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

Abstract

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). 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). 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. 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.