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Epidural steroids

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https://www.readbyqxmd.com/read/29149147/hypothalamic-pituitary-adrenocortical-axis-suppression-following-a-single-epidural-injection-of-methylprednisolone-acetate
#1
Aleem Jameel Abdul, Babita Ghai, Dipika Bansal, Naresh Sachdeva, Anil Bhansali, Saravdeep Singh Dhatt
BACKGROUND: Epidural injections (EIs) are the most commonly performed minimally invasive intervention in managing chronic low back pain (CLBP). There is inconsistency in data to accurately predict the degree of hypothalamic-piuitary-adrenal (HPA) axis suppression in patients receiving exogenous steroid therapy, especially in the form of epidural steroid injections (ESIs). OBJECTIVE: We aim to quantify the degree and duration of HPA axis suppression after a single ESI of 80 mg methyl prednisolone acetate in patients with CLBP...
November 2017: Pain Physician
https://www.readbyqxmd.com/read/29145651/cracks-in-the-case-against-epidural-steroids-examining-the-evidence-for-vertebral-fracture-risk
#2
Tina L Doshi, Steven P Cohen
No abstract text is available yet for this article.
November 14, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/29138074/outcome-of-transforaminal-epidural-steroid-injection-according-to-the-severity-of-cervical-foraminal-stenosis
#3
Min Son Kim, Dong Gyu Lee, Min Cheol Chang
BACKGROUND CONTEXT: Cervical transforaminal epidural steroid injection (TFESI) is considered one of the most effective treatments for radicular pain induced by cervical foraminal stenosis. PURPOSE: To evaluate the treatment outcome of TFESI according to the severity of cervical foraminal stenosis DESIGN: Retrospective study. PATIENT SAMPLE: Fifty-three patients with cervical radiculopathy due to cervical foraminal stenosis. OUTCOME MEASURES: Pain intensity was evaluated using a numeric rating scale (NRS) at pretreatment, 2 weeks, and 1, 2, and 3 months after TFESI...
November 11, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/29119045/lumbar-stenosis-surgery-spine-surgeons-not-insurance-companies-should-decide-when-enough-is-better-than-too-much
#4
EDITORIAL
Nancy E Epstein
Background: Lumbar surgery for spinal stenosis is the most common spine operation being performed in older patients. Nevertheless, every time we want to schedule surgery, we confront the insurance industry. More often than not they demand patients first undergo epidural steroid injections (ESI); clearly they are not aware of ESI's lack of long-term efficacy. Who put these insurance companies in charge anyway? We did. How? Through performing too many unnecessary or overly extensive spinal operations (e...
2017: Surgical Neurology International
https://www.readbyqxmd.com/read/29116946/spinal-cord-injury-by-direct-damage-during-ct-guided-c7-transforaminal-epidural-steroid-injection-a-case-report
#5
Min Cheol Chang
Cervical transforaminal epidural steroid injection (TFESI) under the guidance of computed tomography (CT) can offer great anatomical resolution and precise needle placement in the axial plane. However, some complications, including blood pressure surge, allergic reactions, vasovagal syncope, and cerebral infarct, have been reported after CT-guided cervical TFESI. We report the first case of iatrogenic spinal cord injury (SCI) during a CT-guided cervical TFESI. A 67-year-old woman, upon receiving TFESI on Lt...
November 7, 2017: American Journal of Physical Medicine & Rehabilitation
https://www.readbyqxmd.com/read/29102751/epidural-steroids-at-closure-post-microdiscectomy-laminectomy-for-reduction-of-post-operative-analgesia-systematic-review-and-meta-analysis
#6
Ash Wilson-Smith, Nicholas Chang, Victor M Lu, Ralph J Mobbs, Matthew Fadhil, Declan Lloyd, Sara Kim, Kevin Phan
BACKGROUND: This review assessed the efficacy of epidural steroid administration on the reduction of pain, hospital stay time and use of opioid analgesics postoperatively. METHODS: We searched Medline, PubMed, Embase, Cochrane Central Register of Controlled Trials (CCRCT) and Cochrane Database of Systematic Reviews (CDSR) for studies utilizing epidural steroids through any route following lumbar surgery. The primary study outcomes included pre- and postoperative pain as assessed through the use of a Visual Analogue Scale (VAS), length of hospital stay and postoperative use of opioid analgesics...
November 1, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/29099886/risk-of-osteoporotic-fracture-after-steroid-injections-in-patients-with-medicare
#7
Leah Y Carreon, Kevin L Ong, Edmund Lau, Steven M Kurtz, Steven D Glassman
To further evaluate the relationship between steroid injections and osteoporotic fracture risk, we analyzed Medicare administrative claims data on both large-joint steroid injections (LJSIs) into knee and hip and transforaminal steroid injections (TSIs), as well as osteoporotic hip and wrist fractures. Our hypothesis was that a systemic effect of steroid injections would increase fracture risk in all skeletal locations regardless of injection site, whereas a local effect would produce a disproportionate increased risk of spine fracture with spine injection...
