Cervical interlaminar epidural steroid injection for neck pain and cervical radiculopathy: effect and prognostic factors

Introduction: Transforaminal epidural steroid injection (TFESI) is a widely used nonsurgical procedure in the treatment of patients with radiculopathy. It is efficacious in relieving pain, but a number of complications are being reported. Recently, increasing frequency of major complications, such as spinal cord infarction and cerebral infarction, has been reported with the use of a particulate steroid within fluoroscopic-guided procedures. Methods: We report a 49-year-old man with a history of chronic cervical radiculopathy, who experienced a devastating complication after TFESI. Results: After 2 min of regular TFESI, the patient abruptly experienced muscle weakness in both upper extremities and within 5 min the patient became quadriplegic. Despite active rehabilitation, the patient remained bed-ridden 4 years after the catastrophic event. To our knowledge, this is the first reported case of spinal cord infarction that occurred after TFESI in Korea. Conclusion: Considering the risk of dreadful complications, which appear in an unpredictable manner, TFESI with fluoroscopic guidance should be done only with a nonparticulate steroid.

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Interlaminar Epidural Steroid Injection

Encyclopedia of Pain ◽

10.1007/978-3-540-29805-2_1992 ◽

2006 ◽

pp. 1006-1006

Keyword(s):

Steroid Injection ◽

Epidural Steroid Injection ◽

Interlaminar Epidural Steroid Injection ◽

Epidural Steroid

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

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2018-000005 ◽

2019 ◽

Vol 44 (2) ◽

pp. 253-255 ◽

Cited By ~ 3

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.

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Does the Contrast Dispersion Pattern During Fluoroscopically Guided Cervical Transforaminal Epidural Steroid Injection Predict Short-Term Pain and Functional Outcomes? An Exploratory Analysis of Prospective Cohort Data

Pain Medicine ◽

10.1093/pm/pnaa305 ◽

2020 ◽

Vol 21 (12) ◽

pp. 3350-3359

Author(s):

Aaron Conger ◽

Beau P Sperry ◽

Cole W Cheney ◽

Keith Kuo ◽

Russel Petersen ◽

...

Keyword(s):

Neck Pain ◽

Epidural Space ◽

Functional Outcomes ◽

Steroid Injection ◽

Epidural Steroid Injection ◽

Dispersion Pattern ◽

Arm Pain ◽

Dispersion Patterns ◽

Transforaminal Epidural Steroid Injection ◽

Epidural Steroid

Abstract Summary of Background Data No study has evaluated the relationship between contrast dispersion patterns and outcomes after fluoroscopically guided cervical transforaminal epidural steroid injection (CTFESI). Objectives Determine whether contrast dispersion patterns predict pain and functional outcomes after CTFESI. Methods Secondary analysis of data collected during two prospective studies of CTFESI for the treatment of refractory radicular pain. Contrast dispersion patterns visualized by true anteroposterior (AP) projections during CTFESIs were categorized by flow: 1) completely external to the lateral border of the neuroforamen (zone 1); 2) within the neuroforamen but without entry into the lateral epidural space (zone 2); and 3) with extension into the lateral epidural space (zone 3). At baseline and at 1 month post-CTFESI, neck pain, arm pain, and “dominant index pain” (the greater of arm or neck pain) were evaluated using a numeric rating scale (NRS); physical function was assessed using the Five-Item Version of the Neck Disability Index (NDI-5). Results One-month post-CTFESI, neck pain, arm pain, and “dominant index pain” reductions of ≥50% were observed in 39.4% (95% confidence interval [CI], 28.2–51.8), 55.6% (95% CI, 43.0–67.5), and 44.1% (95% CI, 32.7–56.2) of participants, respectively. Regarding “dominant index pain,” 72.7% (95% CI, 40.8–91.2), 39.4% (95% CI, 24.2–57.0), and 37.5% (95% CI, 20.5–58.2) of participants reported ≥50% pain reduction when zone 1, zone 2, and zone 3 contrast flow patterns were observed. Contrast dispersion zone was not significantly associated with subgroup differences in neck pain, arm pain, or NDI-5 scores (P>0.05). Conclusion Improvements in pain and function 1 month after treatment with CTFESI did not differ significantly based on the contrast dispersion pattern. Future study is needed to confirm or refute these findings in other procedural settings, in broader patient populations, and with longer-term outcome assessment.

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