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https://www.readbyqxmd.com/read/28437329/metastatic-spinal-cord-compression-and-steroid-treatment-a-systematic-review
#1
Abhishek Kumar, Michael H Weber, Ziya Gokaslan, Jean-Paul Wolinsky, Meic Schmidt, Laurence Rhines, Michael G Fehlings, Ilya Laufer, Daniel M Sciubba, Michelle J Clarke, Narayan Sundaresan, Jorrit-Jan Verlaan, Arjun Sahgal, Dean Chou, Charles G Fisher
STUDY DESIGN: Systematic review. OBJECTIVES: We conducted a systematic review of the literature to answer the following questions regarding the use of steroid therapy in metastatic spinal cord compression (MSCC): 1. In cases of MSCC, what is the effect of steroid administration before definitive radiotherapy or surgery on ambulatory status, bowel and bladder function and survival? 2. What steroid dosing regimens are associated with the best outcomes concerning neurological symptoms and complication prevention in cases of MSCC? SUMMARY OF BACKGROUND DATA: Currently, there is significant variation in the initial bolus dose, daily maintenance dose and duration of treatment when steroids are used as a bridge to definitive therapy for MSCC...
May 2017: Clinical Spine Surgery
https://www.readbyqxmd.com/read/28409420/single-fraction-spine-stereotactic-ablative-body-radiotherapy-with-volumetric-modulated-arc-therapy
#2
Matthew M Gestaut, Nitika Thawani, Sangroh Kim, Veera R Gutti, Sameer Jhavar, Niloyjyoti Deb, Andrew Morrow, Russell A Ward, Jason H Huang, Mehul Patel
This study investigated a single institution's experience with volumetric modulated arc therapy (VMAT) directed stereotactic ablative body radiotherapy (SABR) for vertebral metastases. From 2010 to 2014, 95 lesions of spinal metastases in 73 patients were treated with SABR using VMAT. Clinical local control, pain level, and use of steroid medication were employed to evaluate treatment responses. The majority (79%) of patients were treated with a radiation dose of 20 Gy in a single fraction. However, when normal tissue constraints could not be achieved, the dose was reduced to 18 Gy (11%) or 16 Gy (8%) in 1 fraction...
April 13, 2017: Journal of Neuro-oncology
https://www.readbyqxmd.com/read/28405034/a-multicentre-survey-of-the-current-acute-post-operative-pain-management-practices-in-tertiary-care-teaching-hospitals-in-maharashtra
#3
Samina Khaliloddin Khatib, Syed Shamim Razvi, Sadhana Sudhir Kulkarni, Swapnil Parab
BACKGROUND AND AIMS: Undertreated pain can have negative consequences on patients' health as well as the health-care system. The present study was aimed at identifying the current trends in post-operative pain management and availability of acute pain services (APS). In addition, it is also an attempt to assess the availability of analgesia for non-surgical cases, and the attitudes, beliefs, and perceptions of clinicians regarding acute pain management in the tertiary hospitals in the state of Maharashtra (India)...
March 2017: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/28403104/effect-of-bipolar-pulsed-radiofrequency-on-refractory-chronic-cervical-radicular-pain-a-report-of-two-cases
#4
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)
https://www.readbyqxmd.com/read/28392945/pitfalls-in-interventional-pain-medicine-hyponatremia-after-ddavp-for-a-patient-with-von-willebrand-disease-undergoing-an-epidural-steroid-injection
#5
Talal W Khan, Abdulraheem Yacoub
Desmopressin (DDAVP), a synthetic analog of vasopressin, has been used in patients with von Willebrand disease (VWD), mild hemophilia A, and platelet dysfunction to reduce the risk of bleeding associated with surgical and interventional procedures. We report the case of a patient with VWD presenting with a bulging disc and radicular pain that underwent transforaminal epidural steroid injections. Her course was complicated with the interval development of headaches and dizziness symptomatic of moderate hyponatremia, likely due to excessive fluid intake...
2017: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/28384946/a-randomized-controlled-clinical-trial-to-determine-the-effectiveness-of-caudal-epidural-steroid-injection-in-lumbosacral-sciatica
#6
Jaydeep Nandi, Abhishek Chowdhery
INTRODUCTION: Caudal epidural steroid injection have been a part of nonsurgical management of lumbosacral sciatica since last half a century but various randomized controlled trials fail to provide convincing evidence in favour of its effectiveness. AIM: To assess the efficacy of caudal epidural steroid injection in patients of lumbosacral sciatica in comparison to placebo. MATERIALS AND METHODS: The study consisted of patients of sciatica caused by lumbosacral disc prolapse (observed on Magnetic Resonance Imaging (MRI) scan)...
