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Epidural steroids

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https://www.readbyqxmd.com/read/28099288/assessing-the-agreement-between-radiologic-and-clinical-measurements-of-lumbar-and-cervical-epidural-depths-in-patients-undergoing-prone-interlaminar-epidural-steroid-injection
#1
James Harvey Jones, Naileshni Singh, Anna Nidecker, Chin-Shang Li, Scott Fishman
BACKGROUND: Fluoroscopy-guided epidural steroid injection (ESI) commonly is performed to treat radicular pain yet can lead to adverse events if the needle is not advanced with precision. Accurate preoperative assessment of the distance from the skin to the epidural space holds the potential for reducing the risks of adverse effects from ESI. It was hypothesized that the distance from the skin to the epidural space as measured on preoperative magnetic resonance imaging (MRI) would agree with the distance traveled by a Tuohy needle to reach the epidural space during midline, interlaminar ESI...
January 17, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28097241/extraforaminal-needle-tip-position-reduces-risk-of-intravascular-injection-in-ct-fluoroscopic-lumbar-transforaminal-epidural-steroid-injections
#2
Robinson K Yu, Gerritt M Lagemann, Anish Ghodadra, Vikas Agarwal
BACKGROUND: Lumbar transforaminal epidural steroid injection is a common and effective tool for managing lumbar radicular pain, although accidental intravascular injection can rarely result in paralysis. The purpose of this study is to determine the safest needle tip position for computed tomography (CT)-guided lumbar transforaminal epidural steroid injections as determined by incidence of intravascular injection. METHODS: Three radiologists, in consensus, reviewed procedural imaging for consecutive CT-fluoroscopic lumbar transforaminal epidural steroid injections performed during a 16-month period...
December 2016: Journal of Spine Surgery (Hong Kong)
https://www.readbyqxmd.com/read/28094428/intra-operative-results-and-post-operative-clinical-outcomes-of-lumbar-microdiscectomy-in-patients-received-transforaminal-anterior-epidural-steroid-injection-earlier-for-lumbar-radiculopathy
#3
Sait Ozturk, Bekir Akgun, Fatih Serhat Erol, Selami Ates Onal, Metin Kaplan
AIM: We have aimed to describe the intra and postoperative results of patients who received transforaminal anterior epidural steroid injection (TAESI) prior to undergoing lumbar microdiscectomy. MATERIAL AND METHODS: 64 of 2461 patients evaluated who had received minimally invasive technique (MIT) for lumbar radiculopathy and who felt no relief after the procedures. 32 patients of them treated with different techniques other than TAESI and those receiving thrombolytic or anticoagulant drugs before microdiscectomy were excluded...
December 14, 2016: Turkish Neurosurgery
https://www.readbyqxmd.com/read/28072809/optimal-angle-of-contralateral-oblique-view-in-cervical-interlaminar-epidural-injection-depending-on-the-needle-tip-position
#4
Jun Young Park, Myung-Hwan Karm, Doo Hwan Kim, Jae-Young Lee, Hye-Joo Yun, Jeong Hun Suh
BACKGROUND: Chronic neck and upper extremity pain associated with cervical origin is common, and cervical interlaminar epidural steroid injections (CILESIs) are frequently used to manage the symptoms of cervical spinal disorders. However, CILESIs are associated with risks such as dural puncture and cord injury. OBJECTIVES: We aimed to determine the optimal needle tip visualization, in order to minimize CILESIs-induced complications. STUDY DESIGN: Retrospective observational study...
January 2017: Pain Physician
https://www.readbyqxmd.com/read/28072802/efficacy-of-adjuvant-10-hypertonic-saline-in-transforaminal-epidural-steroid-injection-a-retrospective-analysis
#5
Eun Young Joo, Won Uk Koh, Seong-Soo Choi, Jae-Hyung Choi, Ho-Soo Ahn, Hye Joo Yun, Jin-Woo Shin
BACKGROUND: Chronic lower back pain with or without radiculopathy represents an important medical, social, and economic problem. Many treatment modalities and techniques, including surgery and epidural administration of steroids, have been used to manage this pain. Hypertonic saline, which has been used as an adjunct to percutaneous epidural adhesiolysis, can also be injected via a transforaminal approach in expectation of longer-lasting effects. OBJECTIVES: This study aimed to determine the effect of adding hypertonic saline to conventional transforaminal epidural steroid injections (TFEI) to provide pain relief for chronic radiculopathy patients...
January 2017: Pain Physician
https://www.readbyqxmd.com/read/28072635/does-the-timing-of-preoperative-epidural-steroid-injection-affect-infection-risk-after-acdf-or-posterior-cervical-fusion
#6
Jourdan M Cancienne, Brian C Werner, Varun Puvanesarajah, Hamid Hassanzadeh, Anuj Singla, Frank H Shen, Adam L Shimer
STUDY DESIGN: A retrospective database analysis. OBJECTIVE: The aim of this study was to determine whether any association exists between preoperative cervical epidural steroid injections (CESIs) at various time intervals before anterior cervical discectomy and fusion (ACDF) or posterior cervical fusion (PCF) and the incidence of postoperative infection. SUMMARY OF BACKGROUND DATA: Although infectious complications following CESI are uncommon, the association between preoperative CESI and postoperative infection following ACDF or PCF has yet to be evaluated in the current literature...
