Comparison of treatment outcomes in lumbar disc herniation patients treated with epidural steroid injections: interlaminar versus transforaminal approach

2019 ◽  
Vol 61 (3) ◽  
pp. 361-369 ◽  
Author(s):  
Susanne Bensler ◽  
Melissa Walde ◽  
Michael A Fischer ◽  
Christian WA Pfirrmann ◽  
Cynthia K Peterson ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Ct Guided ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Transforaminal Approach ◽  
Pain Scores ◽  
Numerical Rating ◽  
Epidural Steroid

Background The study describes the difference of pain reduction in interlaminar and transforaminal injections. Purpose To compare treatment outcomes after interlaminar versus transforaminal epidural steroid injections in patients with disc herniations at the level L3/4–L5/S1 and analyze associated magnetic resonance imaging (MRI) findings. Material and Methods This retrospective comparative effectiveness outcome study included 198 patients with computed tomography (CT)-guided interlaminar (n = 99) or transforaminal (n = 99) epidural injections with particulate steroids. Pain levels at baseline and one day, one week, and one month after injection were assessed using the 11-point Numerical Rating Scale for Pain. Overall improvement was assessed after one day, one week, and one month using the Patients Global Impression of Change. MRI analysis was performed by two radiologists. Student’s t-test, Chi-square test, and Fisher’s exact test were calculated. Results Baseline pain scores were equal for interlaminar and transforaminal injections (6.23, SD = 2.10 vs. 5.84, SD = 2.02; P = 0.18). There were no significant differences in improvement between the interlaminar and transforaminal approach of epidural steroid injections after one day (30.5% vs. 21.2%, P = 0.432), one week (41.7% vs. 40.8%, P = 1.000), and one month (53.3% vs. 43.9%, P = 0.322), but there was a trend towards better effect of interlaminar injections at one day and one month. The change in Numerical Rating Scale for Pain scores showed no significant differences between the two cohorts after one day, one week, and one month ( P ≥ 0.115). None of the MR findings predicted a better or worse outcome ( P ≥ 0.171). Conclusion Interlaminar and transforaminal injections with particulate corticosteroids were equally effective, with a non-significant advantage of interlaminar injections at one day and one month. None of the MR findings were associated with treatment outcomes.

scholarly journals Factors Predicting Favorable Short-Term Response to Transforaminal Epidural Steroid Injections for Lumbosacral Radiculopathy

Medicina ◽  
2019 ◽  
Vol 55 (5) ◽  
pp. 162 ◽  
Author(s):  
Dong Yoon Park ◽  
Seok Kang ◽  
Joo Hyun Park
Keyword(s):  
Retrospective Study ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Multivariate Logistic Regression Analysis ◽  
Short Term ◽  
Duration Of Symptoms ◽  
Lumbosacral Radiculopathy ◽  
Epidural Steroid Injections ◽  
Epidural Steroid ◽  
Term Response

Background and Objectives: The purpose of this retrospective study was to identify predictors of short-term outcomes associated with a lumbosacral transforaminal epidural steroid injection (TFESI). Materials and Methods: The medical records of 218 patients, who were diagnosed with lumbosacral radiculopathy and treated with a TFESI, were reviewed in this retrospective study. A mixture of corticosteroid, lidocaine, and hyaluronidase was injected during TFESI. Patients with >50% pain relief on the numerical rating scale compared with the initial visit constituted the good responder group. Demographic, clinical, MRI, and electrodiagnostic data were collected to assess the predictive factors for short-term outcomes of the TFESI. Results: A multivariate logistic regression analysis demonstrated that a shorter duration of symptoms and a positive sharp wave (PSW)/fibrillation (Fib) observed in electrodiagnostic study (EDx) increased the odds of significant improvement 2–4 weeks after the TFESI. Conclusions: Shorter duration of symptoms and PSW/Fib on EDx were predictors of favorable short-term response to TFESI.

scholarly journals Role of Advanced Imaging in Gasserian Neurolysis in Head and Neck Cancer with Skull Base Invasion

2019 ◽  
Vol 05 (02) ◽  
pp. 086-088
Author(s):  
Bablesh Mahawar ◽  
Vivek Mahawar
Keyword(s):  
Head And Neck ◽  
Skull Base ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Lateral Approach ◽  
Foramen Ovale ◽  
Trigeminal Neuropathy ◽  
Ct Guided ◽  
Numerical Rating ◽  
Left Maxillary Sinus

Abstract Introduction A 46-year-old female with a postoperated case of carcinoma left upper alveolus diagnosed in March 2018, with recurrence, was presented to the hospital. She had lancinating pain around left facial pain, which gradually increased over 10 months. On numerical rating scale, her pain was 9 on 10. Her chief complaint was continuous dull pain above and below the left eye, with sudden, brief, paroxysmal episodes of intolerable burning and stabbing type of pain. This episodic pain lasted for 30 to 40 seconds. On examination, she had left III, V, and VI nerve palsy with ptosis. Magnetic resonance imaging of face and brain revealed an enhancing infiltrative mass in left maxillary sinus extending to base of skull. Clinical diagnosis of left-sided painful trigeminal neuropathy in ophthalmic and maxillary (V1 and V2) division was made. Aim This study was aimed to relieve patient’s pain and improve her quality of life. Materials and Methods Gasserian neurolysis was successfully completed under computed tomography (CT) guidance because of the distortion of skull base anatomy using a 22-G, 10-cm long spinal needle directed towards foramen ovale (FO) from a lateral approach. Conclusion CT-guided identification of foramen ovale can be labeled as a novel method of locating FO for precise percutaneous techniques to the trigeminal ganglion in advanced head and neck cancers.

