scholarly journals Contrast Dispersion Pattern and Efficacy of Computed Tomography-Guided Cervical Transforaminal Epidural Steroid Injection

2014 ◽  
Vol 6;17 (6;12) ◽  
pp. 487-492
Author(s):  
Chan Hong Park
Keyword(s):  
Computed Tomography ◽  
Steroid Injection ◽  
Radicular Pain ◽  
Small Sample ◽  
Epidural Steroid Injection ◽  
Dispersion Pattern ◽  
Short Term ◽  
Ct Guided ◽  
Significant Difference ◽  
Epidural Steroid

Background: The causes of upper extremity radicular pain or neck pain are varied, often involving disc herniation, spinal stenosis, or spondylosis. Cervical transformaminal epidural steroid injection (C-TFESI) is a common treatment for such pain. However, its efficacy conceivably may depend on needle-tip placement, linking the degree of pain reduction achieved to the pattern of contrast dispersion. Objective: The current study explores this relationship, evaluating contrast dispersion patterns of C-TFESI in conjunction with short-term patient outcomes. Study Design: Prospective evaluation. Methods: A total of 67 patients with cervical radicular pain were enrolled, each of whom underwent computed tomography (CT)-guided C-TFESI. Procedural contrast dispersion was judged as either intraforaminal or extraforaminal. Using the Roland 5-point pain scale, outcomes were scored 2 weeks after injection and then grouped as improvement (scores, 0 – 2) or no improvement (scores, 3 – 5). Results: Contrast dispersion was largely intraforaminal (50 patients), as opposed to extraforaminal (17 patients), with no statistically significant difference in short-term pain relief by contrast pattern (intraforaminal: 56%, 28/50; extraforaminal: 53%, 9/17; P = 0.459). Of the 50 procedures where dispersion of contrast was intraforaminal, 44% (22/50) were scored as unfavorable outcomes. Limitations: Small sample size, brief follow-up, and secondary outcomes were not measured. Authors also did not analyze other variables impacting C-TFESI, and classifying patterns of contrast spread anatomically as epidural or epiradicular (one, both, or neither as applicable) is simply not feasible by CT. Conclusion: C-TFESI is an effective treatment for cervical radicular pain that is refractory to conventional conservative remedies. However, therapeutic response to C-TFESI and dispersion pattern of injected contrast failed to correlate in this study. Key words: Cervical, epidural, contrast, CT-guided, TFESI

Comparison of three CT-guided epidural steroid injection approaches in 104 patients with cervical radicular pain: transforaminal anterolateral, posterolateral, and transfacet indirect

2018 ◽  
Vol 47 (12) ◽  
pp. 1625-1633 ◽  
Author(s):  
Sylvain Bise ◽  
Lionel Pesquer ◽  
Mathieu Feldis ◽  
Myriam Bou Antoun ◽  
Alain Silvestre ◽  
...  
Keyword(s):  
Steroid Injection ◽  
Radicular Pain ◽  
Epidural Steroid Injection ◽  
Ct Guided ◽  
Epidural Steroid

scholarly journals Concordant Pain Provocation During Transforaminal Epidural Steroid Injection for Lumbosacral Radiculopathy: Effect on Pain Outcome and Predictive Factors

2015 ◽  
Vol 18;1 (1;1) ◽  
pp. E19-E26
Author(s):  
Zack McCormick
Keyword(s):  
Pain Relief ◽  
Steroid Injection ◽  
Radicular Pain ◽  
Epidural Steroid Injection ◽  
Foraminal Stenosis ◽  
Short Term ◽  
Pain Provocation ◽  
Pain Outcomes ◽  
Epidural Steroid

