IMPACT OF CERVICAL EPIDURAL STEROID INJECTIONS COMBINED WITH NEURAL MOBILIZATION IN MANAGING CERVICAL RADICULAR PAIN: A SYSTEMATIC REVIEW

Background: Cervical radicular pain is a prevalent condition caused by nerve root irritation or compression, often due to disc herniation or degenerative cervical spine disorders. It significantly impacts daily functioning and quality of life. Cervical epidural steroid injection (CESI) is widely used to reduce inflammation and provide symptomatic relief, while neural mobilization (NM) is a manual therapy technique aimed at restoring nerve mobility and reducing mechanosensitivity. The combined therapeutic value of CESI and NM, however, remains unexplored in clinical trials. Objective: To systematically review existing literature evaluating the clinical effectiveness of combining CESI with NM in the management of cervical radicular pain compared to either therapy alone or conventional physiotherapy. Methods: A structured literature search was carried out in PubMed, Scopus, PEDro, and the Cochrane Library, covering studies published up to March 2025. Keywords and MeSH terms included “cervical radiculopathy,” “epidural steroid injection,” “neural mobilization,” and related terms. Inclusion criteria encompassed randomized controlled trials, quasi-experimental, and comparative studies involving adults with clinically and radiologically confirmed cervical radicular pain. Primary outcomes assessed were pain intensity (VAS, NRS), functional disability (NDI), cervical range of motion, and quality of life metrics (SF-36, EQ-5D). Study quality was appraised using the PEDro scale, with risk of bias systematically evaluated. Results: Out of 3,152 initially identified studies, 28 met the final inclusion criteria. Among these, 14 were randomized controlled trials, 5 were systematic reviews, 4 retrospective studies, and the rest included prospective and clinical trials. While individual efficacy of CESI and NM was well-documented—with most studies reporting statistically significant improvements in pain (p < 0.05) and NDI scores—no trial directly assessed their combined effect. Therefore, a meta-analysis could not be conducted. Conclusion: This review highlights a significant gap in the literature regarding the combined use of CESI and NM for cervical radicular pain. Despite strong individual evidence, high-quality, large-scale randomized controlled trials are urgently needed to investigate the potential synergistic benefits of this integrative approach.