scholarly journals Interventional Spine Considerations for Radiosensitivity in a Patient with Ligase IV Syndrome

2020 ◽  
pp. 135-140
Author(s):  
David J. Kohns
Keyword(s):  
Steroid Injection ◽  
Critical Role ◽  
Epidural Steroid Injection ◽  
Leg Pain ◽  
Distinct Advantage ◽  
Ligase Iv ◽  
Minimize Radiation Exposure ◽  
History Of ◽  
Key Words Epidural ◽  
Epidural Steroid

Background: Patient selection plays a critical role in any interventional pain practice. Rare conditions may not always have clearly established guidelines for interventional pain procedures. Ligase IV (LIG4) syndrome is a rare inherited condition with a wide variety of features, including radiosensitivity.. Case Report: A 36-year-old woman with a known history of LIG4 syndrome presented with an acute on chronic left L5 and S1 radiculopathy from a large L5-S1 central disc herniation. In an effort to minimize radiation exposure, an ultrasound (US)-guided caudal epidural steroid injection was used to help manage her radicular leg pain. Conclusion: Interventional spine providers should be aware of rare radiosensitive conditions and strive to offer appropriate treatment alternatives. While limitations do exist, emerging US-guide spine procedures hold a distinct advantage for patients with radiosensitivities. Key words: Epidural steroid injection, Ligase IV syndrome, radiculopathy, radiology, radiosensitivity, ultrasound

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 Prognostic value of hypersensitivity reactions on epidural steroid injection outcomes: a phenotypic signature? A prospective cohort study

2019 ◽  
Vol 44 (5) ◽  
pp. 586-594 ◽  
Author(s):  
Steven P Cohen ◽  
Tina L Doshi ◽  
Timothy C Dawson ◽  
Anita Gupta ◽  
Shravani Durbhakula ◽  
...  
Keyword(s):  
Central Sensitization ◽  
Steroid Injection ◽  
Epidural Steroid Injection ◽  
Leg Pain ◽  
Successful Outcome ◽  
Hypersensitivity Reactions ◽  
Post Procedure ◽  
Immune Mediated ◽  
The Mean ◽  
Epidural Steroid

BackgroundStudies have found that diffuse pain, indicative of central sensitization, portends poor interventional outcomes. Multiple chemical sensitivities are associated with signs of central sensitization. We sought to prospectively determine whether hypersensitivity reactions (HR) were associated with epidural steroid injection (ESI) outcomes.MethodsHR were classified as immune-related or non-immune-related and categorized by number (0=low, 1 or 2=intermediate, ≥3=high). The primary outcome measure was mean reduction in average leg pain score 1 month post-procedure. A positive outcome was defined as a two-point or greater decrease in average leg pain accompanied by satisfaction 1 month post-procedure.ResultsThe mean number of immune-mediated and non-immune-mediated HR were 0.6±1.2 and 0.8±1.4, respectively. Individuals in the high (n=24) total HR group had a mean reduction in average leg pain of 0.1±2.7, compared with those in the low (n=61; 1.8±2.1, p=0.025) and intermediate groups (n=52; 1.6±3.1, p=0.060). For back pain and categorical successful outcome, those with fewer HR experienced greater benefit. There were no differences in outcomes when patients were stratified by immune-related HR. Among participants in the low, intermediate and high non-immune-mediated HR groups, the mean reductions in average leg pain scores were 1.7±2.5, 1.6±3.0, and −0.2±2.3, respectively (p = 0.002). 51%, 35%, and 12% of people with low, intermediate and high numbers of non-immune-mediated HR experienced a positive categorical outcome, respectively (p=0.007).ConclusionsNon-immune-related HR were inversely correlated with some ESI outcome measures.

scholarly journals Clinical Effectiveness and Prognostic Indicators of Parasagittal Interlaminar Epidural Injection

2016 ◽  
Vol 6;19 (6;7) ◽  
pp. E877-E884
Author(s):  
JiHee Hong
Keyword(s):  
Spinal Stenosis ◽  
Beck Depression Inventory ◽  
Steroid Injection ◽  
Clinical Effectiveness ◽  
Prognostic Indicator ◽  
Epidural Steroid Injection ◽  
Leg Pain ◽  
Prognostic Indicators ◽  
Interlaminar Epidural Steroid Injection ◽  
Epidural Steroid

