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Cervical transforaminal epidural

Min Cheol Chang
RATIONALE: Despite undergoing transforaminal epidural steroid injection (TFESI), many patients complain of persisting cervical radicular pain. For the management of chronic cervical radicular pain, clinicians are widely applying pulsed radiofrequency (PRF) stimulation to dorsal root ganglions (DRGs). To enhance the effect of PRF stimulation, we conducted bipolar PRF stimulation in 2 patients with chronic cervical radicular pain that was refractory to monopolar PRF and repeated TFESIs...
April 2017: Medicine (Baltimore)
Adam Meir, Keith Bush
PURPOSE: To show that with C5 radiculopathy and profound neurological deficit, good outcomes can be obtained with injection therapy. METHOD: We present two cases of cervical radiculopathy secondary to disc prolapse associated with profound neurological deficit. In both cases, cervical injection therapy was used as the primary management. RESULTS: The two cases presented were both male, 59 and 36 years, and were diagnosed on MRI imaging with C4/5 disc prolapses...
March 27, 2017: European Spine Journal
Bradly S Goodman, L McLean House, Sridhar Vallabhaneni, Srinivas Mallempati, Matthew R Willey, Matthew Thomas Smith
Setting.:  Epidural hematoma rarely complicates interventional spine procedures. While anticoagulant and antiplatelet drugs increase bleeding risk, cessation may precipitate serious thromboembolic events. The Spine Intervention Society (SIS) and American Society of Regional Anesthesia and Pain Medicine (ASRA) put forth guidelines that dissent with regard to management of hemostatically active agents during commonly performed spinal injections. Objective.:  To validate an antiplatelet/anticoagulant management table based on modifications of the SIS 2013 and ASRA 2015 guidelines...
October 6, 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Jangsup Moon, Hyung-Min Kwon
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...
January 2017: Case Reports in Neurology
Euddeum Shim, Joon Woo Lee, Eugene Lee, Joong Mo Ahn, Yusuhn Kang, Heung Sik Kang
Advances in imaging and the development of injection techniques have enabled spinal intervention to become an important tool in managing chronic spinal pain. Epidural steroid injection (ESI) is one of the most widely used spinal interventions; it directly delivers drugs into the epidural space to relieve pain originating from degenerative spine disorders-central canal stenoses and neural foraminal stenoses-or disk herniations. Knowledge of the normal anatomy of the epidural space is essential to perform an effective and safe ESI and to recognize possible complications...
March 2017: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Priyesh Mehta, Isaac Syrop, Jaspal Ricky Singh, Jonathan Kirschner
OBJECTIVE: To systematically analyze published studies in regard to the comparative efficacy of particulate versus nonparticulate corticosteroids for cervical and lumbosacral epidural steroid injections (ESI) in reducing pain and improving function. TYPE: Systematic review. LITERATURE SURVEY: MEDLINE (Ovid), EMBASE, and Cochrane databases were searched from the period of 1950 to December 2015. METHODOLOGY: Criteria for inclusion in this review were (1) randomized controlled trials and (2) retrospective studies that compared particulate versus nonparticulate medication in fluoroscopically guided injections via a transforaminal (TF) or interlaminar (IL) approach...
November 30, 2016: PM & R: the Journal of Injury, Function, and Rehabilitation
Fei Wang, Qian Zhou, Lizu Xiao, Juan Yang, Donglin Xong, Disen Li, LiPing Liu, Sigdha Ancha, Jianguo Cheng
BACKGROUND: We demonstrated a combination of pulsed radiofrequency (PRF) and cervical nerve root block (CNRB) via a posterior approach was superior to a transforaminal epidural steroid injection through the anterolateral approach for cervical radicular pain in a previous study. This randomized trial was conducted to determine the comparative efficacy between CNRB, PRF, and CNRB + PRF for cervical radicular pain. METHODS: A prospective and randomized design was used in this study...
