Poster 264: Is it Safe for Patients to Undergo Epidural Steroid Injections While Taking Non-Steroidal Anti-inflammatory Medications? A Case Report in Which a Patient Developed a Subacute Epidural Hematoma After Lumbar Epidural Steroid Injection

PM&R ◽  
2009 ◽  
Vol 1 ◽  
pp. S218-S218
Author(s):  
Sanjog Pangarkar ◽  
Chris Janssen ◽  
Ai Mukai
Keyword(s):  
Case Report ◽  
Epidural Hematoma ◽  
Steroid Injection ◽  
Epidural Steroid Injection ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Anti Inflammatory ◽  
Epidural Steroid

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.

scholarly journals What Is the Role of Epidural Steroid Injections in Lumbar Spinal Disease with Moderate Disability?

2016 ◽  
Vol 4;19 (4;5) ◽  
pp. 293-298
Author(s):  
Jae-Young Hong
Keyword(s):  
Steroid Injection ◽  
Radicular Pain ◽  
Epidural Steroid Injection ◽  
Spinal Disease ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Pain Scores ◽  
One Year ◽  
Lumbar Spinal ◽  
Epidural Steroid

Epidural steroid injections have been gaining popularity as an alternative to surgical treatment of radicular pain with associated spinal derangement. To determine the effectiveness and indications of lumbar epidural steroid injections in patients with or without surgery, we performed a prospective observational study. We gathered data from 262 degenerative short-segment spinal disease patients (affected at one or 2 levels) with greater than 12 weeks of medication-resistant radicular pain without neurological deficits but with moderate disability (visual analog scale < 6.5; Oswestry Disability Index < 35). All patients received initial fluoroscopically guided transforaminal epidural steroid injections of the affected vertebral level(s) corresponding to their symptoms. Those with inadequate responses or who wanted subsequently surgery underwent decompression surgery. Clinical and demographic characteristics were assessed to compare the differences between the groups. Results: Of the 262 patients who received epidural steroid injections, 204 did not have operations for up to one year. However, 58 patients experienced inadequate relief of pain or wanted operations and therefore underwent surgery. At baseline, the 2 groups had similar mean disability indices and pain scores, as well as gender ratios, ages, and durations of symptoms (P > 0.05). In the patients who underwent surgery, the mean disability and pain scores were not significantly decreased after injection compared to those in the injection-alone group, although the scores for the injection plus surgery patients decreased significantly after surgery (P < 0.05). In contrast, patients who underwent epidural steroid injection alone experienced a significant decrease in disability and pain after injection, and that persisted up to one year of follow-up (P < 0.05). Epidural steroid injection can decrease the pain and disability in the majority of a moderate disability group for up to one year, although a significant number of patients underwent surgery regardless of injection. We recommend epidural steroid injection as a first-line treatment in patients with moderate disability that can be converted to surgery without significant delay. Key words: Epidural steroid injection, spinal surgery, lumbar spinal disease, lumbar radiculopathy, lumbar radicular pain

scholarly journals Conus Medullaris Syndrome Days After A Single Epidural Steroid Injection

2020 ◽  
pp. 1-2
Author(s):  
Rafid Kasir ◽  
◽  
Jad Khalil ◽  
Keyword(s):  
Steroid Injection ◽  
Cauda Equina ◽  
Conus Medullaris ◽  
Epidural Steroid Injection ◽  
Chronic Lower Back Pain ◽  
Unique Case ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Lower Back ◽  
Epidural Steroid

Background: Epidural steroid injections (ESI) are commonly used in treatment of chronic lower back pain. Conus medullaris and cauda equina syndromes are rare complications of ESI. However, these typically occur after multiple injections within a few minutes to hours. Some reported cases are also transient, with patients completely regaining neurological function. We discuss a unique case of a patient developing conus medullaris syndrome over 24 hours after a single epidural steroid injection without resolution of symptoms.

Comparison of Caudal Epidural Steroid Injection with Interlaminar Lumbar Inj. Epidural in Spinal Stenosis

2021 ◽  
Vol 15 (8) ◽  
pp. 1877-1879
Author(s):  
Muhammad Akram ◽  
Faheem Mubashir Farooqi ◽  
Shumaila Jabbar
Keyword(s):  
Spinal Stenosis ◽  
Oswestry Disability Index ◽  
Steroid Injection ◽  
Epidural Steroid Injection ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Group I ◽  
Group Ii ◽  
Epidural Steroid ◽  
Caudal Epidural