September 2017: American Journal of Orthopedics
https://www.readbyqxmd.com/read/29074369/transient-hypokalemic-quadriplegia-following-a-lumbar-transforaminal-epidural-dexamethasone-injection-a-case-report
#8
Maryam Tahmasbi Sohi, William J Sullivan, Dustin J M Anderson
A 30-year-old male with no significant past medical history presented with hypokalemic quadriplegia four hours after he received a lumbar transforaminal epidural steroid injection (TFESI) containing dexamethasone and lidocaine. A comprehensive work up ruled out acquired and hereditary causes of hypokalemic paralysis. Symptoms gradually resolved within hours after potassium restoration with no residual neurologic deficits. Paralysis after TFESI is uncommon, but has been associated with particulate steroids that can coalesce into aggregates and occlude vessels...
October 23, 2017: PM & R: the Journal of Injury, Function, and Rehabilitation
https://www.readbyqxmd.com/read/29049686/national-practice-variation-in-pneumonectomy-perioperative-care-among-canadian-thoracic-surgeons
#9
Biniam Kidane, John K Peel, Andrew Seely, Richard A Malthaner, Christian Finley, Sean Grondin, Brian E Louie, Sadeesh Srinathan, Gail E Darling
OBJECTIVES: Our objective was to assess perioperative pneumonectomy practices among Canadian thoracic surgeons as part of a quality-improvement initiative to determine practice variability and identify areas for study/improvement. METHODS: After several rounds of survey development and piloting, a 29-item survey was distributed using the Dillman method to all practicing members of the Canadian Association of Thoracic Surgeons. RESULTS: The response rate was 87% (62 of 71)...
July 28, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/29039154/severe-headache-following-ozone-therapy-pneumocephalus
#10
Hüseyin Toman, Uğur Özdemir, Hasan Ali Kiraz, Nurettin Lüleci
Pneumocephalus is defined as air in the cranial cavity. Pneumocephalus can result from inadvertent dural puncture during lumbar epidural anesthesia or epidural steroid injection. Presently described is case of 41-year-old woman who had undergone lumbar disc hernia operation but due to ongoing complaints, was diagnosed as having failed back surgery syndrome. Percutaneous epidural neuroplasty was performed. In the operating room, under sterile conditions and under sedoanalgesia, Racz catheter was inserted in caudal area and guided to epidural area with scope...
July 2017: Aǧrı: Ağrı (Algoloji) Derneği'nin Yayın Organıdır, the Journal of the Turkish Society of Algology
https://www.readbyqxmd.com/read/29016914/spinal-cord-injury-during-attempted-cervical-interlaminar-epidural-injection-of-steroids
#11
Milton H Landers
Background: Interlaminar cervical epidural injections are commonly performed in the practice of interventional pain medicine. Injury to the spinal cord following injection into the substance of the cord is a known complication of this procedure, but it has rarely been reported and illustrated in the literature. Objective: To describe and analyze a case where an inadvertent injection of contrast medium into the cervical spinal cord occurred. Highlighted is the dissonance between how the procedure was performed and published guidelines for its performance...
July 11, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/29016866/anesthetic-test-dose-and-seizure-risk-with-cervical-transforaminal-epidural-steroid-injection
#12
Fred DeFrancesch, David O'Brien, Clark C Smith
No abstract text is available yet for this article.
July 17, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28987313/pneumocephalus-and-sixth-nerve-palsy-after-epidural-steroid-injection-case-report-and-review-of-the-literature
#13
Wendy F Li, Kyle Kovacs, Adeniyi A Fisayo
BACKGROUND: Pneumocephalus has been described as an unintended outcome after epidural injections. However, oculomotor palsy from pneumocephalus after epidural injection is very rare. CASE REPORT: We report a case of pneumocephalus-induced sixth nerve palsies and diplopia in an 87-year-old woman after epidural steroid injection. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Pneumocephalus-induced oculomotor palsy is a rare complication after epidural injection, a commonly performed medical procedure...
November 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28984753/cervical-epidural-analgesia-complicated-by-epidural-abscess-a-case-report-and-literature-review
#14
REVIEW
Jun-Hui Zhang, Zhi-Li Wang, Li Wan
RATIONALE: Spinal epidural abscess is an uncommon complication in clinical practice. If the abscess is large enough, the patient will rapidly develop neurologic signs of spinal injury, and urgent neurosurgical intervention may be required. PATIENT CONCERNS: Rapid and correct diagnosis and treatment is important for spinal epidural abscess complication. DIAGNOSES: This report describes a cervical epidural abscess (CEA) caused by epidural analgesia, wherein the patient was punctured twice...