Background: Interlaminar epidural steroid injection (ESI) is a well-established intervention to improve radicular leg pain. However, few studies have demonstrated the prognostic factors for interlaminar ESI. Objective: To investigate the clinical effectiveness and prognostic indicators of parasagittal interlaminar ESI during a 2-week follow-up. Study Design: Prospective evaluation. Setting: An interventional pain management practice in South Korea. Methods: After Institutional Review Board approval, parasagittal interlaminar ESI under fluoroscopic guidance was performed in 55 patients with central spinal stenosis. The numerical rating scale (NRS) and the Oswestry Disability Index (ODI) (%) were used to evaluate clinical efficacy and prognostic indicators. To determine the prognostic indicators, treatment outcomes were classified as successful (decreased NRS ≥ 50%, decreased ODI ≥ 40%) and unsuccessful (decreased NRS < 50%, decreased ODI < 40%) results. Results: Parasagittal interlaminar ESI significantly improved the NRS and ODI (%) scores after 2 weeks compared to those measured pretreatment. Paresthesia provocation (P = 0.006) was a significant prognostic factor on the NRS, whereas the Beck Depression Inventory (BDI) score (P = 0.007), paresthesia provocation (P = 0.035), and epidurography finding (P = 0.038) were significant on the ODI (%) score between patients with successful and unsuccessful outcomes. Limitations: We included the method of parasagittal interlaminar ESI only, therefore, direct comparison with other techniques was not available. Conclusion: Parasagittal interlaminar ESI significantly improved the NRS and ODI (%) scores. Paresthesia provocation was a prognostic indicator on the NRS and ODI (%) scores, and BDI scores and epidurography findings were prognostic indicators for the ODI (%) score. Key words: Parasagittal interlaminar epidural steroid injection, spinal stenosis, radicular leg pain, prognostic indicator, paresthesia provocation, epidurography, Beck Depression Inventory

Pre-Contrast Injection Multiple Needle Placement Technique: An Alternative Method for Performing Challenging Transforaminal Epidural Steroid Injections for Radicular Pain

2020 ◽  
pp. 39-44
Author(s):  
Sanjeeva Gupta
Keyword(s):  
Steroid Injection ◽  
Epidural Injection ◽  
Radicular Pain ◽  
Epidural Steroid Injection ◽  
Needle Placement ◽  
Contrast Injection ◽  
Epidural Steroid Injections ◽  
Key Words Epidural ◽  
Epidural Steroid ◽  
Placement Technique

Abstract: A subpedicular transforaminal epidural steroid injection (TFESI) at the L5-S1 level can be technically challenging due to lumbar spondylosis. As described in the cases below, in challenging cases, placing multiple needles (normally 2 needles, occasionally 3 needles) before injecting the radiocontrast dye can improve the chances of depositing the steroid in the area of pathology responsible for pain. This will, of course, add to the risk of the procedure due to multiple needles being close to the nerve root. On balance, however, it may be less risky than not placing the steroid at the appropriate pathological site, which may fail to provide pain relief leading to unnecessary suffering and, in some cases, surgical intervention. However, if the spread of contrast medium and the subsequent steroid injection through the first needle is satisfactory, then the other needles can be removed without injecting. The “pre-contrast injection multiple needle placement” technique has been used by the author on multiple occasions and 3 cases are described below. Key words: Epidural steroid injection, transforaminal epidural injection, sciatica, radicular pain, multiple needle technique

scholarly journals EPIDURAL STEROID INJECTION IN HERNIATED DISC AND LUMBAR CANAL STENOSIS: IS IT JUST A PLACEBO?