Background: Lumbar spinal stenosis is a condition caused by narrowing of spinal canal. Steroid injection either lumbar or caudal can improve the functional outcome and low back pain. Aim: To compare the outcome of caudal epidural steroid injection with lumbar epidural steroid injection in treating spinal stenosis in patients suffering from sciatica. Methods: In this prospective study 338 patients having low backache due to spinal stenosis with sciatica were included from June 2013 to December 2014. Patients were randomly divided into two groups. Group I and II. Patients in Group I (160 patients) received caudal epidural steroid injections while the patients in Group II (178 patients) received lumbar epidural steroid injections. Visual analog scale (VAS) and Oswestry Disability Index (ODI) was used to assess outcome of the Caudal and Lumbar steroid injections and was measured at 2 weeks, at 3months, and improvement was declared if VAS decrease ≥50% of baseline and Oswestry disability index decrease ≥40% at 3 months. Results: In group I, there were 70(43.75%) males and 90(56.25%) females, while in group II there were 98(55.1%) males and 80(44.9%) females. The mean age of the patients in group I was 46.46±10.37 (18-75 years) years and was 43.77±15.27 years (18-75 years) in group II (P=0.0619). The change in pain score (>50%) was observed in 159 (89.33%) in group II compared with 121 (75%) in group I (P=0.0008). Conclusion: Lumbar epidural of steroids injections are more effective then caudal epidural injection of steroids in treating spinal stenosis. MeSH words: Caudal epidural, Lumbar epidural, Sciatica

scholarly journals Caudal Epidural Steroid Injection under Fluoroscopy in Management of Chronic Low Back Pain with or without Radiculopathy

2020 ◽  
Vol 9 (1) ◽  
pp. 3-7
Author(s):  
Rupak Bhattarai ◽  
Bandana Paudel ◽  
Sangeeta Subba ◽  
Kumud Pyakurel ◽  
Bijay K. C. ◽  
...  
Keyword(s):  
Steroid Injection ◽  
Epidural Steroid Injection ◽  
Pain Clinic ◽  
Low Back ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Vas Score ◽  
Epidural Steroid ◽  
Caudal Epidural

Background: Low back pain with or without radiculopathy is most common presentations of chronic pain. Caudal epidural steroid injection is one of the treatment modalities of this type of pain syndromes. Materials and Methods: The study was conducted in 100 patient who presented in our pain clinic. These patients were given caudal epidural steroid injections under fluoroscopy guidance with 60 mg depo-methylprednisolone added to 0.5% lignocaine making a volume of 10 ml. All these patients were asked to follow up at pain clinic at 1 month, 3 months & 6 months to assess the visual analogue scale (VAS) score, Oswestry disability index (ODI), Straight leg Raise test (SLRT) & Patient satisfaction scale. Results: There was significant reduction in VAS score in one month, three months and six months follow up after caudal epidural steroid injection. The 50% reduction in pain was seen in 72 patients, 69 patients and 62 patients in one month, three months and six months respectively. The mean VAS score were 7.84 before pre-injection, 4.32 at one hour, 4.06 at one month, 4.18 at 3 months and 4.64 at 6 months after the procedure.The mean ODI were 35.16 before pre-injection, 32.12 at one hour, 28.14 at one month, 28.57 at 3 months and 28.68 at 6 months after the procedure. Conclusion: Caudal epidural steroid injections causes significant relief in pain symptoms of backache with or without radiculopathy and increases the quality of life.  

scholarly journals Flushing Following Interlaminar Lumbar Epidural Steroid Injection with Dexamethasone

2010 ◽  
Vol 5;13 (5;9) ◽  
pp. 481-484
Author(s):  
Chong H. Kim
Keyword(s):  
Back Pain ◽  
Side Effects ◽  
Steroid Injection ◽  
Treatment Plan ◽  
Epidural Steroid Injection ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Interlaminar Approach ◽  
Epidural Steroid

Background: Epidural steroid injections are commonly used in managing radicular pain. Most complications related to epidural injections are minor and self-limited. Flushing is considered as one such minor side effect. Flushing has been studied using various steroid preparations including methylprednisone, triamcinolone, and betamethasone but its frequency has never been studied using dexamethasone. Objective: This study evaluates the frequency of flushing associated with fluoroscopyguided lumbar epidural steroid injections using dexamethasone. Study Design: Retrospective cohort design study. Patients presenting with low back pain were evaluated and offered a fluoroscopically guided lumbar epidural steroid injection using dexamethasone via an interlaminar approach as part of a conservative care treatment plan. Setting: University-based Pain Management Center. Intervention: All injections were performed consecutively over a 2-month period by one staff member using 16 mg (4 mg/mL) of dexamethasone. A staff physician specifically asked each participant about the presence of flushing following the procedure prior to discharge on the day of injection and again on follow-up within 48 hours after the injections. The answers were documented as “YES” or “NO.” Results: A total of 150 participants received fluoroscopically guided interlaminar epidural steroid injection. All participants received 16 mg (4 mg/mL) of dexamethasone with 2 mL of 0.2% ropiviciane. Overall incidence of flushing was 42 out of 150 cases (28%). Of the 42 participants who experienced flushing, 12 (28%) experienced the symptom prior to discharge following the procedure. Twenty-seven of the 42 (64%) were female (P < 0.05). All the participants who experienced flushing noted resolution by 48 hours. No other major side effects or complications were noted. Limitations: Follow-up data were solely based on subjective reports by patients via telecommunication. Follow-up time was limited to only 48 hours, which overlooks the possibility that more participants might have noted flushing after the 48 hour limit. Conclusions: Flushing is commonly reported following epidural steroid injections. With an incidence of 28%, injections using dexamethasone 16 mg by interlaminar epidural route appear to be associated with more flushing reaction than previously reported with other steroid preparations. Additionally, female participants are more likely to experience flushing though the reactions seem to be self-limiting with resolution by 48 hours. Key words: flushing, side effects, epidural, back pain, lumbar, steroid, dexamethasone, injections.