scholarly journals EUS-Guided Versus Percutaneous Celiac Neurolysis for the Management of Intractable Pain Due to Unresectable Pancreatic Cancer: A Randomized Clinical Trial

2020 ◽  
Vol 9 (6) ◽  
pp. 1666
Author(s):  
Won Jae Yoon ◽  
Yul Oh ◽  
Changhoon Yoo ◽  
Sunguk Jang ◽  
Seong-Sik Cho ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Abdominal Pain ◽  
Back Pain ◽  
Cancer Patients ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Intractable Pain ◽  
Point Reduction ◽  
Pain Scores ◽  
Numerical Rating

Although endoscopic ultrasound-guided celiac neurolysis (EUS-CN) and percutaneous celiac neurolysis (PCN) are utilized to manage intractable pain in pancreatic cancer patients, no direct comparison has been made between the two methods. We compared the efficacy and safety of EUS-CN and PCN in managing intractable pain in such patients. Sixty pancreatic cancer patients with intractable pain were randomly assigned to EUS-CN (n = 30) or PCN (n = 30). The primary outcomes were pain reduction in numerical rating scale (NRS) and opioid requirement reduction. Secondary outcomes were: successful pain response (NRS decrease ≥50% or ≥3-point reduction from baseline); quality of life; patient satisfaction; adverse events; and survival rate at 3 months postintervention. Both groups reported sustained decreases in pain scores up to 3 months postintervention (mean reductions in abdominal pain: 0.9 (95% confidence interval (CI): −0.8 to 4.2) and 1.7 (95% CI: −0.3 to 2.1); back pain: 1.3 (95% CI: −0.9 to 3.4) and 2.5 (95% CI: −0.2 to 5.2) in EUS-CN, and PCN groups, respectively). The differences in mean pain scores between the two groups at baseline and 3 months were −0.5 (p = 0.46) and −1.4 (p = 0.11) for abdominal pain and 0.1 (p = 0.85) and −0.9 (p = 0.31) for back pain in favor of PCN. No significant differences were noted in opioid requirement reduction and other outcomes. EUS-CN and PCN were similarly effective and safe in managing intractable pain in pancreatic cancer patients. Either methods may be used depending on the resources and expertise of each institution.

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 The Safety of CT-Guided Epidural Steroid Injections in an Older Patient Cohort

2016 ◽  
Vol 8;19 (8;11) ◽  
pp. E1139-E1146
Author(s):  
Andrew J. Fenster
Keyword(s):  
Back Pain ◽  
Procedure Time ◽  
Older Patient ◽  
Dose Length Product ◽  
Ct Guided ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
The Mean ◽  
Procedure Duration ◽  
Epidural Steroid

Background: Epidural steroid injections (ESIs) are a common method for treating lower back pain, which is one of the most prevalent health-related complaints in the adult U.S. population. Although the safety of CT-guided ESIs has been extensively studied in adults, there is limited data concerning the procedure’s safety profile in an older patient population. Objective: This retrospective study analyzed safety data among a single-center cohort of patients > 65 years-old who received one or more CT-guided interlaminar ESIs from 2012 to 2015. Study Design: An Institutional Review Board (IRB)-approved retrospective chart review. Setting: University hospital center. Methods: A total of 688 CT-guided ESI procedures were evaluated and a linear regression analysis was conducted to examine the relationship between dose length product (DLP), body mass index (BMI), procedure duration, and kVp/mA settings. Further analysis was performed on a sample of long procedure time, average-DLP and high-DLP procedures. Results: Average age was 75.77 years, with 44% having a BMI > 30. The mean DLP was 55.58 mGy x cm and the mean procedure duration was 5.94 minutes. All procedures were technically successful and no complications were observed during or after any of the procedures, including at one-month follow-up office visits. The kVp and mA settings were the strongest predictors of DLP, followed by procedure time. The high-DLP cases had a greater number of needle placement series, more intervertebral disc spaces included in each planning series and higher machine settings (kVp 120; mA 87.5) than the average-DLP cases (kVp 100; mA 49.9). Limitations: This study is limited by its retrospective design. Conclusion: CT-guided interlaminar ESIs can be performed safely, with low procedure times, relatively low DLP’s and without complications in an older patient population. Key words: Epidural steroid injection, interlaminar approach, CT-guidance, older adults, back pain, lumbar spine, thoracic spine, cervical spine, dose length product, radiation exposure

scholarly journals Radiation Dose for 345 CT-Guided Interlaminar Lumbar Epidural Steroid Injections

2013 ◽  
Vol 34 (10) ◽  
pp. 1882-1886 ◽  
Author(s):  
A.L. Chang ◽  
A.H. Schoenfeld ◽  
A.L. Brook ◽  
T.S. Miller
Keyword(s):  
Radiation Dose ◽  
Ct Guided ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Epidural Steroid
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