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Transforaminal epidural

Gang Wang, Jing Liang, Zishan Jia, Lei Wan, Mingxia Yang
RATIONALE: Spinal cord infarction is one of the complications of epidural steroid injections (ESIs), but has only been reported in cervical vertebra by transforaminal injection and lumbar vertebra by transforaminal injection; and up to now, there is no reporting about spinal cord infarction caused by caudal injection. Here, we report a case. PATIENT CONCERNS: A 52-year-old man was admitted to our hospital. He was diagnosed as lumbar disc herniation in other hospital, and the patient suffered bilateral lower limb motor and sensory disorders after administration of caudal ESI...
March 2018: Medicine (Baltimore)
Stefan Ignjatovic, Reza Omidi, Rahel A Kubik-Huch, Suzanne Anderson, Frank J Ahlhelm
Background Compared with other available injection techniques for lumbar transforaminal epidural steroid injections (LTFESIs), the traditionally performed subpedicular approach is associated with a higher risk of spinal cord infarction, a rare but catastrophic complication. Purpose To assess the short-term efficacy of the retroneural approach for computed tomography (CT)-guided LTFESIs with respect to different needle-tip positions. Material and Methods This retrospective analysis included 238 patients receiving 286 CT-guided LTFESIs from January 2013 to January 2016...
January 1, 2018: Acta Radiologica
Stanley Sau Ching Wong, Qiu Qiu, Chi Wai Cheung
OBJECTIVE: Lumbar transforaminal epidural steroid injection is commonly used for treating lumbar radicular pain. We report a case of segmental spinal myoclonus that developed during lumbar transforaminal epidural injection with local anesthetic and steroid. CASE REPORT: A 58-year-old woman with failed back surgery syndrome presented with low back and right L3 and L4 radicular pain. As she had responded well previously to diagnostic selective nerve root injection with local anesthetic at the right L3 and L4 levels, lumbar transforaminal epidural steroid injection at the same levels was scheduled...
February 16, 2018: Regional Anesthesia and Pain Medicine
A Cotten, J-L Drapé, N Sans, A Feydy, J-M Bartoli, J-F Meder
No abstract text is available yet for this article.
February 14, 2018: Diagnostic and Interventional Imaging
Kazuyoshi Kobayashi, Kei Ando, Fumihiko Kato, Tokumi Kanemura, Koji Sato, Yudo Hachiya, Yuji Matsubara, Mitsuhiro Kamiya, Yoshihito Sakai, Hideki Yagi, Ryuichi Shinjo, Yoshihiro Nishida, Naoki Ishiguro, Shiro Imagama
PURPOSE: Posterior lumbar interbody fusion (PLIF)/transforaminal lumbar interbody fusion (TLIF) can have complications that require reoperation. The goal of the study was to identify risk factors for reoperation within 2 years after PLIF/TLIF. METHODS: A retrospective analysis of a prospective multicenter database was performed for patients who underwent PLIF/TLIF. A total of 1363 patients (689 males and 674 females) were identified, with an average age of 65.9 years old...
February 8, 2018: European Spine Journal
Dajie Wang
Chronic pain is a common medical condition. Patients who suffer uncontrolled chronic pain may require interventions including spinal injections and various nerve blocks. Interventional procedures have evolved and improved over time since epidural injection was first introduced for low back pain and sciatica in 1901. One of the major contributors in the improvement of these interventions is the advancement of imaging guidance technologies. The utilization of image guidance has dramatically improved the accuracy and safety of these interventions...
January 26, 2018: Current Pain and Headache Reports
Min Cheol Chang, Dong Gyu Lee
BACKGROUND: Lumbar foraminal spinal stenosis (LFSS) is a common cause of radicular pain in the lower extremities. Transforaminal epidural steroid injection (TFESI) is being used widely for controlling radicular pain induced by LFSS. The efficacy of TFESI has been demonstrated in previous studies. However, no study has evaluated the outcome of TFESI according to the severity of LFSS. OBJECTIVE: In this study, we evaluated the outcome of TFESI in patients with chronic lumbar radicular pain due to LFSS according to the severity of LFSS by using magnetic resonance imaging (MRI)...
January 2018: Pain Physician
Edward Braun, Andrew M Sack, Dawood Sayed, Smith Manion, Brian Hamm, Michael Brimacombe, Michael Tollette, Talal W Khan, Walter Orr, Andrea Nicol
BACKGROUND: Fluoroscopy-guided lumbar transforaminal epidural steroid injections (L-TFESI) result in radiation exposure that carries risks to patients, physicians, and procedural staff. OBJECTIVE: We aim to evaluate the feasibility of using pulsed fluoroscopy to safely reduce radiation exposure during L-TFESI. STUDY DESIGN: This is a prospective, double-blind, randomized controlled trial. SETTING: This study took place in a single-center, academic, outpatient interventional pain management clinic...
January 2018: Pain Physician
Atilla Kircelli, Tufan Cansever, Cem Yılmaz
BACKGROUND: Epidural steroid injection is widely used to treat the short and long-term symptoms of low back and radicular pain. To the best of our knowledge, the influence of transforaminal epidural steroid injection (TFSI) combined with caudal epidural steroid injection (CESI) on pain intensity, patient satisfaction, and quality of life in lumbar radiculopathy has not been examined. AIM: To evaluate the short and long-term efficacy of TFSI, and TFSI combined with CESI (TFSI + CESI) in patients with lumbar radiculopathy...
