire for the quality of life assessment","volume":"67","year":"2010","journal-title":"Przegl. Lek."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1007\/s40273-019-00811-7","article-title":"Valuation of EQ-5D-5L Health States in Poland: The First EQ-VT-Based Study in Central and Eastern Europe","volume":"37","author":"Golicki","year":"2019","journal-title":"Pharmacoeconomics"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1097\/AAP.0000000000000521","article-title":"A Prospective Randomized Comparative Trial of Targeted Steroid Injection via Epidural Catheter Versus Standard C7-T1 Interlaminar Approach for the Treatment of Unilateral Cervical Radicular Pain","volume":"42","author":"McCormick","year":"2017","journal-title":"Reg. Anesth. Pain Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1111\/papr.13401","article-title":"Comparative Analysis of Contrast Distribution in Cervical Epidural Steroid Injections Utilizing a Modified Paramedian Interlaminar Approach with Varied Needle Tip Positions: A Randomized Controlled Trial","volume":"24","author":"Yoo","year":"2024","journal-title":"Pain Pract."},{"key":"ref_13","first-page":"E1229","article-title":"Correlation Between the Extent of Injectate Spread and Clinical Outcomes in Cervical Interlaminar Epidural Injection","volume":"25","author":"Kim","year":"2022","journal-title":"Pain Physician"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies","volume":"61","author":"Altman","year":"2008","journal-title":"J. Clin. Epidemiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.1016\/j.jpainsymman.2010.08.016","article-title":"Studies Comparing Numerical Rating Scales, Verbal Rating Scales, and Visual Analogue Scales for Assessment of Pain Intensity in Adults: A Systematic Literature Review","volume":"41","author":"Hjermstad","year":"2011","journal-title":"J. Pain Symptom Manag."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1016\/S0140-6736(74)90884-8","article-title":"Measurement of Pain","volume":"2","author":"Huskisson","year":"1974","journal-title":"Lancet"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.pain.2004.12.010","article-title":"Comparison of Pain Syndromes Associated with Nervous or Somatic Lesions and Development of a New Neuropathic Pain Diagnostic Questionnaire (DN4)","volume":"114","author":"Bouhassira","year":"2005","journal-title":"Pain"},{"key":"ref_18","first-page":"409","article-title":"The Neck Disability Index: A Study of Reliability and Validity","volume":"14","author":"Vernon","year":"1991","journal-title":"J. Manip. Physiol. Ther."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"S240","DOI":"10.1002\/acr.20543","article-title":"Measures of Adult Pain: Visual Analog Scale for Pain (Vas Pain), Numeric Rating Scale for Pain (Nrs Pain), Mcgill Pain Questionnaire (Mpq), Short-Form Mcgill Pain Questionnaire (Sf-Mpq), Chronic Pain Grade Scale (Cpgs), Short Form-36 Bodily Pain Scale (Sf-36 Bps), and Measure of Intermittent and Constant Osteoarthritis Pain (Icoap)","volume":"63","author":"Hawker","year":"2011","journal-title":"Arthritis Care Res."},{"key":"ref_20","first-page":"155","article-title":"EuroQol-5D (EQ-5D): An instrument for measuring quality of life","volume":"78","author":"Balestroni","year":"2012","journal-title":"Monaldi Arch. Chest Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.jmpt.2003.11.003","article-title":"Assessing the Clinical Significance of Change Scores Recorded on Subjective Outcome Measures","volume":"27","author":"Hurst","year":"2004","journal-title":"J. Manip. Physiol. Ther."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"E365","DOI":"10.36076\/ppj\/2016.19.E365","article-title":"Epidural Injections for Lumbar Radiculopathy and Spinal Stenosis: A Comparative Systematic Review and Meta-Analysis","volume":"19","author":"Manchikanti","year":"2016","journal-title":"Pain Physician"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Carassiti, M., Pascarella, G., Strumia, A., Russo, F., Papalia, G.F., Cataldo, R., Gargano, F., Costa, F., Pierri, M., and De Tommasi, F. (2021). Epidural Steroid Injections for Low Back Pain: A Narrative Review. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19010231"},{"key":"ref_24","first-page":"100528","article-title":"Evaluating the Effectiveness of Interlaminar Epidural Steroid Injections for Cervical Radiculopathy Using PROMIS as an Outcome Measure","volume":"3","author":"Stephens","year":"2024","journal-title":"Interv. Pain Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e4777","DOI":"10.1002\/ejp.4777","article-title":"Are Stabilisation Exercises Effective After Epidural Steroid Injection in Patients with Cervical Radiculopathy? A Prospective Randomised Controlled Trial","volume":"29","author":"Tayboga","year":"2025","journal-title":"Eur. J. Pain"},{"key":"ref_26","first-page":"155","article-title":"Distribution Range of Cervical Interlaminar Epidural Injections: A Comparative Study with 2.5 mL, 5 mL, and 10 mL of Contrast","volume":"16","author":"Lee","year":"2013","journal-title":"Pain Physician"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e5206","DOI":"10.1097\/MD.0000000000005206","article-title":"Optimal Volume of Injectate for Fluoroscopy-Guided Cervical Interlaminar Epidural Injection in Patients with Neck and Upper Extremity Pain","volume":"95","author":"Park","year":"2016","journal-title":"Medicine"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1097\/00000542-200702000-00022","article-title":"Comparison of the Particle Sizes of Different Steroids and the Effect of Dilution: A Review of the Relative Neurotoxicities of the Steroids","volume":"106","author":"Benzon","year":"2007","journal-title":"Anesthesiology"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Cuenca-Zald\u00edvar, J.N., Fern\u00e1ndez-Carnero, J., S\u00e1nchez-Romero, E.A., \u00c1lvarez-Gonzalo, V., Conde-Rodr\u00edguez, R., Rodr\u00edguez-Sanz, D., and Calvo-Lobo, C. (2023). Effects of a Therapeutic Exercise Protocol for Patients with Chronic Non-Specific Back Pain in Primary Health Care: A Single-Group Retrospective Cohort Study. J. Clin. Med., 12.","DOI":"10.20944\/preprints202308.1715.v1"},{"key":"ref_30","unstructured":"(2026, July 16). Identifying Cervical Predictors of Recreational Mixed Martial Arts Participation: A Case-Control Study\u2014PubMed, Available online: https:\/\/pubmed.ncbi.nlm.nih.gov\/40423291\/."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"E46","DOI":"10.1097\/BRS.0b013e31821fd21f","article-title":"Effects of Epidural Steroid Injections on Blood Glucose Levels in Patients with Diabetes Mellitus","volume":"37","author":"Even","year":"2012","journal-title":"Spine"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1016\/j.jbspin.2006.10.009","article-title":"Systemic Effects of Epidural and Intra-Articular Glucocorticoid Injections in Diabetic and Non-Diabetic Patients","volume":"74","author":"Younes","year":"2007","journal-title":"Jt. Bone Spine"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2299","DOI":"10.1056\/NEJMp1511754","article-title":"Serious Neurologic Events after Epidural Glucocorticoid Injection\u2014The FDA\u2019s Risk Assessment","volume":"373","author":"Racoosin","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_34","first-page":"100606","article-title":"Rates of Complications after Cervical Transforaminal Epidural Steroid Injections for Patients with Cervical Radiculopathy Utilizing a Large National Database","volume":"4","author":"Stephens","year":"2025","journal-title":"Interv. Pain Med."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Expert Panel on Neurological Imaging, Eldaya, R.W., Parsons, M.S., Hutchins, T.A., Avery, R., Burns, J., Griffith, B., Hassankhani, A., Khan, M.A., and Ng, H. (2025). ACR Appropriateness Criteria\u00ae Cervical Pain or Cervical Radiculopathy: 2024 Update. J. Am. Coll. Radiol., 22, S136\u2013S162.","DOI":"10.1016\/j.jacr.2025.02.035"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.2147\/JPR.S132769","article-title":"Treatment of Chronic Low Back Pain\u2014New Approaches on the Horizon","volume":"10","author":"Knezevic","year":"2017","journal-title":"J. Pain Res."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/15\/5900\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T16:00:55Z","timestamp":1785254455000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/15\/5900"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,28]]},"references-count":36,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcm15155900"],"URL":"https:\/\/doi.org\/10.3390\/jcm15155900","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,28]]}}}