October 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28962959/effect-of-interlaminar-epidural-steroid-injection-in-patients-with-central-cervical-spinal-stenosis
#15
Dong Gyu Lee, Min Cheol Chang
OBJECTIVE: The authors investigated the effect of interlaminar ESI for the management of central cervical spinal stenosis-induced posterior neck pain. METHODS: Forty-five patients with posterior neck pain caused by central cervical spinal stenosis were recruited retrospectively. For the ESI procedure, a 21-g Touhy needle was inserted into the epidural space between C7 and T1, and 20 mg (40 mg/mL) of dexamethasone with 4 mL of normal saline was injected. The effect of the procedure was evaluated using a numerical rating scale (NRS) at 1, 2, and 3 months after the procedure...
September 26, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28962912/a-minimum-of-5-year-follow-up-after-lumbar-transforaminal-epidural-steroid-injections-in-patients-with-lumbar-radicular-pain-due-to-intervertebral-disc-herniation
#16
David J Kennedy, Patricia Z Zheng, Matthew Smuck, Zachary L McCormick, Lisa Huynh, Byron J Schneider
BACKGROUND CONTEXT: Patients with lumbosacral radiculopathy from an intervertebral disc herniation are frequently treated by transforaminal epidural steroid injections (TFESIs). The long-term outcomes of these patients are poorly described. PURPOSE: We aimed to determine the long-term outcomes for a homogenous group of patients with acute unilateral lumbar radicular pain due to single-level herniated nucleus after lumbar epidural steroid injection at ≥5 years...
September 28, 2017: Spine Journal: Official Journal of the North American Spine Society
https://www.readbyqxmd.com/read/28962907/effect-of-pre-injection-opioid-use-on-post-injection-patient-reported-outcomes-following-epidural-steroid-injections-for-radicular-pain
#17
Johnny J Wei, Silky Chotai, Ahilan Sivaganesan, Kristin R Archer, Byron J Schneider, Aaron J Yang, Clinton J Devin
BACKGROUND CONTEXT: Chronic opioid therapy is associated with worse patient-reported outcomes (PROs) following spine surgery. However, little literature exists on the relationship between opioid use and PROs following epidural steroid injections for radicular pain. PURPOSE: We evaluated the association between pre-injection opioid use and PROs following spine epidural steroid injection. STUDY DESIGN: This study is a retrospective analysis of a prospective longitudinal registry database...
September 28, 2017: Spine Journal: Official Journal of the North American Spine Society
https://www.readbyqxmd.com/read/28953648/intramuscular-hematoma-with-motor-weakness-after-trigger-point-injection-a-case-report
#18
Sang Gyun Kim, Kwang Seok Shim, Dong Won Lee, Eun Ju Kim, Sang-Gon Lee, Ji-Hyang Lee, Ji Hyun An
RATIONALE: Although trigger point injection is known as an easy and low-risk procedure, it is contraindicated to patients with hemorrhagic disorders or who regularly take anticoagulants/antiplatelets. However, taking clopidogrel is not a defined contraindication to this low-risk procedure. PATIENT CONCERNS: The chief complaint of a 76-year old woman regularly taking clopidogrel was low back and left buttock pain which prolonged for several years. DIAGNOSES: The patient was diagnosed with L4-5 and L5-S1 spinal stenosis at the orthopedics department and was referred for lumbar spinal epidural steroid injection...
September 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28943459/descriptive-cadaveric-study-comparing-the-accuracy-of-ultrasound-versus-fluoroscopic-guidance-for-first-sacral-transforaminal-injections
#19
Bradley F Thompson, Matthew J Pingree, Wenchun Qu, Naveen S Murthy, Nirusha Lachman, Mark Friedrich Hurdle
BACKGROUND: Ultrasound is rarely used for guiding lumbosacral epidural steroid injections due to its technical limitations. For example, sonographic imaging lacks the ability to confirm epidural spread and identify vascular uptake. The perceived risk that these limitations pose to human subjects has precluded any large scale clinical trials to date. OBJECTIVE: To compare the accuracy of ultrasound versus fluoroscopic guidance for first sacral transforaminal epidural injections DESIGN: Cadaveric comparative study using dichotomous outcomes...
September 21, 2017: PM & R: the Journal of Injury, Function, and Rehabilitation
https://www.readbyqxmd.com/read/28941874/pneumocephalus-and-seizures-following-epidural-steroid-injection
#20
Joseph Sorber, David Levy, Adam Schwartz
We describe a patient with pneumocephalus following an epidural steroid injection (ESI) who presented with altered mental status, headache, focal neurologic findings and seizures. Pneumocephalus has rarely been described following ESI. A 34-year-old female presented with an altered level of consciousness worsening over approximately 18h following an ESI for lumbar back pain. She had associated headache, right-sided facial twitching and right upper extremity weakness. A brain CT scan revealed pneumocephalus in the right lateral ventricle and quadrigeminal plate cistern...
September 18, 2017: American Journal of Emergency Medicine
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