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JOURNAL ARTICLE
Nishan Bingham, Raymon Dhall, Michael Montuori, Kristoffer Padjen, Christopher Gharibo, Lisa Doan
BACKGROUND: Epidural steroid injections (ESI) are one of the most commonly performed pain procedures; however, there has been variation in techniques and approaches amongst pain physicians in the United States. The formation of a multidisciplinary working group was made with considerations to help guide ESI practice. OBJECTIVE: Pain medicine physicians in the United States were surveyed in order to provide an update on current practices for both transforaminal and interlaminar ESI...
September 2022: Pain Physician
#22
JOURNAL ARTICLE
Paul M Kitei, David E Surrey, Jeremy I Simon, David S Stolzenberg
The epidural space is commonly accessed via an interlaminar or transforaminal approach in order to administer corticosteroids for radicular pain. An alternative is a trans-articular approach, which may be considered when conventional access to the epidural space is either not desired or contraindicated. This approach has been described in the cervical spine using computed tomography guidance but not fluoroscopic guidance. We describe a cervical trans-articular approach to the epidural space under fluoroscopy and review the computed tomography-guided literature...
August 9, 2022: American Journal of Physical Medicine & Rehabilitation
#23
JOURNAL ARTICLE
Ayse Kinci, Sinem Sari, Esra Ertilav, Osman Nuri Aydin
AIM: To evaluate the efficacy and safety of combined transforaminal anterior epidural steroid injection (TAESI) and dorsal root ganglion pulsed radiofrequency (DRG-PRF) therapy on the radicular neck pain. MATERIAL AND METHODS: The results of 84 patients with cervical radicular pain who underwent combined DRG-PRF and TAESI under fluoroscopy were evaluated retrospectively. Primer outcome is the pain measurements of the patients before and after the procedure at the 1st, 3rd, and 6th months were evaluated with the Verbal Pain Scale (VPS)...
January 7, 2022: Turkish Neurosurgery
#24
REVIEW
Eugene Lee, Joon Woo Lee, Heung Sik Kang
Spine intervention is an important treatment option for the management of spinal pain, and the numbers of the most representative epidural steroid injection (ESI) procedures performed are expected to increase significantly in the future along with increased life expectancy and the increasing prevalence of spinal disorders. Therefore, it is important to understand the efficacy of ESIs according to each spinal disorder they are administered to treat, and one must be familiar with the possible complications. In fact, although numerous ESI-related articles have been published, there is still considerable controversy regarding the efficacy of ESI procedures...
July 20, 2022: Skeletal Radiology
#25
JOURNAL ARTICLE
Ji Seon Chae, Won-Joong Kim, Mi Jin Jue
BACKGROUND: A cervical transforaminal epidural (TFE) steroid injection is a useful treatment option for cervical radicular pain, but it carries a small risk of catastrophic complications. Several studies have reported that cervical facet joint (FJ) steroid injection can reduce cervical radicular pain through an indirect epidural spread. The aim of this retrospective comparative study was to evaluate the pain scores and functional disability in subjects receiving cervical FJ or TFE steroid injection for the treatment of cervical radicular pain due to foraminal stenosis (FS)...
June 27, 2022: Journal of Korean Medical Science
#26
JOURNAL ARTICLE
Zakk M Borton, Ben J Oakley, Jonathan A Clamp, Nick C Birch, Antony H Bateman
AIMS: Cervical radiculopathy is a significant cause of pain and morbidity. For patients with severe and poorly controlled symptoms who may not be candidates for surgical management, treatment with transforaminal epidural steroid injections (CTFESI) has gained widespread acceptance. However, a paucity of high-quality evidence supporting their use balanced against perceived high risks of the procedure potentially undermines the confidence of clinicians who use the technique. We undertook a systematic review of the available literature regarding CTFESI to assess the clinical efficacy and complication rates of the procedure...
May 2022: Bone & Joint Journal
#27
MULTICENTER STUDY
Rekib Sacaklidir, Ekim Can Ozturk, Savas Sencan, Osman Hakan Gunduz
BACKGROUND: Although fluoroscopy-guided interventional therapies have declined in recent years, radiation exposure remains a critical issue for both patients and medical staff. Radiation exposure varies according to the physicians' experience, procedure time, patients' body mass index (BMI), imaging techniques, and the type of procedure performed. OBJECTIVE: The purpose of this study is to report procedure times and calculate the radiation doses for 4 different approaches of fluoroscopy-guided epidural injections per procedure and BMI to provide radiations doses for potential use in future dose reduction strategies...