February 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28379464/filum-terminale-needle-placement-during-caudal-epidural-steroid-injection
#7
Ryan R Ramsook, David Spinner, Rajiv R Doshi
Objective. : Caudal epidural steroid injections (ESIs) are commonly used to treat lumbar radicular pain. Touhy needles are placed under live fluoroscopic guidance to ensure epidural administration of medication. This is a case report of direct needle and catheter placements into and through the filum terminale during a caudal approach to the epidural space. Design. : Single case report. Setting. : Beth Israel Deaconess Medical Center...
March 30, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28375914/low-back-pain
#8
Jinny O Tavee, Kerry H Levin
PURPOSE OF REVIEW: This article provides an overview of evaluating and treating low back pain in the outpatient setting. RECENT FINDINGS: As most cases of acute low back pain have a favorable prognosis, current guidelines on imaging studies recommend conservative treatment for 6 weeks prior to obtaining an MRI if no red flags are present. Of these red flags, a prior history of cancer is the strongest risk factor for a malignant etiology and requires urgent evaluation with MRI...
April 2017: Continuum: Lifelong Learning in Neurology
https://www.readbyqxmd.com/read/28349269/successful-outcomes-following-transforaminal-epidural-steroid-injections-for-c4-5-cervical-disc-prolapse-associated-with-profound-neurological-deficit
#9
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
https://www.readbyqxmd.com/read/28340495/residents-learning-curve-of-lumbar-transforaminal-epidural-steroid-injections
#10
Holger Joswig, Sarah Roberta Haile, Gerhard Hildebrandt, Martin Nikolaus Stienen
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*cm(2), 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...
March 24, 2017: Journal of Neurological Surgery. Part A, Central European Neurosurgery
https://www.readbyqxmd.com/read/28340251/thermal-qst-phenotypes-associated-with-response-to-lumbar-epidural-steroid-injections-a-pilot-study
#11
Dermot P Maher, Weihua Ding, Sarabdeep Singh, Arissa Opalacz, Claire Fishman, Mary Houghton, Shihab Ahmed, Lucy Chen, Jianren Mao, Yi Zhang
Objective.:  Response to lumbar epidural steroid injection in lumbar radicular pain varies. The purpose of this study is to characterize the changes in quantitative sensory testing (QST) phenotypes of subjects and compare the QST characteristics in patients who do respond to treatment of radicular pain with a lumbar epidural steroid injection (ESI). Design.:  Prospective, observational pilot study. Setting.:  Outpatient pain center. Methods...
March 13, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28340163/does-cervical-interlaminar-epidural-steroid-injection-with-low-dose-lidocaine-cause-objective-upper-extremity-weakness-a-preliminary-study
#12
Zachary L McCormick, Ariana Nelson, Mark C Kendall, Robert J McCarthy, Geeta Nagpal, David R Walega
Objective. : Low-dose local anesthetic is often used in cervical interlaminar epidural steroid injections (CIESI), yet its effect on upper extremity strength has not been studied. The presence of consequent weakness has potential implications for postprocedure safety. This study aimed to determine whether low-dose lidocaine in a C7-T1 CIESI causes objective weakness. Design. : Prospective case series. Setting. : Academic pain center...
March 18, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28340088/does-pain-reduction-with-oral-steroids-predict-pain-reduction-after-a-first-time-cervical-epidural-steroid-injection-in-patients-with-cervical-radicular-pain-a-pilot-study
#13
Dana G Crovo, Wendy Y Craig, Craig S Curry, Janelle M Richard, James V Pisini
Objective.:  Oral and injected steroids are used commonly in the treatment of cervical radicular pain despite a paucity of data demonstrating their efficacy. The purpose of this study is to assess whether the response to orally administered steroids among patients with acute cervical radicular pain who develop recurrent pain is associated with their subsequent response to cervical epidural steroid injections. Methods.:  Patients referred to our center were evaluated and then referred for cervical epidural steroid injections at the clinical discretion of the provider; those who met inclusion criteria were offered participation in the study...
March 3, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28302996/spinal-cord-ischemia-secondary-to-epidural-metastasis-from-small-cell-lung-carcinoma
#14
Hirotoshi Yasui, Naoya Ozawa, Satoshi Mikami, Kenji Shimizu, Takahiro Hatta, Nami Makino, Mayu Fukushima, Satoshi Baba, Yasushi Makino
BACKGROUND Spinal cord ischemia is an uncommon event that is mainly caused by dissociation of the ascending aorta as a complication after aortic surgery. Spinal arteries can develop collateral circulation; therefore, the frequency of spinal infarction is about 1% of that in the brain. Few cases of spinal cord ischemia developing in the course of lung cancer have been reported. CASE REPORT We presented the case of a 56-year-old man with small cell lung carcinoma, cT4N2M1a (stage IV). He was treated with irradiation and 2 courses of platinum and etoposide combination chemotherapy...