January 2018: Neurology India
Maciej J K Simon, Henry F H Halm, Markus Quante
BACKGROUND: Degenerative adult de novo (DAD) scoliosis appears characteristically in the sixth or seventh decade with symptoms of severe back pain and radiculopathy or spinal claudication. The aim of this study was to enhance the knowledge of perioperative complications and detect possible risk factors in this selective DAD scoliosis surgery. METHODS: This retrospective study included only patients with DAD scoliosis undergone correction spondylodesis with previous failure of conservative treatment...
January 10, 2018: BMC Musculoskeletal Disorders
Paolo Maino, Stefano Presilla, Paola A Colli Franzone, Sander M J van Kuijk, Roberto S G M Perez, Eva Koetsier
BACKGROUND: Transforaminal epidural steroid injections (TFESIs) and facet joint blocks can be performed under fluoroscopy or computed tomography (CT) guidance. The purpose of this retrospective cohort study was to compare patient radiation dose for lumbar TFESIs and facet joint blocks under CT guidance versus fluoroscopic guidance. METHODS: The primary outcome of this retrospective cohort study was the difference between the estimated effective dose (ED) of CT guidance and fluoroscopic guidance for TFESIs and facet joint blocks...
December 28, 2017: Pain Practice: the Official Journal of World Institute of Pain
Sorayouth Chumnanvej, Kitipat Kittayapirom, Siriluk Chumnanvej
BACKGROUND: Epidural steroid injection for low back and leg pain has been shown to result in a positive clinical outcome. Lumbosacral selective nerve root block (SNRB) via a transforaminal approach is commonly performed under fluoroscopic guidance. However, ultrasound guidance is an alternative to overcome the radiologic disadvantages. This study examined the accuracy of needle-tip localization under ultrasound guidance with a contrast bubble, compared with fluoroscopic guidance. OBJECTIVE: The primary objectives were to envisage the needle-tip localization with an air bubble by ultrasound and also to determine the accuracy of needle-tip location in transforaminal lumbar SNRB for low back and leg pain patients who were not surgical candidates...
December 21, 2017: World Neurosurgery
Vance L Fredrickson, Arati Patel, Martin H Pham, Ben A Strickland, Ifije Ohiorhenuan, Thomas Chen
BACKGROUND: Over-shunting of cerebral spinal fluid may lead to intracranial hypotension and dilation of spinal epidural veins. Radiculopathy may rarely occur secondary to these engorged spinal epidural veins. In addition, the etiology of the radiculopathy may be obscured by concomitant spinal degenerative changes. CASE DESCRIPTION: We present a case of a 29-year-old female with positional headaches from intracranial hypotension in the setting of cerebral spinal fluid over-shunting...
December 14, 2017: World Neurosurgery
Nicolas Hustinx, Arnaud Steyaert, Bernard le Polain de Waroux, Patrice Forget
In 2011, national diagnostic reference levels (DRLs) were proposed for pain management fluoroscopic procedures in Belgium. The primary goal of this work is to compare the dose area product values (DAP) recorded at the Saint-Luc University Hospital to these DRLs. From 2012 to 2015, 7664 interventional pain management procedures (4740 epidural, 2097 medial branch and 807 transforaminal infiltrations) were performed. Uni/multivariable analyses were done regarding the influence of different factors. The fluoroscopy duration and the DAP are lower to the DRLs (p < 0...
December 5, 2017: Radiation Protection Dosimetry
Tomoyuki Kawada
No abstract text is available yet for this article.
March 2018: American Journal of Physical Medicine & Rehabilitation
Harald Ekedahl, Bo Jönsson, Richard B Frobell
No abstract text is available yet for this article.
March 2018: American Journal of Physical Medicine & Rehabilitation
Carlos E Rivera
Lumbar epidural steroid injections under fluoroscopic guidance are used very commonly for the treatment of low back and lower extremity radicular pain. These procedures have been shown to be effective for pain relief in the short term and are relatively safe. The indications, evidence, and safety considerations for 2 different techniques-namely, interlaminar and transforaminal-are discussed.
February 2018: Physical Medicine and Rehabilitation Clinics of North America
Byron J Schneider, Simone Maybin, Eric Sturos
Serious neurologic complications following cervical transforaminal epidural steroid injections (CTFESI) and cervical interlaminar epidural steroid injections (CILESI) have been reported. For CILESI, this is caused by aberrant needle placement or space-occupying lesions, such as hematoma or abscess. For CTFESI, this is caused by embolic infarct when inadvertent intra-arterial injection of particulate steroids has occurred. Multiple safety techniques are used to mitigate the risk of these serious complications...
February 2018: Physical Medicine and Rehabilitation Clinics of North America
Lawrence McLean House, Kevin Barrette, Ryan Mattie, Zachary L McCormick
Cervical epidural steroid injections are a common treatment of cervical radicular pain. Important safety considerations include attention to the possibility of spinal cord infarction and spinal epidural hematoma. When appropriate, radiographic, technical, and pharmacologic principals are used, these procedures are relatively safe. Cervical epidural steroid injections are effective for the short-term treatment of radicular pain. More rigorously designed clinical outcomes studies of both cervical interlaminar and transforaminal epidural steroid injections are needed...
February 2018: Physical Medicine and Rehabilitation Clinics of North America
Yanjie Zhu, Yongzhao Zhao, Guoxin Fan, Guangfei Gu, Shiyu Sun, Shuo Hu, Shisheng He
BACKGROUND: Local anesthesia (LA) is recommended for percutaneous transforaminal endoscopic discectomy (PTED) but clinical practice indicates that LA cannot achieve satisfactory pain management during PTED. OBJECTIVES: The study aimed to investigate the comparisons between LA and EA for PTED in elderly population over 65 years old. METHODS: We performed a retrospective analysis of patients over 65 years old received PTED from May 2013 to December 2014...
December 2017: International Journal of Surgery
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