Cervical epidural hematoma following interlaminar epidural steroid injection via the contralateral oblique view in patient taking omega-3 fatty acids

2019 ◽  
Vol 44 (2) ◽  
pp. 253-255 ◽  
Author(s):  
Drew Beasley ◽  
Johnathan H. Goree
Keyword(s):  
Fatty Acids ◽  
Epidural Hematoma ◽  
Steroid Injection ◽  
Epidural Steroid Injection ◽  
Omega 3 Fatty Acids ◽  
Omega 3 ◽  
Oblique View ◽  
Anti Inflammatory ◽  
Interlaminar Epidural Steroid Injection ◽  
Epidural Steroid

Background and objectivesWe sought to describe a case of an epidural hematoma after a cervical interlaminar epidural steroid injection (ILESI) performed using contralateral oblique view. We also discuss factors that could have placed this patient at increased risk, including concurrent use of omega-3 fatty acids and non-steroidal anti-inflammatory medications.Case reportA 74-year-old woman returned to the pain clinic, within 15 min of discharge, after an apparent uncomplicated cervical ILESI using the contralateral oblique technique with severe periscapular pain and muscle spasms. Cervical MRI showed a large epidural hematoma which was subsequently emergently evacuated. On postoperative examination, the patient had no neurologic deficits and full resolution of her painful symptoms.ConclusionsTo our knowledge, this is the first reported case of cervical epidural hematoma in which the contralateral oblique technique was used. Also, this is the second case in which the combination of non-steroidal anti-inflammatory medications and omega-3 fatty acids has been considered as a contributor to increased hematoma risk. This case underscores the risk of epidural hematoma using a novel fluoroscopic technique and the need for potential discontinuation of supplements like omega-3 fatty acids.

Thoracic Interlaminar Epidural Steroid Injection

2018 ◽  
pp. 349-354
Author(s):  
Michael B. Furman ◽  
Frank J.E. Falco ◽  
Jimmy M. Henry ◽  
Akil S. Benjamin
Keyword(s):  
Steroid Injection ◽  
Epidural Steroid Injection ◽  
Interlaminar Epidural Steroid Injection ◽  
Epidural Steroid

Cervical Interlaminar Epidural Steroid Injection Complications Resulting in Monoplegia and Pneumocephalus: A Case Report

PM&R ◽  
2013 ◽  
Vol 5 ◽  
pp. S294-S294
Author(s):  
Nancy Vuong ◽  
Matthew B. McAuliffe ◽  
Adam E. Flanders ◽  
Michael K. Mallow ◽  
Adam L. Schreiber
Keyword(s):  
Case Report ◽  
Steroid Injection ◽  
Epidural Steroid Injection ◽  
Interlaminar Epidural Steroid Injection ◽  
Epidural Steroid

scholarly journals Clinical Effectiveness and Prognostic Indicators of Parasagittal Interlaminar Epidural Injection

2016 ◽  
Vol 6;19 (6;7) ◽  
pp. E877-E884
Author(s):  
JiHee Hong
Keyword(s):  
Spinal Stenosis ◽  
Beck Depression Inventory ◽  
Steroid Injection ◽  
Clinical Effectiveness ◽  
Prognostic Indicator ◽  
Epidural Steroid Injection ◽  
Leg Pain ◽  
Prognostic Indicators ◽  
Interlaminar Epidural Steroid Injection ◽  
Epidural Steroid