January 2022: Pain Physician
#28
JOURNAL ARTICLE
Christin A Tiegs-Heiden, Ajay A Madhavan, Felix E Diehn, Vance T Lehman, Naveen S Murthy
OBJECTIVE: Ensuring medication delivery to the epidural space is crucial for effective transforaminal epidural steroid injections. Epidural needle placement is determined by injecting a small amount of contrast at the final needle position. The purpose of this study is to illustrate the appearance of contrast flow in the retrodural retroligamentous space of Okada during computed tomography- and fluoroscopy-guided cervical and lumbar transforaminal epidural steroid injections. DESIGN: This retrospective study will use a series of cases to demonstrate contrast within the space of Okada during epidural transforaminal steroid injections...
May 30, 2022: Pain Medicine
#29
JOURNAL ARTICLE
Jiseob Kim, Kilhyun Kim, MinKyu Lee, Saeyoung Kim
PURPOSE: Cervical transforaminal epidural blocks (CTEBs) are useful for the treatment of cervical radicular pain. However, during CTEBs, inadvertent intravascular injection can introduce particulate steroids into the bloodstream, thus leading to serious complications. Moreover, the risk factors associated with intravascular injection during CTEBs have not been identified. Cervical neural foraminal stenosis (CNFS) is a form of neural foraminal narrowing and a common cause of cervical radicular pain...
2021: Journal of Pain Research
#30
RANDOMIZED CONTROLLED TRIAL
Sang Hoon Lee, Hyun Hee Choi, Min Cheol Chang
BACKGROUND: Many patients complain of chronic cervical radicular pain, and pulsed radiofrequency (PRF) is known to have a positive effect for alleviating neuropathic pain. OBJECTIVES: In the present study, we used ultrasound (US) guidance and compared the effects of monopolar PRF with those of bipolar PRF in patients with chronic cervical radicular pain refractory to repeated transforaminal epidural steroid injections. METHODS: Sixty-six patients with chronic cervical radicular pain were included in this study...
2022: Journal of Back and Musculoskeletal Rehabilitation
#31
JOURNAL ARTICLE
Mougnyan Cox, Kofi-Buaku Atsina, Preethi Ramchand, Jonathan Ji, Neda Sedora-Roman, Bryan Pukenas
BACKGROUND: Intrathecal nusinersen is the first Food and Drug Administration-approved treatment for spinal muscular atrophy. Reliable intrathecal access is critical for initial and maintenance therapy; however, this can be challenging in older patients with spinal muscular atrophy many of whom have had prior lumbar instrumentation and osseous fusion. Transforaminal lumbar punctures have emerged as a technique for intrathecal access that avoids the hazards of cervical punctures. We describe our technique for transforaminal lumbar punctures under computed tomography guidance using local anesthesia and a straight 22-gauge needle...
June 2022: Interventional Neuroradiology
#32
JOURNAL ARTICLE
Mustfa K Manzur, Andre M Samuel, Avani Vaishnav, Catherine Himo Gang, Evan D Sheha, Sheeraz A Qureshi
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The objective of this study is to determine how often patients with degenerative cervical myelopathy (DCM) and initially treated with cervical steroid injections (CSI) and to determine whether these injections provide any benefit in delaying ultimate surgical treatment. METHODS: All patients with a new diagnosis of DCM, without previous cervical spine surgery or steroid injections, were identified in PearlDiver, a large insurance database...
July 5, 2021: Global Spine Journal
#33
Zachary L McCormick, Aaron Conger, Beau P Sperry, Masaru Teramoto, Russell Petersen, Fabio Salazar, Shellie Cunningham, A Michael Henrie, Erica Bisson, Richard Kendall
No abstract text is available yet for this article.
May 24, 2021: Pain Medicine
#34
RANDOMIZED CONTROLLED TRIAL
Aaron Conger, Richard W Kendall, Beau P Sperry, Russell Petersen, Fabio Salazar, Shellie Cunningham, A Michael Henrie, Erica F Bisson, Masaru Teramoto, Zachary L McCormick
OBJECTIVES: The objective of this study was to evaluate the long-term effectiveness of catheter-directed cervical interlaminar epidural steroid injection with triamcinolone compared with cervical transforaminal steroid injection with dexamethasone for the treatment of refractory unilateral radicular pain. DESIGN: Prospective, randomized, comparative trial. METHODS: The primary outcome was the proportion of participants with ≥50% Numeric Rating Scale 'dominant pain' (the greater of arm vs neck) reduction from baseline...