Background: Anecdotal report suggests that provocation of pain during epidural steroid injection (ESI) that is concordant with typical radicular symptoms predicts pain outcome following injection. However, limited evidence exists that substantiates this theory. Additionally, there is a paucity of literature investigating factors associated with the provocation of pain during ESI. Objectives: The goal of this study was to determine whether provocation of concordant radicular pain during transforaminal ESI predicts pain relief immediately after injection and at short-term follow-up. Demographic, radiologic, and procedural factors associated with the pain provocation and pain outcomes at immediate and short-term follow-up were also investigated. Study Design: Longitudinal cohort study. Setting: Urban academic outpatient interventional spine clinics. Methods: Adults who underwent a fluoroscopically guided transforaminal ESI without sedation between January 1, 2006, and October 29, 2007, for the treatment of lumbosacral radicular pain were included in this study. The relationships between provocation of concordant pain, immediate post-injection, and follow-up visual analogue scale (VAS) pain scores, as well as with demographic, radiologic, and procedural factors were determined using chi-square/Fisher’s exact tests for categorical variables and t-tests or ANOVA for numerical variables. Results: One thousand twenty one patients, 42.4% (433) male/57.6% (588) female, with a mean (SD) age of 54.1 (16.7) years were included in the study. Concordant pain provocation did not predict the magnitude of pain reduction (P = 0.9255) or the frequency of achieving > 50% pain relief (P = 0.7449) at short-term follow-up. Radiologic evidence of foraminal stenosis or nerve root impingement (P < 0.0001) and the lack of a medial-superior contrast flow pattern (P = 0.0199) were associated with a greater frequency of pain provocation during transforaminal ESI. Limitations: This study is primarily limited by possible selection bias given that patients who did not follow-up in the clinic could not be studied, and an incomplete follow-up rate (66%). Conclusions regarding subacute and long-term pain outcomes cannot be determined from this study as only short-term data were available. Conclusions: Provocation of concordant radicular pain does not predict pain relief at short-term follow-up after a transforaminal ESI. Foraminal stenosis, nerve root impingement, and lack of a medial-superior contrast flow pattern are associated with pain during the transforaminal ESI. Thus, clinicians should be aware of these radiologic and procedural risk factors for inciting pain during transforaminal ESI. Key words: Epidural steroid injection, lumbar, radicular pain, outcomes, prognostic

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.

Translaminar Cervical Epidural Steroid Injection: Short-term Results and Factors Influencing Outcome

2007 ◽  
Vol 18 (9) ◽  
pp. 1151-1155 ◽  
Author(s):  
William M. Strub ◽  
Thomas A. Brown ◽  
Jun Ying ◽  
Mary Hoffmann ◽  
Robert J. Ernst ◽  
...  
Keyword(s):  
Steroid Injection ◽  
Epidural Steroid Injection ◽  
Short Term ◽  
Factors Influencing ◽  
Epidural Steroid

EFFECTIVENESS OF EPIDURAL STEROID INJECTION FOR THE MANAGEMENT OF CHRONIC LOW BACK PAIN.

2021 ◽  
pp. 52-54
Author(s):  
Ravi Ranjan Singh ◽  
Bharat Singh
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Steroid Injection ◽  
Lumbar Disc ◽  
Radicular Pain ◽  
Epidural Steroid Injection ◽  
Low Back ◽  
Herniated Lumbar Disc ◽  
Epidural Steroid

INTRODUCTION: Low-back pain is a common clinical presentation of herniated lumbar disc. The incidence of low back pain is high in our country due to difcult working and living environment. The initial treatment of low back pain is conservative. Epidural steroid injection (ESI) is being slowly established as a simple, effective and minimally invasive treatment modality. The aim of this study is to assess the effectiveness of epidural steroid injection for low back and radicular pain. MATERIALS AND METHODS :This is a Prospective observational study. It was carried out on the patients presenting with low back pain due to herniated lumbar disc not responding to conservational management and had Magnetic Resonance Imaging (MRI) proven lumbar disc prolapsed at different level. Injection Methyl prednisolone 80 mg and 2 ml of 0.5% bupivacaine was diluted in 8 ml of normal saline and injected into the affected lumbar epidural space. The functional status of the patient and the severity of pain were evaluated before injection and after injection during the follow-up period by using Ostrewy disability index and visual analogue score. RESULTS: Fifty six patients received the epidural steroid injections, among them three patients did not came for regular follow up till six months and six patients required surgery . remaining forty seven were analyzed , among them 27(55.44%) were male and 20(42.55%) were female. The functional status and pain response of the patients were improved signicantly during all the follow-up periods (p < 0.001). The success rate of this study was 83.92%. No major complications were encountered. CONCLUSION:The ESI is a simple, safe, effective and minimally invasive modality for the management of lumbar radicular pain.

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