January 15, 2017: Spine
https://www.readbyqxmd.com/read/28059710/inadvertent-intrafacet-injection-during-lumbar-interlaminar-epidural-steroid-injection-a-comparison-of-ct-fluoroscopic-and-conventional-fluoroscopic-guidance
#7
P G Kranz, A B Joshi, L A Roy, K R Choudhury, T J Amrhein
BACKGROUND AND PURPOSE: Inadvertent intrafacet injection can occur during interlaminar epidural steroid injection, resulting in a false-positive loss of resistance and nontarget injection of medication. The purpose of this investigation was to compare the observed rates of this phenomenon during lumbar interlaminar epidural steroid injection performed by using conventional fluoroscopic and CT fluoroscopic guidance. MATERIALS AND METHODS: We retrospectively reviewed 349 lumbar interlaminar epidural steroid injections performed by using conventional fluoroscopy or CT fluoroscopic guidance to determine the observed rates of inadvertent intrafacet injection with each technique...
November 10, 2016: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/28053849/long-term-outcome-of-medical-and-surgical-co-management-of-craniospinal-aspergillosis-in-an-immunocompromised-patient
#8
Dipu Sathyapalan, Sabarish Balachandran, Anil Kumar, Bindu Mangalath Rajamma, Ashok Pillai, Vidya P Menon
35 yr old steroid dependent lady with Pulmonary TB underwent debridement of epidural abscess & posterior stabilization for paraparesis. With histopathology and cultures showing Aspergillus fumigatus, voricanozole was started. By the fourth week, she developed persistent fever, and altered mental status. Brain MRI and CSF study including multiplex PCR evaluation confirmed cerebral aspergillosis. Voricanozole was changed to intravenous lipid complex Amphotericin B to achieve sustained clinical and radiological response after six months of therapy...
December 2016: Medical Mycology Case Reports
https://www.readbyqxmd.com/read/28034968/is-there-a-relationship-between-body-mass-index-and-fluoroscopy-time-during-cervical-interlaminar-epidural-steroid-injections
#9
Zachary L McCormick, Ryan Mattie, Ali Ebrahimi, David T Lee, Austin Marcolina, Joel Press, D J Kennedy, Matthew Smuck, David R Walega, Daniel Cushman
: BACKGROUND : The challenge of obtaining medical imaging in individuals with higher body mass index (BMI) is described, but there is minimal data regarding the relationship between BMI and fluoroscopy time during cervical interlaminar epidural steroid injection (CIESI). OBJECTIVE : To determine the relationship between BMI and fluoroscopy time during CIESI. METHODS : Retrospective cohort study of patients who underwent fluoroscopically guided CIESI between January 2014 and February 2015 at an academic pain medicine center...
December 29, 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28025354/the-effectiveness-and-risks-of-non-image-guided-lumbar-interlaminar-epidural-steroid-injections-a-systematic-review-with-comprehensive-analysis-of-the-published-data
#10
REVIEW
Yakov Vorobeychik, Anil Sharma, Clark C Smith, David C Miller, Milan P Stojanovic, Steve M Lobel, Marc A Valley, Belinda Duszynski, David J Kennedy
OBJECTIVE: To determine the effectiveness and risks of non-image-guided lumbar interlaminar epidural steroid injections. DESIGN: Systematic review. INTERVENTIONS: Three reviewers with formal training and certification in evidence-based medicine searched the literature on non-image-guided lumbar interlaminar epidural steroid injections. A larger team of seven reviewers independently assessed the methodology of studies found and appraised the quality of the evidence presented...
December 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28025353/imaging-determinants-of-clinical-effectiveness-of-lumbar-transforaminal-epidural-steroid-injections
#11
Timothy P Maus, Christine A El-Yahchouchi, Jennifer R Geske, Rickey E Carter, Timothy J Kaufmann, John T Wald, Felix E Diehn
OBJECTIVE: To examine associations between imaging characteristics of compressive lesions and patient outcomes after lumbar transforaminal epidural steroid injections (TFESIs) stratified by steroid formulation (solution versus suspension). DESIGN/SUBJECTS: Retrospective observational study, academic radiology practice. A 516-patient sample was selected from 2,634 consecutive patients receiving lumbar TFESI for radicular pain. METHODS: The advanced imaging study(s) preceding sampled TFESI were reviewed...
December 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28025351/immediate-adverse-events-in-interventional-pain-procedures-a-multi-institutional-study
#12
Carrie M Carr, Christopher T Plastaras, Matthew J Pingree, Matthew Smuck, Timothy P Maus, Jennifer R Geske, Christine A El-Yahchouchi, Zachary L McCormick, David J Kennedy
SETTING: Interventional procedures directed toward sources of pain in the axial and appendicular musculoskeletal system are performed with increasing frequency. Despite the presence of evidence-based guidelines for such procedures, there are wide variations in practice. Case reports of serious complications such as spinal cord infarction or infection from spine injections lack appropriate context and create a misleading view of the risks of appropriately performed interventional pain procedures...
