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Epidural steroid injections

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https://www.readbyqxmd.com/read/29016914/spinal-cord-injury-during-attempted-cervical-interlaminar-epidural-injection-of-steroids
#1
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
#2
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
#3
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...
October 5, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28984753/cervical-epidural-analgesia-complicated-by-epidural-abscess-a-case-report-and-literature-review
#4
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
#5
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
#6
David J Kennedy, Patricia Z Zheng, Matthew Smuck, Zachary L McCormick, Lisa Huynh, Byron J Schneider
BACKGROUND CONTEXT: Patients with lumbosacral radiculopathy from a intervertebral disc herniation are frequently treated by transforaminal epidural steroid injections (TFESIs). The long-term outcomes of these patients are poorly described. PURPOSE: 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. DESIGN: Prospective cohort study...
September 26, 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
#7
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 patient-reported outcomes following epidural steroid injections for radicular pain. PURPOSE: We evaluated the association between pre-injection opioid use and patient-reported outcomes following spine epidural steroid injection. STUDY DESIGN: This study is a retrospective analysis of a prospective longitudinal registry database...
September 26, 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
#8
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
#9
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
#10
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
https://www.readbyqxmd.com/read/28936912/epidural-hematoma-development-contralateral-to-dura-after-lumbar-transforaminal-epidural-steroid-injection
#11
Semih Gungor, Rohit Aiyer
AIM: To illustrate the anatomical and pathophysiological risks of epidural hematoma formation, other than direct needle trauma, after lumbar transforaminal epidural steroid injection in the setting of severe central canal stenosis. CASE REPORT: This case report presents the development of an epidural hematoma after lumbar transforaminal epidural steroid injection in a patient who has anatomical risk factor of severe lumbar spinal stenosis. The anatomic location of epidural hematoma was at the injected level, but on the contralateral side of the dura at a distance from the needle path...
September 2017: Pain Management
https://www.readbyqxmd.com/read/28928587/unexpected-complication-after-caudal-epidural-steroid-injection-hiccup
#12
Ayhan Kaydu, Ebru Tarıkçı Kılıç, Erhan Gökçek, Mehmet Salim Akdemir
Persistent hiccup is uncommon, and the mechanism is poorly understood. We present the case of a 43-year-old male patient referred to the Algology department due to chronic back pain who developed what we believe a rare case of persistent hiccup secondary to caudal epidural steroid injection (CESI). The causes of hiccup are many and include electrolyte derangement, nutritional deficiencies, gastrointestinal disorders and instrumentation, cardiovascular disorders, renal impairment, central nervous system disorders, and drugs; however, the cause may be unknown...
July 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/28928574/impact-of-different-approaches-of-epidural-steroid-injection-on-outcome-of-patients-treated-for-low-backache
#13
Sukhdeep Kaur, Ruchi Gupta, Saru Singh, Raj Kumar, Kulvinder Singh
OBJECTIVES: The objective of this study was to evaluate the clinical efficacy of epidural steroid injections through different approaches using pain relief and improvement in functional capacity as outcome measures. MATERIALS AND METHODS: Sixty patients with low backache and unilateral radiculopathy were randomly assigned to three groups of twenty patients each, for undergoing lumbar epidural steroid injection (LESI) through midline, transforaminal, and paramedian approaches under fluoroscopic guidance...
July 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/28914617/distribution-patterns-of-the-vulnerable-vessels-around-cervical-nerve-roots-a-computed-tomography-based-study
#14
Donghwi Park
OBJECTIVE: The aim of the study was to evaluate the prevalence of vulnerable vessels around the target of cervical transforaminal epidural steroid injection at the C3-C7 cervical nerve root levels in a clinical setting. DESIGN: Retrospective, cross-sectional study was conducted. PARTICIPANTS: Patients complaining of neck or arm pain with no previous surgical history and who had undergone both precontrast and contrast-enhanced neck computed tomography were included retrospectively...
September 13, 2017: American Journal of Physical Medicine & Rehabilitation
https://www.readbyqxmd.com/read/28838872/the-value-of-short-term-pain-relief-in-predicting-the-long-term-outcome-of-lumbar-transforaminal-epidural-steroid-injections
#15
Holger Joswig, Armin Neff, Christina Ruppert, Gerhard Hildebrandt, Martin Nikolaus Stienen
BACKGROUND: A previous report demonstrated the predictive power of short-term leg pain relief after lumbar transforaminal epidural steroid injection for 1-month treatment response. The question whether the long-term response could be similarly predicted remained unanswered. METHODS: A prospective cohort of n=57 patients who underwent transforaminal epidural steroid injection for sciatica secondary to a lumbar disc herniation was followed for 24 months. Leg and back pain on the visual analog scale, health-related quality of life with the Short Form-12 and functional outcome with the Oswestry Disability Index were assessed...