September 2021: Regional Anesthesia and Pain Medicine
#35
JOURNAL ARTICLE
Josh Levin, David Levi, Nolan Gall, Scott Horn, Matthew Smuck
BACKGROUND: Few studies have evaluated the effect of final needle position on contrast flow patterns during the performance of cervical transforaminal epidural steroid injections (TFESIs). OBJECTIVE: To analyze fluoroscopically guided cervical TFESI contrast flow patterns based upon final needle tip position. DESIGN: Retrospective, observational in vivo study. SETTING: Outpatient private practice physical medicine and rehabilitation spine clinic...
March 2022: PM & R: the Journal of Injury, Function, and Rehabilitation
#36
RANDOMIZED CONTROLLED TRIAL
Ji Hoon Sim, Han Park, Yujin Kim, Jin-Woo Shin, Jeong-Gil Leem, Hyun-Seok Cho, Seong-Soo Choi
BACKGROUND: Cervical epidural steroid injections (ESI) are performed either by interlaminar (IL) or transforaminal (TF) approaches; however, there is controversy over which is better for safety and efficacy. OBJECTIVES: This clinical trial aimed to compare the effectiveness of the parasagittal IL and TF approaches for cervical ESI in patients who were suffering from cervical radicular pain. STUDY DESIGN: A prospective randomized assessor-blind study...
March 2021: Pain Physician
#37
LETTER
Zachary L McCormick, Aaron Conger
No abstract text is available yet for this article.
June 4, 2021: Pain Medicine
#38
LETTER
Min Cheol Chang, Tae Uk Kim
No abstract text is available yet for this article.
June 4, 2021: Pain Medicine
#39
JOURNAL ARTICLE
Min Young Lee, Min Cheol Chang
We herein report a case of chemical meningitis that developed after cervical transforaminal steroid injection. A 49-year-old man presented with symptoms of meningitis (severe headache and neck stiffness) after cervical transforaminal steroid injection at the right C5-6 level. The injection solution was a mixture of lidocaine (0.3 mL), hyaluronidase (1 mL), placenta hydrolysate (2 mL), and normal saline (1 mL). The patient developed symptoms of meningitis 2.5 hours after the cervical epidural injection. Cerebrospinal fluid (CSF) analysis was performed 1 day after the injection, and the results showed an elevated white blood cell count at 7106 cells/µL...
February 2021: Journal of International Medical Research
#40
REVIEW
Laxmaiah Manchikanti, Nebojsa Nick Knezevic, Annu Navani, Paul J Christo, Gerard Limerick, Aaron K Calodney, Jay Grider, Michael E Harned, Lynn Cintron, Christopher G Gharibo, Shalini Shah, Devi E Nampiaparampil, Kenneth D Candido, Amol Soin, Alan D Kaye, Radomir Kosanovic, Trevor R Magee, Douglas P Beall, Sairam Atluri, Myank Gupta, Standiford Helm Ii, Bradley W Wargo, Sudhir Diwan, Steve M Aydin, Mark V Boswell, Bill W Haney, Sheri L Albers, Richard Latchaw, Alaa Abd-Elsayed, Ann Conn, Hans Hansen, Thomas T Simopoulos, John R Swicegood, David A Bryce, Vijay Singh, Salahadin Abdi, Sanjay Bakshi, Ricardo M Buenaventura, Joseph A Cabaret, Jessica Jameson, Sunny Jha, Adam M Kaye, Ramarao Pasupuleti, Kartic Rajput, Mahendra R Sanapati, Nalini Sehgal, Andrea M Trescot, Gabor B Racz, Sanjeeva Gupta, Manohar Lal Sharma, Vahid Grami, Allan T Parr, Emilija Knezevic, Sukdeb Datta, Kunj G Patel, Deborah H Tracy, Harold J Cordner, Lee T Snook, Ramsin M Benyamin, Joshua A Hirsch
BACKGROUND: Chronic spinal pain is the most prevalent chronic disease with employment of multiple modes of interventional techniques including epidural interventions. Multiple randomized controlled trials (RCTs), observational studies, systematic reviews, and guidelines have been published. The recent review of the utilization patterns and expenditures show that there has been a decline in utilization of epidural injections with decrease in inflation adjusted costs from 2009 to 2018. The American Society of Interventional Pain Physicians (ASIPP) published guidelines for interventional techniques in 2013, and guidelines for facet joint interventions in 2020...
January 2021: Pain Physician
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