March 17, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/28298750/comparison-of-fluoroscopic-guided-transforaminal-epidural-injections-of-steroid-and-local-anaesthetic-with-conservative-management-in-patients-with-chronic-lumbar-radiculopathies
#15
Nandita Mehta, Misbah Salaria, A Q Salaria
BACKGROUND: Chronic lumbar radiculopathy is a common medical problem and the treatment modalities used over years have been many ranging from conservative or symptomatic management to open decompression surgery. This study was aimed at to compare two modalities of treatment, i.e., conservative and lumbar transforaminal epidural steroid injections (TFESIs). MATERIALS AND METHODS: A total of 120 patients of American Society of Anesthesiology class - (a healthy patient or a patient with mild systemic disease) were randomized to two groups...
January 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/28291411/the-impact-of-preoperative-epidural-injections-on-postoperative-infection-in-lumbar-fusion-surgery
#16
Anuj Singla, Scott Yang, Brian C Werner, Jourdan M Cancienne, Ali Nourbakhsh, Adam L Shimer, Hamid Hassanzadeh, Francis H Shen
OBJECTIVE Lumbar epidural steroid injections (LESIs) are performed for both diagnostic and therapeutic purposes for a variety of indications, including low-back pain, the leading cause of disability and expense due to work-related conditions in the US. The steroid agent used in epidural injections is reported to relieve nerve root inflammation, local ischemia, and resultant pain, but the injection may also have an adverse impact on spinal surgery performed thereafter. In particular, the possibility that preoperative epidural injections may increase the risk of surgical site infection after lumbar spinal fusion has been reported but has not been studied in detail...
March 14, 2017: Journal of Neurosurgery. Spine
https://www.readbyqxmd.com/read/28288089/complication-rates-for-fluoroscopic-guided-interlaminar-lumbar-epidural-steroid-injections-performed-by-certified-registered-nurse-anesthetists-in-diverse-practice-settings
#17
Donald E Beissel
STUDY QUESTION: What is the complication rate for Certified Registered Nurse Anesthetists (CRNAs) performing fluoroscopic guided lumbar epidural steroid injections (LESIs)? METHODS: CRNA pain practitioners responded to questionnaires regarding their education level, experience, and practice locations. Participants also collected data on number of fluoroscopic guided LESIs performed and each of 20 complications for a 6-month period, and answered a poll regarding satisfaction with the data collection process...
November 2016: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/28259071/epidural-lipomatosis-with-cauda-equina-syndrome-in-chronic-alcoholic-patient-a-case-report
#18
Sung-Soo Kim, Dong-Ju Lim
INTRODUCTION: Epidural lipomatosis of the lumbar spine is a rare condition, which is described as the accumulation of fat in the extradural territory. PRESENTATION OF CASE: We report the case of a 60-year-old, non-obese, and chronic alcoholic man who was transferred to our spine department with cauda equina syndrome (CES) for 4 months. On magnetic resonance imaging (MRI), spinal epidural lipomatosis (SEL) was confirmed in the multilevel lumbar lesion. A decompression surgery was performed and the patient recovered significantly...
February 20, 2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/28257294/the-1-year-results-of-lumbar-transforaminal-epidural-steroid-injection-in-patients-with-chronic-unilateral-radicular-pain-the-relation-to-mri-findings-and-clinical-features
#19
Harald Ekedahl, Bo Jönsson, Mårten Annertz, Richard B Frobell
OBJECTIVE: In patients with chronic radicular pain, we aimed to evaluate subgroup differences in 1-yr response to transforaminal epidural steroid injection. DESIGN: In this longitudinal cohort study of 100 subjects, 170 transforaminal epidural steroid injections were performed for 1 yr. The sample was stratified by type of disc herniation (protrusion n = 57, extrusion n = 27), by location of disc herniation (central/subarticular n = 60, foraminal n = 24), by grade of nerve root compression (low-grade compression n = 61, high-grade subarticular nerve compression n = 14, high-grade foraminal nerve compression n = 25), and by positive Slump test (n = 67)...
March 2, 2017: American Journal of Physical Medicine & Rehabilitation
https://www.readbyqxmd.com/read/28248888/comparison-between-bipolar-pulsed-radiofrequency-and-monopolar-pulsed-radiofrequency-in-chronic-lumbosacral-radicular-pain-a-randomized-controlled-trial
#20
RANDOMIZED CONTROLLED TRIAL
Min Cheol Chang, Yun Woo Cho, Sang Ho Ahn
BACKGROUND: Chronic lumbosacral radicular pain is a challenging medical problem with respect to therapeutic management. Many patients with lumbosacral radicular pain complain of persistent leg pain after transforaminal epidural steroid injection. Nowadays, pulsed radiofrequency (PRF) stimulation on the dorsal root ganglion (DRG) is widely used for controlling lumbosacral radicular pain. METHODS: We evaluated the effect of bipolar PRF on the DRG for the management of lumbosacral radicular pain...
March 2017: Medicine (Baltimore)
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