Feasibility of Using Lumbar Magnetic Resonance Imaging Severity of Disc Protrusion and Foraminal Stenosis in Association with Pain Reduction Following Lumbar Transforaminal Epidural Steroid Injection (LTFESI)

PM&R ◽  
2013 ◽  
Vol 5 ◽  
pp. S293-S293
Author(s):  
Robert E. Moore ◽  
Moeid Khan ◽  
Kermit W. Fox ◽  
Brian Snitily ◽  
Richard D. Wilson
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Steroid Injection ◽  
Pain Reduction ◽  
Epidural Steroid Injection ◽  
Foraminal Stenosis ◽  
Resonance Imaging ◽  
Disc Protrusion ◽  
Transforaminal Epidural Steroid Injection ◽  
Epidural Steroid

scholarly journals Diagnosis and Spontaneous Resolution of an Epidural Hematoma in a Patient Presenting after Cervical Epidural Steroid Injection

2018 ◽  
pp. 213-219
Author(s):  
Ivan Urits
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Neck Pain ◽  
Epidural Hematoma ◽  
Steroid Injection ◽  
Spontaneous Resolution ◽  
Resonance Imaging ◽  
Radiographic Findings ◽  
History Of ◽  
Epidural Steroid

While not a cure for the underlying spinal pathology, cervical epidural steroid injections (CESI) are an important minimally invasive treatment for neck pain with radiculopathy. Although CESIs are considered safe, cervical epidural hematoma (CEH) is a major complication and has previously been reported. Patients, who develop CEH, present with acute neck pain and upper extremity radiculopathy. A prolonged time to treatment may lead to worsened neurological outcome. Diagnostic magnetic resonance imaging and surgical decompression is the mainstay of treatment. This report presents a patient with a history of chronic neck pain and repeat cervical injections, who presented with increased neck pain and upper extremity weakness after undergoing a CESI. Initial radiographic findings were complicated and inconclusive of a definitive epidural hematoma. With conservative management, the patient showed signs of clinical improvement and ultimately had spontaneous resolution of his CEH. Though CEH are frequently rapidly progressing and most often surgically decompressed, some acutely presenting cases may be approached conservatively. Though MRI is an important diagnostic tool for CEH, interpretation of radiographic findings, following a recent CESI, may be challenging due to distortion of the epidural space anatomy. Patients with a history of multiple cervical epidural injections may have an increased risk for the development of CEH. Key words: Cervical epidural steroid injection, cervical epidural hematoma, spontaneous resolution, conservative management, magnetic resonance imaging, complication

scholarly journals CT-guided transforaminal epidural steroid injection for discogenic lumbar radiculopathy: influence of contrast dispersion and radiologist’s experience on clinical outcome

2021 ◽  
Author(s):  
Christoph Germann ◽  
Dimitri N. Graf ◽  
Benjamin Fritz ◽  
Reto Sutter
Keyword(s):  
Pain Relief ◽  
Steroid Injection ◽  
Pain Reduction ◽  
Therapeutic Outcome ◽  
Epidural Steroid Injection ◽  
Dispersion Pattern ◽  
Ct Guided ◽  
Transforaminal Epidural Steroid Injection ◽  
Epidural Steroid ◽  
The Impact

Abstract Objective To investigate the impact of contrast dispersion pattern/location during lumbar CT-guided transforaminal epidural steroid injection (TFESI) and experience of the performing radiologist on therapeutic outcome. Materials and methods In this single-center retrospective cohort study, two observers analyzed contrast dispersion during CT-guided TFESI of 204 patients (age 61.1 ± 14 years) with discogenic unilateral single-level L4 or L5 radiculopathy. The contrast dispersion pattern was classified as “focal,” “linear,” or “tram-track”; the location was divided into “extraforaminal,” “foraminal,” or “recessal.” Pain was assessed before and 4 weeks after treatment using a numerical rating scale (0, no pain; 10, intolerable pain). Additionally, the patient global impression of change (PGIC) was assessed. The TFESI was performed by musculoskeletal radiologists (experience range: first year of musculoskeletal fellowship training to 19 years). Contrast pattern/location and radiologist’s experience were compared between “good responder” (≥ 50% pain reduction) and “poor responder” (< 50%). A p-value < 0.05 was considered to be statistically significant. Results Overall, CT-guided TFESI resulted in a substantial pain reduction in 46.6% of patients with discogenic radiculopathy. The contrast dispersion pattern and location had no effect on pain relief (p = 0.75 and p = 0.09) and PGIC (p = 0.70 and p = 0.21) 4 weeks after TFESI. Additionally, the experience of the radiologist had no influence on pain reduction (p = 0.92) or PGIC (p = 0.75). Regarding pre-interventional imaging findings, both the location and grading of nerve compression had no effect on pain relief (p = 0.91 and p = 0.85) and PGIC (p = 0.18 and p = 0.31). Conclusion Our results indicate that neither contrast agent dispersion/location nor the experience of the radiologist allows predicting the therapeutic outcome 4 weeks after the procedure.

scholarly journals Successful treatment of unilateral neck pain with transforaminal epidural steroid injection on the left C3 nerve root: a case report

2020 ◽  
Vol 48 (11) ◽  
pp. 030006052096953
Author(s):  
Min Cheol Chang ◽  
Mathieu Boudier-Revéret ◽  
Ming-Yen Hsiao ◽  
Shaw-Gang Shyu
Keyword(s):  
Case Report ◽  
Neck Pain ◽  
Nerve Root ◽  
Rating Scale ◽  
Steroid Injection ◽  
Radicular Pain ◽  
Epidural Steroid Injection ◽  
Foraminal Stenosis ◽  
Transforaminal Epidural Steroid Injection ◽  
Epidural Steroid

In clinical practice, neck pain is one of the most common complaints. Although most of the cervical radicular pain is manifested in the neck and upper extremities, C3 or C4 radicular pain only results in neck pain. It does not produce upper extremity radiating pain. This case report describes a 70-year-old male that presented with a numeric rating scale score of 5 out of 10 for the left neck pain that he had been experiencing for the previous 1 month. Hyperalgesia was present on the left C3 dermatome. Foraminal stenosis at the left C2–C3 was observed on cervical magnetic resonance imaging. In order to manage the neck pain on the left side due to the foraminal stenosis at the left C2–C3, a transforaminal epidural steroid injection (TFESI) was undertaken on the left C3 nerve root. Thirty minutes after TFESI, the patient’s neck pain had completely resolved. At the 1-month and 3-month follow-ups, no neck pain was evident. Clinicians should consider the possibility of C3 radicular pain as a cause of neck pain, especially when the neck pain presents as neuropathic pain combined with sensory deficits.

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