2021 ◽  
Vol 20 (3) ◽  
pp. 189-191
Author(s):  
AJAY KUMAR SHETTY PAPANNA ◽  
SUJITH RAO VITTALDAS ◽  
BALAMURUGAN THIRUGNANAM ◽  
VIDYADHARA SRINIVASA
Keyword(s):  
Back Pain ◽  
Pain Score ◽  
Steroid Injection ◽  
Epidural Steroid Injection ◽  
Leg Pain ◽  
P Value ◽  
Lumbar Canal Stenosis ◽  
Canal Stenosis ◽  
The Mean ◽  
Epidural Steroid

ABSTRACT Objective To study the role of epidural steroid injection (ESI) in patients with lumbar disc herniation (LDH) and lumbar canal stenosis (LCS). ESIs are regularly used to support non-operative treatment for LBP, and our anecdotal impression is that a considerable proportion of patients report substantial pain relief after ESI. Methods One thousand consecutive patients (645 patients with LDH and 355 patients with LCS) who required ESI from January-August 2018 were included. All were given the same ESI, prepared with triamcinolone (80 mg), bupivacaine (0.25%, 4 ml) and normal saline (4 ml). Patients were evaluated using the numerical rating scale (NRS) immediately after the injection, after 7 days, and after 3 months. Results The mean NRS back-pain score of the LDH-group was reduced from 5 (range: 4-8) to 4 (range: 2-7) immediately after injection, 2 (range: 1-7) after 7 days and 2 (range: 1-7) after 3 months (p-value<0.001). The mean NRS back-pain score of the LCS-group was reduced from 5 (range: 4-8) to 4 (range: 2-7) immediately after injection, 2 (range: 1-7) after 7 days and 3 (range: 1-7) after 3 months (p-value <0.001). The mean NRS leg-pain score of the LDH group was reduced from 5 (range: 4-9) to 3 (range: 3-7) immediately after injection, 1 (range: 1-6) after 7 days and 2 (range: 1-7) after 3 months (p-value <0.001). The mean NRS leg-pain score of the LCS group was reduced from 5 (range: 4-9) to 4 (range: 3-7) immediately after injection, 3 (range: 1-7) after 7 days and 2 (range 1-6) after 3 months (p-value <0.001). Conclusion ESI causes statistically significant improvement in back and leg pain in patients with LDH and LCS. However, the short and medium-term efficacy of ESI in the LCS group was lower than in the LDH group. Level of evidence IV; Prospective hospital-based study.

scholarly journals The Efficacy of Transforaminal Epidural Steroid Injection by the Conventional Technique in FarLateral Herniation of Lumbar Disc

2012 ◽  
Vol 5;15 (5;9) ◽  
pp. 415-420
Author(s):  
Joon-Hee Park
Keyword(s):  
Oswestry Disability Index ◽  
Steroid Injection ◽  
Lumbar Disc ◽  
Conventional Technique ◽  
Epidural Steroid Injection ◽  
Leg Pain ◽  
Significant Difference ◽  
Transforaminal Epidural Steroid Injection ◽  
Far Lateral ◽  
Epidural Steroid

Background: Owing to the anatomical difference between the far lateral herniation of the lumbar disc (FHLD) and the intraspinal herniation of lumbar disc (iHLD), the outcome of transforaminal epidural steroid injections (TFESI) in patients with FHLD seems to be different from that in patients with iHLD. However, few studies have evaluated the efficacy of TFESI in FHLD. Objective: To evaluate and compare the efficacy of TFESI in FHLD and iHLD patients. Study Design: A retrospective design. Methods: There were 15 and 70 patients in the FHLD and iHLD groups, respectively. Patients received a fluoroscopically guided TFESI. Failure rates of TFESI were recorded, and questionnaires, including a visual analog scale (VAS) for leg pain and Oswestry Disability Index (ODI) were administered before the initial injection, at 2 weeks, 6 weeks, and 12 weeks after the injections. Results: There was no failure for TFESI in the iHLD group, while 9 patients had to undergo alternative blocks in the FHLD group due to lancinating leg pain when the needle was advanced for TFESI. In the iHLD group, there was a statistically significant improvement in the VAS and ODI score 12 weeks after injection. Considering only successful cases of the FHLD group, significant improvement in the VAS and ODI score was also demonstrated in the FHLD group 12 weeks after injection. Moreover, there was no statistically significant difference of the VAS and ODI between the both groups. Limitations: A relatively small numbers of cases were included in the FHLD group. Conclusion: The current study suggests that an alternative needle placement technique for TFESI appears to be necessary for FHLD patients. Key words: Far lateral herniation of lumbar disc, intraspinal herniation of lumbar disc, transforaminal epidural steroid injection, safe triangle, herniated lumbar disc, visual analog pain scale, Oswestry disability index, radiculopathy

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.

Sign in / Sign up

Export Citation Format

Share Document