October 14, 2016: Pain Practice: the Official Journal of World Institute of Pain
Dong Gyu Lee, Sang-Ho Ahn, Jungwon Lee
Transforaminal Epidural steroid injections (TFESI) have been widely adopted to alleviate and control radicular pain in accord with current guidelines. However, sometimes repeated steroid injections have adverse effects, and thus, this prospective randomized trial was undertaken to compare the effectivenesses of pulsed radiofrequency (PRF) administered to a targeted dorsal root ganglion (DRG) and TFESI for the treatment of radicular pain due to disc herniation. Subjects were recruited when first proved unsuccessful (defined as a score of > 4 on a visual analogue scale (VAS; 0-10 mm) and of > 30% according to the Oswestry Disability Index (ODI) or the Neck Disability Index (NDI))...
August 2016: Journal of Korean Medical Science
Jung Hwan Lee, Sang-Ho Lee
Epidural steroid injection (ESI) is known to be an effective treatment for neck or radicular pain due to herniated intervertebral disc (HIVD) and spinal stenosis (SS). Although repeat ESI has generally been indicated to provide more pain relief in partial responders after single ESI, there has been little evidence supporting the usefulness of this procedure. The purpose of this study, therefore, was to determine whether repeat ESI at a prescribed interval of 2 to 3 weeks after the first injection would provide greater clinical benefit in patients with partial pain reduction than intermittent ESI performed only when pain was aggravated...
July 2016: Medicine (Baltimore)
Bradly Goodman, Sridhar Vallabhaneni, Bradley Cubitt, Srinivas Mallempati
Unintended dural punctures with leakage of cerebrospinal fluid (CSF) are recognized as a frequent complication of spinal surgery. Although conservative or invasive options may be used to treat postoperative CSF leaks, the existing literature does not define either an algorithmic treatment approach or a universally accepted standard of care. We believe that a transforaminal epidural blood patch (EBP) can serve as a minimally invasive, cost-effective option to treat postsurgical CSF leaks that do not resolve with conservative management...
June 16, 2016: PM & R: the Journal of Injury, Function, and Rehabilitation
Ameet S Nagpal, George C Chang-Chien, Jonathan A Benfield, Kenneth D Candido, Maunak V Rana, Maxim Eckmann
BACKGROUND: Epidural steroid injections (ESIs) are among the most common procedures performed in an interventional pain management practice. It is well known that tragic complications may arise from ESIs, most commonly those performed using a transforaminal approach. Digital subtraction angiography (DSA) has been hailed as a fluoroscopic technique that can be used to detect arterial placement of the injection needle, and therefore as a safety measure that can decrease the incidence of catastrophic sequelae of these procedures...
2016: Pain Physician
S M Channabasappa, S Dharmappa, R Pandurangi
A 48-year-old male patient with a long-standing history of ankylosing spondylitis (AS) presented for ureteroscopic stone removal. On preoperative assessment, tracheal intubation was likely to be difficult due to decreased cervical spine mobility. Traditional neuraxial block was impossible due to the fusion of vertebral bodies. AS patients present the most serious array of intubation, which is secondary to decrease in cervical spine mobility and possible temporomandibular joint disease. Management of a case of AS can be very challenging when the airway and the central neuraxial blockade, both are difficult...
January 2016: Saudi Journal of Anaesthesia
I H Feeley, E F Healy, J Noel, P J Kiely, T M Murphy
BACKGROUND: Steroids in transforaminal epidural injections are widely used to ease radicular pain in both cervical and lumbar radiculopathy. Concerns have been articulated about the use of particulate steroids for this intervention, as a number of case reports have been published linking them with post procedural paralysis, possibly due to spinal ischaemia secondary to a steroid particulate embolism. Non-particulate, or soluble steroids, are mooted as an alternative; however, their effectiveness relative to particulate steroids has not been conclusively proven...
February 2017: European Spine Journal
Roderick J Finlayson, John-Paul B Etheridge, Pornpan Chalermkitpanit, Worakamol Tiyaprasertkul, Bill Nelems, De Q H Tran, Marc A Huntoon
BACKGROUND AND OBJECTIVES: Compared with the thoracic and lumbar spine, transforaminal epidural injections and medial branch blocks in the cervical spine are associated with a higher incidence of neurological complications. Accidental breach of small periforaminal arteries has been implicated in many instances. In this observational study, using ultrasonography, we surveyed the incidence of periforaminal bloods vessels in the cervical spine. METHODS: Patients undergoing ultrasound-guided cervical medial branch blocks were scanned using color power and pulsed wave Doppler...