scholarly journals FISH OIL AS A POTENTIAL CONTRIBUTOR TO EPIDURAL HEMATOMA FOLLOWING CERVICAL EPIDURAL STEROID INJECTION: A CASE REPORT AND FOCUSED LITERATURE REVIEW

2017 ◽  
pp. 19-26
Author(s):  
Ramsin Benyamin
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Fish Oil ◽  
Epidural Hematoma ◽  
Steroid Injection ◽  
Epidural Injection ◽  
Epidural Steroid Injection ◽  
Bleeding Complications ◽  
Over The Counter ◽  
Epidural Steroid

Fish oil has been anecdotally linked to bleeding complications during interventional spinal procedures. We present a case report involving a cervical epidural hematoma following cervical epidural injection in a patient who has been taking fi sh oil, with detailed literature review. A 49-year-old woman with a previous history of anterior cervical disc fusion at C5-C6 underwent routine cervical epidural injection for neck pain due to a disc herniation below her fusion. Thirty minutes after the procedure, she experienced numbness and tingling in both arms and developed severe pain between her shoulder blades. She was sent to the emergency room and soon developed a left-sided wrist drop. An emergent cervical magnetic resonance image (MRI) revealed an epidural hematoma at C6-C7. She underwent emergent surgical decompression of the hematoma through multiple laminectomies at C6, C7, and T1. The surgeon noticed excessive blood oozing through the incision site and left two drains in the wound. She recovered without neurological defi cit. Upon further investigation, it was discovered that she had been taking high doses of over-the-counter fi sh oil. Ingredients in over-the-counter preparations are not regulated or standardized. Fish oil use may predispose a patient to bleeding complications when used in higher doses alone or when used at any dose in conjunction with antiplatelet therapy. The benefi ts of fi sh oil use should be weighed against the potential risk of bleeding with cessation of fi sh oil in patients undergoing spinal interventions. As described by others, signifi cant pain at the site of injection which is unusual and different from the pain experienced in the past as well as complicating factor of loss of resistance technique in closed space must be considered. Finally, rapid diagnosis and intervention avoids neurological defi cit. Key words: Fish oil, omega-3, aspirin, cervical epidural steroid injection, complication, epidural hematoma, literature review

scholarly journals Vertebral Osteomyelitis: A Potentially Catastrophic Outcome after Lumbar Epidural Steroid Injection

2008 ◽  
Vol 5;11 (10;5) ◽  
pp. 693-697 ◽  
Author(s):  
Thomas T. Simopoulos
Keyword(s):  
Staphylococcus Aureus ◽  
Back Pain ◽  
Spinal Stenosis ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Steroid Injection ◽  
Epidural Steroid Injection ◽  
Methicillin Resistant ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Epidural Steroid

Background and Objective: Epidural steroid injections are commonly used to palliate the symptoms of spinal stenosis. Deep tissue infection is a known potential complication of these injections. There have been no previous published cases of osteomyelitis without epidural abscess after such injections. We present a case in an elderly patient who presented only with persistent axial low back pain following a lumbar epidural steroid injection (LESI). We emphasize early patient evaluation, consideration of infectious predisposing factors, sterile technique, and skin disinfectant. Design: Open-label case report. Case description: A 77-year-old diabetic male with a history of radicular pain related to lumbar spinal stenosis was treated successfully several years prior with a series of lumbar epidural steroid injections (LESI) and was re-treated with LESIs for recurrent symptoms. Following his second epidural injection, he presented with back pain and induration at the injection site without fever or neurological deficits. Urgent magnetic resonance imaging (MRI) revealed a soft tissue abscess extending close to the epidural space around the corresponding L4/L5 vertebral level. The patient recovered after incision and drainage of the abscess which was associated with an osteomyelitis of the L4 and L5 vertebral spine. The causative organism was methicillin-resistant Staphylococcus Aureus. Conclusion: This case demonstrates that even with proper aseptic techniques, immune-compromised patients who are colonized with an aggressive micro-organism may develop a potentially catastrophic infectious complication if subtle persistent symptomatic complaints are not promptly and carefully evaluated. Key words: osteomyelitis, epidural steroid injection, methicillin-resistant staphylococcus aureus (MRSA)

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