scholarly journals Recent Preoperative Lumbar Epidural Steroid Injection Is an Independent Risk Factor for Incidental Durotomy During Lumbar Discectomy

2019 ◽  
Vol 9 (8) ◽  
pp. 807-812 ◽  
Author(s):  
Lawal A. Labaran ◽  
Varun Puvanesarajah ◽  
Sandesh S. Rao ◽  
Dennis Chen ◽  
Francis H. Shen ◽  
...  
Keyword(s):  
Disc Herniation ◽  
Steroid Injection ◽  
Multivariate Logistic Regression Analysis ◽  
Lumbar Discectomy ◽  
Epidural Steroid Injection ◽  
Medicare Patient ◽  
Significant Difference ◽  
History Of ◽  
Epidural Steroid ◽  
Incidental Durotomy

Study Design: Retrospective review. Objective: To investigate the association between lumbar epidural steroid injection (LESI) and incidental durotomy (ID) in patients with a diagnosis of disc herniation undergoing a primary discectomy. Methods: A Medicare patient database was queried for patients between the ages of 65 and 85 years who underwent a primary lumbar discectomy for a diagnosis of lumbar disc herniation or degeneration from 2008 to 2014. Our main cohort of 64 849 patients was then divided into 2 groups: patients who experienced a dural tear (N = 2369) and our matched (age, gender, and history of diabetes) control cohort of patients who did not (N = 62 480). All patients who had a history of LESI were further identified and stratified into 4 subgroups by duration between LESI and discectomy (<3 months, 3-6 months, 6 months to 1 year, and overall), and a comparison of the relative incidence of ID was made among these subgroups. A multivariate logistic regression analysis was employed to determine the relationship between LESI and ID. Results: Overall incidence of ID was 3.7%. There was a significant difference in incidence of LESI (27.1% vs 35.0%, P < .001) between our control and ID groups. An adjusted odds ratio (OR) showed that prior LESI within 3 to 6 months (OR 1.47, 95% CI 1.20-1.81, P < .001) and within less than 3 months (OR 1.46, 95% CI 1.24-1.72, P < .001) of surgery were significantly associated with ID. Conclusion: LESI increases the risk of ID in patients who undergo a subsequent lumbar discectomy within 6 months of injection.

scholarly journals Spinal Cord Infarction after Cervical Transforaminal Epidural Steroid Injection: Case Report and Literature Review

2017 ◽  
Vol 9 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Jangsup Moon ◽  
Hyung-Min Kwon
Keyword(s):  
Spinal Cord ◽  
Steroid Injection ◽  
Cervical Radiculopathy ◽  
Epidural Steroid Injection ◽  
Spinal Cord Infarction ◽  
Catastrophic Event ◽  
History Of ◽  
Transforaminal Epidural Steroid Injection ◽  
Active Rehabilitation ◽  
Epidural Steroid

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.

scholarly journals Transforaminal Epidural Steroid Injection Combined with Radio Frequency for the Treatment of Lumbar Disc Herniation: A 2-year Follow-up

2020 ◽  
Author(s):  
Wenbo Wei ◽  
Shajie Dang ◽  
Ling Wei ◽  
Tian Liu ◽  
Jue Wang
Keyword(s):  
Radio Frequency ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Steroid Injection ◽  
Lumbar Disc ◽  
Epidural Steroid Injection ◽  
Hospitalization Time ◽  
Post Operation ◽  
Transforaminal Epidural Steroid Injection ◽  
Epidural Steroid