August 21, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28827823/comparison-of-efficacy-of-continuous-epidural-block-and-pulsed-radiofrequency-to-the-dorsal-root-ganglion-for-management-of-pain-persisting-beyond-the-acute-phase-of-herpes-zoster
#16
COMPARATIVE STUDY
Eung Don Kim, Young In Lee, Hue Jung Park
BACKGROUND: There is little evidence regarding the effectiveness of intervention methods in the treatment of zoster-related pain (ZAP) after the acute phase of zoster. Generally, if ZAP remains after more than 180 days from its onset, the likelihood of pain reduction is very low; this condition is considered as a "well established" post-herpetic neuralgia (PHN). Although the clinical efficacy of intrathecal steroid injection and spinal cord stimulation (SCS) for ZAP management has been reported, these interventions are not widely used due to inherent disadvantages...
2017: PloS One
https://www.readbyqxmd.com/read/28807894/advances-in-the-diagnosis-and-management-of-neck-pain
#17
REVIEW
Steven P Cohen, W Michael Hooten
Neck pain imposes a considerable personal and socioeconomic burden-it is one of the top five chronic pain conditions in terms of prevalence and years lost to disability-yet it receives a fraction of the research funding given to low back pain. Although most acute episodes resolve spontaneously, more than a third of affected people still have low grade symptoms or recurrences more than one year later, with genetics and psychosocial factors being risk factors for persistence. Nearly half of people with chronic neck pain have mixed neuropathic-nociceptive symptoms or predominantly neuropathic symptoms...
August 14, 2017: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/28801567/effectiveness-of-a-multimodal-pain-management-concept-for-patients-with-cervical-radiculopathy-with-focus-on-cervical-epidural-injections
#18
Achim Benditz, Melanie Brunner, Florian Zeman, Felix Greimel, Völlner Florian, Daniel Boluki, Joachim Grifka, Markus Weber, Tobias Renkawitz
Cervical radiculopathy has become an increasing problem worldwide. Conservative treatment options have been recommended in many reviews on cervical radiculopathy, ranging from different types of physiotherapy to waiting for remission by natural history. No multimodal pain management concept (MPM) on an inpatient basis has been evaluated. This study aimed at showing the positive short-term effects of an inpatient multimodal pain management concept with focus on cervical translaminar epidural steroid injection for patients with cervical radiculopathy...
August 11, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28796547/do-superior-or-inferior-interlaminar-approach-or-bevel-orientation-predispose-to-nonepidural-needle-penetration
#19
RANDOMIZED CONTROLLED TRIAL
Nicholas A Koontz, Richard H Wiggins, Gregory J Stoddard, Lubdha M Shah
OBJECTIVE: There is a paucity of evidence-based literature regarding the advantages and disadvantages of the interlaminar approach and needle bevel orientation for performing a lumbar interlaminar epidural steroid injection (ESI). The purpose of this study was to determine if superior versus inferior lamina approach, needle bevel tip orientation, or both may predispose to inadvertent nonepidural penetration during lumbar interlaminar ESI. SUBJECTS AND METHODS: A prospective study was performed of patients with low back pain with or without radicular pain or neurogenic claudication referred for lumbar interlaminar ESI...
October 2017: AJR. American Journal of Roentgenology
https://www.readbyqxmd.com/read/28759948/the-role-of-epidural-contrast-distribution-in-predicting-the-effectiveness-of-steroid-and-local-anesthetic-injection-in-patients-with-lumbar-spinal-stenosis
#20
Jong Won Kwon, Sang Jun Kim
STUDY DESIGN: A prospective observational comparative study. BACKGROUND: Because epidural corticosteroids are more effective for pain relief when delivered close to the site of pathology, lumbar spinal stenosis with multilevel stenotic areas can be treated more effectively when medications cover all of the stenotic areas. Distribution of medications to the pathologic sites is considered an important factor in the effectiveness of inter-laminar epidural injection...
July 14, 2017: Journal of Back and Musculoskeletal Rehabilitation
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