December 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28017166/comparison-of-transforaminal-and-interlaminar-epidural-steroid-injections-for-the-treatment-of-chronic-lumbar-pain
#13
Serbülent Gökhan Beyaz
STUDY DESIGN: A cross-sectional study. OBJECTIVE: We compared the 12 month outcomes of fluoroscopically guided transforaminal epidural steroid injections with interlaminar epidural steroid injections for the treatment of chronic lumbar spinal pain. Chronic lower back pain is a multifactorial disorder with many possible etiologies. The lifetime prevalence of spinal pain is reportedly 65-80% in the neck and lower back. Epidural injection of corticosteroids is a commonly used intervention for managing chronic spinal pain...
January 2017: Brazilian Journal of Anesthesiology
https://www.readbyqxmd.com/read/28007291/-complex-regional-pain-syndrome-a-review
#14
Berenice Carolina Hernández-Porras, Ricardo Plancarte-Sánchez, Silvia Alarcón-Barrios, Marcela Sámano-García
BACKGROUND: Complex regional pain syndrome is characterized by spontaneous or induced pain disproportionate in relation to the initial event and is accompanied by a variety of regional and motor disturbances, leading to a variety of clinical presentations. It is often associated with surgery and minor trauma. PATHOPHYSIOLOGY: Three mechanisms are postulated: changes secondary to post traumatic inflammation, peripheral vasomotor dysfunction and structural and functional changes of the central nervous system as a result of maladaptation...
December 19, 2016: Cirugia y Cirujanos
https://www.readbyqxmd.com/read/28000203/comparison-of-continuous-epidural-block-and-continuous-paravertebral-block-in-postoperative-analgaesia-after-video-assisted-thoracoscopic-surgery-lobectomy-a-randomised-non-inferiority-trial
#15
Sylweriusz Kosiński, Edward Fryźlewicz, Michał Wiłkojć, Adam Ćmiel, Marcin Zieliński
BACKGROUND: Video-assisted (VATS) lung lobectomy can be associated with stronger postoperative pain than is commonly believed. It is generally accepted to introduce multimodal analgaesic strategies based on regional blockade, opioids and non-steroidal anti-inflammatory drugs. However, there is still no consensus regarding the optimal regional technique. The aim of this study was to compare the analgaesic efficacy of continuous thoracic epidural block (TEA) and percutaneous continuous paravertebral block (PVB) in patients undergoing video-assisted lung lobectomy...
2016: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/27935769/fluoroscopically-guided-epidural-injections-of-the-cervical-and-lumbar-spine
#16
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...
December 9, 2016: Radiographics: a Review Publication of the Radiological Society of North America, Inc
https://www.readbyqxmd.com/read/27922950/a-prospective-randomized-comparative-trial-of-targeted-steroid-injection-via-epidural-catheter-versus-standard-c7-t1-interlaminar-approach-for-the-treatment-of-unilateral-cervical-radicular-pain
#17
Zachary L McCormick, Ariana Nelson, Meghan Bhave, Mikhail Zhukalin, Mark Kendall, Robert J McCarthy, Dost Khan, Geeta Nagpal, David R Walega
BACKGROUND AND OBJECTIVES: No study has compared cervical interlaminar epidural steroid injection (CIESI) with epidural catheter advancement to the side and level of pathology versus standard C7-T1 CIESI. This study investigated whether cervical radicular pain is more effectively treated by CIESI with a targeted epidural catheter versus a standard C7-T1 approach. METHODS: Prospective, randomized, single-blinded trial. PRIMARY OUTCOME: Numerical Rating Scale (NRS) pain at 1 month...
January 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/27915069/systematic-review-of-the-efficacy-of-particulate-versus-nonparticulate-corticosteroids-in-epidural-injections
#18
REVIEW
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
https://www.readbyqxmd.com/read/27906952/conus-medullaris-infarction-after-a-right-l4-transforaminal-epidural-steroid-injection-using-dexamethasone
#19
Christopher G Gharibo, Michael Fakhry, Sudhir Diwan, Alan D Kaye
BACKGROUND: For decades, epidural steroid injections have been an effective tool in the management of many pain related conditions, including lumbar radiculopathy. Transforaminal epidural steroid injections in particular have been reported to potentially result in central nervous system infarctions which have not been reported with interlaminar epidural steroid injections, while providing comparable efficacy. This rare, catastrophic complication has been attributed by some authors to be due to vascular injury secondary to vasospasm, thrombus formation, dissection, as well as concerns with placing the needle at the so-called "safe triangle...
November 2016: Pain Physician
https://www.readbyqxmd.com/read/27906944/the-safety-of-ct-guided-epidural-steroid-injections-in-an-older-patient-cohort
#20
Andrew J Fenster, Kevin Fernandes, Alan L Brook, Todd Miller
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 US 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...
November 2016: Pain Physician
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