March 2016: Regional Anesthesia and Pain Medicine
Jung Hwan Lee, Sang-Ho Lee
Transforaminal (TF) approach is preferred by physician to interlaminar (IL) approach because it can deliver injectates directly around nerve root and dorsal root ganglion, which is regarded as main pain sources. Axial neck pain is originated from sinuvertebral nerve located in ventral epidural spaces, which has been described to be related to central or paramedian disc herniation. It is very questionable that TF injection is also more effective than IL injection in the patients with axial neck or interscapular pain...
January 2016: Medicine (Baltimore)
Jun Kyu Lee, Ki Whan Chae, Chang Il Ju, Byoung Wook Kim
Cervical epidural steroid injection is frequently used in the conservative management of neck pain and cervical radiculopathy. Epidural cervical transforaminal injections are usually well-tolerated with mild side effects such as transient decreased sensory and motor function, or headache due to dural puncture. Although there are a few case reports about adverse effects of cervical epidural injection in the literature, it can cause severe complications such as large hematoma, infarction by spinal vascular injury...
November 2015: Journal of Korean Neurosurgical Society
Prashanth J Rao, Kevin Phan, Rajesh Reddy, Daniel B Scherman, Peter Taylor, Ralph J Mobbs
STUDY DESIGN: Prospective cohort study. OBJECTIVE: To evaluate if degenerative disc-related back or neck pain and/or radicular symptoms are caused by infection with low virulent bacterial organisms. SUMMARY OF BACKGROUND DATA: The potential relationship between disc infection and disc degeneration-related symptoms remains controversial, with contradictory evidence available in the literature. Several studies have demonstrated the presence of infected extruded nucleus tissue from first-time disc herniation, implicating the role of disc microbial infection in disc degeneration...
June 2016: Spine
G M Lagemann, M P Yannes, A Ghodadra, W E Rothfus, V Agarwal
BACKGROUND AND PURPOSE: Cervical transforaminal epidural steroid injections are commonly performed for temporary pain relief or diagnostic presurgical planning in patients with cervical radiculopathy. Intravascular injection of steroids during the procedure can potentially result in cord infarct, stroke, and even death. CT-fluoroscopy allows excellent anatomic resolution and precise needle positioning. This study sought to determine the safest needle tip position during CT-guided cervical transforaminal epidural steroid injection as determined by the incidence of intravascular injection...
April 2016: AJNR. American Journal of Neuroradiology
Alan D Kaye, Laxmaiah Manchikanti, Salahadin Abdi, Sairam Atluri, Sanjay Bakshi, Ramsin Benyamin, Mark V Boswell, Ricardo Buenaventura, Kenneth D Candido, Harold J Cordner, Sukdeb Datta, Gulshan Doulatram, Christopher G Gharibo, Vahid Grami, Sanjeeva Gupta, Sachin Jha, Eugene D Kaplan, Yogesh Malla, Dharam P Mann, Devi E Nampiaparampil, Gabor Racz, Prithvi Raj, Maunak V Rana, Manohar Lal Sharma, Vijay Singh, Amol Soin, Peter S Staats, Ricardo Vallejo, Bradley W Wargo, Joshua A Hirsch
BACKGROUND: Epidural injections have been used since 1901 in managing low back pain and sciatica. Spinal pain, disability, health, and economic impact continue to increase, despite numerous modalities of interventions available in managing chronic spinal pain. Thus far, systematic reviews performed to assess the efficacy of epidural injections in managing chronic spinal pain have yielded conflicting results. OBJECTIVE: To evaluate and update the clinical utility of the efficacy of epidural injections in managing chronic spinal pain...
November 2015: Pain Physician
Nam Chull Paik
BACKGROUND AND PURPOSE: In CT fluoroscopy (CTF)-guided cervical transforaminal epidural steroid injection (TFESI), the majority of radiation dose is contributed by the planning CT scan rather than the CTF procedure itself. We replaced the planning helical CT with a spot CTF and accordingly changed the patient posture during scout and planning scans. The aim of this study was to test whether radiation dose reduction would be achieved by this protocol modification while still maintaining technical performance...
April 2016: Cardiovascular and Interventional Radiology
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