Efficacy of subcutaneous perispinal infiltration of triamcinolone in patients with symptomatic cervical osteoarthritis.

Abstract

Objective: To assess the efficacy and safety of subcutaneous perispinal infiltration of low dose of triamcinolone and lidocaine indicated for pain control in patients with cervical osteoarthritis (COA).

Methods: Patients with symptomatic COA resistant to conventional treatment including anti-inflammatory drugs, analgesics, and physical therapy were included. Technetium-99 m pyrophosphate (99mTc-PYP) scintigraphy and computerized tomography (CT) fusion scans images were used for diagnosis of COA and as a guide for level(s) of infiltration(s). Infiltration consisted of subcutaneous administration of 1 cc of a mixture of triamcinolone (6 mg/0.7 cc) and 2% lidocaine (6 mg/0.3 cc) into the posterior central interspinal area, at the levels where the greatest uptake of the radiotracer was observed. Response was assessed using a pain analogue scale (PAS) (range 0-10 with 10 representing worst pain).

Results: Forty-two patients were included. Thirty-six (85.7%) were women. The mean age was 59.2 years. Three months after infiltration clinical improvement was confirmed by a decrease in the PAS value: before and after infiltrations was 7.26 (range 4-10, SD:1.48) and 1.97 (range 0-6, SD:1.24), respectively. This difference being statistically significant (P < 0.05). No patient presented local or systemic adverse effects.

Conclusions: Low dose subcutaneous perispinal injection of triamcinolone and lidocaine may offer clinical benefits for patients with symptomatic COA refractory to conventional treatments. 99mTc-PYP/CT fusion scans images were useful as a guide for localization of infiltrations.