Abstract Objective: To assess the therapeutic efficacy of transforaminal epidural steroid injection (TFESI) combined with radio frequency (RF) for the treatment of lumbar disc herniation (LDH). Methods: A total of 230 patients participated in the study: TFESI (Group T, n=110), TFESI combined with RF (Group TR, n=120). Visual analogue scale (VAS), Oswestry disability index (ODI) and Global perceived effect (GPE) scale were measured pre-operation, 1, 3, 6, 12 and 24 months after the operation. Hospitalization time, operation time, complications, and recurrence were compared between the two groups.Results: The VAS and ODI at each observation point of the post-operation were significantly decreased compared with the pre-operation in both groups (P < 0.05). There was no statistically different of VAS and ODI between the two groups at 1 and 3 months of the post-operation (P > 0.05). However, The VAS and ODI scores in Group TR were significantly lower than that in Group T at 6, 12 and 24 months of the post-operation (P < 0.05). The GPE in group TR was high in the early days, while that at 1 and 3 month after treatment was significantly higher than that in group T (P < 0.05). The recurrence rate in Group TR was lower than that in Group T (P = 0.002). There was no significant difference of hospitalization time, complications, VAS and ODI score at the pre-operation between the two groups (P > 0.05).Conclusion: These findings suggest that TFESI combined with RF could effectively improve the pain and function, and had a long-term satisfactory effect for the treatment of LDH.

scholarly journals Transforaminal epidural steroid injection combined with radio frequency for the treatment of lumbar disc herniation: a 2-year follow-up

2021 ◽  
Author(s):  
Wenbo Wei ◽  
Shajie Dang ◽  
Ling Wei ◽  
Tian Liu ◽  
Jue Wang
Keyword(s):  
Radio Frequency ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Steroid Injection ◽  
Lumbar Disc ◽  
Epidural Steroid Injection ◽  
Hospitalization Time ◽  
Post Operation ◽  
Transforaminal Epidural Steroid Injection ◽  
Epidural Steroid

Abstract Objective: To assess the therapeutic efficacy of transforaminal epidural steroid injection (TFESI) combined with radio frequency (RF) for the treatment of lumbar disc herniation (LDH). Methods: A total of 230 patients participated in the study: TFESI (Group T, n=110), TFESI combined with RF (Group TR, n=120). Visual analogue scale (VAS), Oswestry disability index (ODI) and Global perceived effect (GPE) scale were measured pre-operation, 1, 3, 6, 12 and 24 months after the operation. Hospitalization time, treatment time, complications, and recurrence were compared between the two groups.Results: The VAS and ODI at each observation point of the post-operation were significantly decreased compared with the pre-operation in both groups (P < 0.05). There was no statistically difference of VAS and ODI between the two groups at 1 and 3 months of the post-operation (P > 0.05). However, The VAS and ODI scores in Group TR were significantly lower than that in Group T at 6, 12 and 24 months of the post-operation (P < 0.05). The GPE in group TR was high in the early days, while that at 1 and 3 months after treatment was significantly higher than that in group T (P < 0.05). The recurrence rate in Group TR was lower than that in Group T (P = 0.002). There was no significant difference in hospitalization time, complications, VAS and ODI score at the pre-operation between the two groups (P > 0.05).Conclusion: These findings suggest that TFESI combined with RF could effectively improve the pain and function, and had a long-term satisfactory effect for the treatment of LDH.

scholarly journals Paraplegia after transforaminal epidural steroid injection in a patient with severe lumbar disc herniation - A case report -

2021 ◽  
Vol 16 (1) ◽  
pp. 96-102
Author(s):  
Seok Ho Jeon ◽  
Won Jang ◽  
Sun-Hee Kim ◽  
Yong-Hyun Cho ◽  
Hyun Seok Lee ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Steroid Injection ◽  
Treatment Plan ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Epidural Steroid Injection ◽  
Correct Treatment ◽  
Transforaminal Epidural Steroid Injection ◽  
Epidural Steroid

Background: Transforaminal epidural steroid injection (TFESI) is a conservative treatment for patients with lumbar disc herniation (LDH). However, there are reports of various complications that can occur after TFESI; among these, paraplegia is a serious complication. Case: A 70-year-old woman who was unable to lie supine due to low back pain exacerbation during back extension underwent TFESI. After injection, there was pain relief and the patient was able to lie supine; however, paraplegia developed immediately. Magnetic resonance imaging confirmed cauda equina syndrome (CES) due to nerve compression from L1–2 LDH. We determined that the patient's LDH was already severe enough to be considered CES and that the TFESI procedure performed without an accurate understanding of the patient's condition aggravated the disease. Conclusions: It is important to accurately determine the cause of pain and disease state of a patient to establish a correct treatment plan before TFESI is performed.

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