Background: Interlaminar epidural steroid injection (ESI) is a well-established intervention to improve radicular leg pain. However, few studies have demonstrated the prognostic factors for interlaminar ESI. Objective: To investigate the clinical effectiveness and prognostic indicators of parasagittal interlaminar ESI during a 2-week follow-up. Study Design: Prospective evaluation. Setting: An interventional pain management practice in South Korea. Methods: After Institutional Review Board approval, parasagittal interlaminar ESI under fluoroscopic guidance was performed in 55 patients with central spinal stenosis. The numerical rating scale (NRS) and the Oswestry Disability Index (ODI) (%) were used to evaluate clinical efficacy and prognostic indicators. To determine the prognostic indicators, treatment outcomes were classified as successful (decreased NRS ≥ 50%, decreased ODI ≥ 40%) and unsuccessful (decreased NRS < 50%, decreased ODI < 40%) results. Results: Parasagittal interlaminar ESI significantly improved the NRS and ODI (%) scores after 2 weeks compared to those measured pretreatment. Paresthesia provocation (P = 0.006) was a significant prognostic factor on the NRS, whereas the Beck Depression Inventory (BDI) score (P = 0.007), paresthesia provocation (P = 0.035), and epidurography finding (P = 0.038) were significant on the ODI (%) score between patients with successful and unsuccessful outcomes. Limitations: We included the method of parasagittal interlaminar ESI only, therefore, direct comparison with other techniques was not available. Conclusion: Parasagittal interlaminar ESI significantly improved the NRS and ODI (%) scores. Paresthesia provocation was a prognostic indicator on the NRS and ODI (%) scores, and BDI scores and epidurography findings were prognostic indicators for the ODI (%) score. Key words: Parasagittal interlaminar epidural steroid injection, spinal stenosis, radicular leg pain, prognostic indicator, paresthesia provocation, epidurography, Beck Depression Inventory

scholarly journals Patients with Refractory Back Pain Treated in the Emergency Department: Is Immediate Interlaminar Epidural Steroid Injection Superior to Hospital Admission and Standard Medical Pain Management?

2015 ◽  
Vol 2;18 (2;3) ◽  
pp. E171-E176
Author(s):  
Todd Miller Todd Miller
Keyword(s):  
Emergency Department ◽  
Back Pain ◽  
Pain Management ◽  
Hospital Admission ◽  
Patient Population ◽  
Steroid Injection ◽  
Epidural Injection ◽  
Epidural Steroid Injection ◽  
Interlaminar Epidural Steroid Injection ◽  
Epidural Steroid

Background: Hospital admissions for back pain are prolonged, costly, and common. Epidural steroid injections are frequently performed in an outpatient setting with an excellent safety and efficacy profile. Objectives: The purpose was to review data from patients with severe pain that did not respond to aggressive medical treatment in the emergency department (ED) and determine the effectiveness of an interlaminar epidural steroid injection (ESI) in this patient population. Study Design: Retrospective matched cohort design. Setting: Single urban emergency department at a tertiary referral center. Methods: A retrospective cohort comparison pairing 2 groups that both failed aggressive pain control in the ED was performed. The epidural injection group (1ESI) received an interlaminar ESI while in the ED. The standard therapy group (2ST) was admitted for medical pain management. Groups were matched for pain intensity, age, and symptom duration. Results: Thirty-five patients in 1ESI (NRS 8.8, 5 – 10, 0.35), and 28 patients in 2ST (NRS 8.9, 4 – 10, 1.7). Pain score after ESI 0.33 (0 – 2, 0.6); all were discharged. Pain score on day 1 of hospital admission for 2ST was 8.7 (7 – 10, 1.5). Total ED time was 8 hours for 1ESI and 13 hours for 2ST (P < 0.002). 1ESI patients received less narcotics while in the ED (P < 0.002) and were discharged home with less narcotics than 2ST (< 0.002). Average inpatient length of stay (LOS) for 2ST was 5 (1.5 – 15, 3.3) days. Cost of care was over 6 times greater for those patients admitted for pain management (P < 0.001). Limitations: Retrospective design, non-randomized sample, and a small patient population. Conclusion: An ED patient cohort with severe refractory pain was treated with an interlaminar ESI after failing maximal medical pain management while in the ED. Complete pain relief was achieved safely and rapidly. The need for inpatient admission was eliminated after injection. Costs were lower in the group that received an epidural injection. Narcotic requirements upon discharge were decreased as well. Key words: Low back pain, epidural steroid injection, emergency department, hospital admission

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