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 Comparison of Transforaminal and Parasagittal Epidural Steroid Injections in Patients With Radicular Low Back Pain

2015 ◽  
Vol 5 (3) ◽  
Author(s):  
Masoud Hashemi ◽  
Mohamad Reza Aryani ◽  
Sirus Momenzadeh ◽  
Seyed Sajad Razavi ◽  
Gholamreza Mohseni ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Low Back ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Epidural Steroid

Residents' Learning Curve of Lumbar Transforaminal Epidural Steroid Injections

2017 ◽  
Vol 78 (05) ◽  
pp. 460-466 ◽  
Author(s):  
Sarah Haile ◽  
Gerhard Hildebrandt ◽  
Martin Stienen ◽  
Holger Joswig
Keyword(s):  
Learning Curve ◽  
Radiation Exposure ◽  
Learning Curves ◽  
Outcome Analysis ◽  
Monotone Regression ◽  
Procedure Time ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Operative Notes ◽  
Epidural Steroid

Background and Study Aims There is a paucity of literature on beginners' training and on its connection with patient safety for transforaminal epidural steroid injections (TFESIs). This study retrospectively assessed the learning curves and associated complications of neurosurgery residents never previously exposed to TFESI and compared them with experienced board-certified faculty neurosurgeons (BCFNs). Material and Methods Procedure time in minutes, dose-area product (DAP) in cGy*cm2, periprocedural observations, and complications in 354 TFESIs for radicular pain secondary to lumbar disk herniation or lumbar spinal stenosis were extracted from operative notes and the electronic infiltration logbook in the per-injection format. Learning curves for 238 residents and 116 BCFN TFESIs in terms of procedure time and DAP were estimated using monotone regression. Results Residents' TFESI procedure time and DAP reached BCFN level (4.7 minutes and 140.2 Gy*cm2) after 67 and 68 cases, respectively. Residents' TFESIs were unsuccessful in 1.7%, mostly for severe obesity and hypertrophied facet joints, but no severe complications were noted. Obesity, however, did not result in increased procedure times or radiation exposure in general. Residents were faster and required less fluoroscopy in TFESI of the upper lumbar nerve roots than for L5 or S1 in particular. Conclusion The residents' learning curve for TFESIs in terms of procedure time and radiation exposure can be overcome safely after < 70 TFESIs. An outcome analysis correlating to the interventionalist's training level would be worth investigating in future studies.

Sign in / Sign up

Export Citation Format

Share Document