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Agri 2019 Apr;31(2):104-106

Department of Anesthesiology and Reanimation, Pain Clinic, Ege University, Izmir, Turkey.

Transforaminal epidural steroid injections are a common intervention in the treatment of radicular pain. Complications are rare, but can be catastrophic. One of the potentially devastating complications is occlusion of the artery of Adamkiewicz (AKA). Read More

Agri 2019 Apr;31(2):93-100

Division of Algology, Department of Anaesthesiology and Reanimation, Adnan Menderes University Faculty of Medicine, Aydın, Turkey.

Objectives: The aim of this retrospective study was to evaluate the efficacy of transforaminal anterior epidural steroid and local anesthetic injections (TAESE) and the effects on quality of life in patients with low back pain.

Methods: The study patients (n=191) were divided into 3 groups: disc herniation (DH), failed back surgery (FBS), and spinal stenosis (SS). A visual analog scale (VAS) and verbal pain scale (VPS) were used to assess patient pain. Read More

Global Spine J 2019 Apr 31;9(2):143-149. Epub 2018 Jul 31.

Cleveland Clinic, Cleveland, Ohio, USA.

Study Design: Retrospective cohort.

Objectives: There are conflicting reports on the short- and long-term quality of life (QOL) outcomes and cost-effectiveness of cervical epidural steroid injections (ESIs). The present study analyzes the cost-effectiveness analysis of ESIs versus conservative management for patients with radiculopathy or neck pain in the short term. Read More

Pain Res Manag 2019 3;2019:2651504. Epub 2019 Mar 3.

Spine Center, Korea University Anam Hospital, Seoul, Republic of Korea.

Introduction: There is no report on the effect of injectate viscosity on epidural distribution for lumbar transforaminal epidural steroid injections (L-TFESIs). The aim of this study was to evaluate the influence of injectate viscosity on the volume needed to reach specific landmarks in L-TFESIs.

Methods: A prospective, randomized, comparative human study involving 118 patients undergoing L-TFESIs was conducted. Read More

Neurospine 2019 Mar 31;16(1):82-95. Epub 2019 Mar 31.

Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, NM, USA.

Objective: To review concepts of a standalone endoscopically assisted lumbar interbody fusion as a simplified method to treat spinal instability.

Methods: MacNab outcomes and complications were analyzed in a series of 48 consecutive patients who underwent standalone lordotic endoscopic wedge lumbar interbody fusion (LEW-LIF) for advanced lumbar disc degeneration, spinal stenosis, and spondylolisthesis.

Results: Forty-two of the 48 patients (77. Read More

Semin Arthritis Rheum 2019 Mar 4. Epub 2019 Mar 4.

Department of cardiothoracic surgery, The First People's Hospital of YunNan Province, YunNan, China. Electronic address:

Background: Evaluate the comparative effectiveness of treatment strategies for patients with pain due to lumbar disc prolapse (LDP).

Methods: PubMed, EMBASE, and the Cochrane Database were searched through September 2017. Randomized controlled trials on LDP reporting on pain intensity and/or global pain effects which compared included treatments head-to-head, against placebo, and/or against conventional care were included. Read More

Pain Med 2019 Apr 2. Epub 2019 Apr 2.

Division of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah, USA.

J Pain Res 2019 20;12:1033-1039. Epub 2019 Mar 20.

Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, USA.

Background: Morbidity has been reported as a sequelae of crystalline steroid epidural steroid injections (ESIs), and particulate steroid size, aggregation, and embolization in brain and spinal cord may be the mechanism related to these neurologic effects.

Objective: The objective of the study was to examine the aggregation properties of triamcinolone acetonide in commonly used local anesthetics with and without human serum.

Setting: This study was conducted in an academic tertiary care center. Read More

Eur J Case Rep Intern Med 2019 20;6(3):001082. Epub 2019 Mar 20.

Service de Médecine Interne et Cancérologie, Centre Hospitalier Saint-Cyr, Villeneuve-sur-Lot, France.

We report a case of brainstem infarction following a C5-C6 cervical transforaminal injection, a rare and serious neurological complication of this procedure. Cervical transforaminal steroid injection is a common therapy for patients with persistent cervical radiculopathy not relieved by conservative treatment, and is effective in 65-70% of cases. Unfortunately, this procedure may lead to serious complications such as neurological damage. Read More

Anesth Analg 2019 Mar 27. Epub 2019 Mar 27.

Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts.

Background: Closed malpractice claim studies allow a review of rare but often severe complications, yielding useful insight into improving patient safety and decreasing practitioner liability.

Methods: This retrospective observational study of pain medicine malpractice claims utilizes the Controlled Risk Insurance Company Comparative Benchmarking System database, which contains nearly 400,000 malpractice claims drawn from >400 academic and community medical centers. The Controlled Risk Insurance Company Comparative Benchmarking System database was queried for January 1, 2009 through December 31, 2016, for cases with pain medicine as the primary service. Read More

PM R 2019 Apr 29;11(4):409-419. Epub 2019 Mar 29.

Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, PA.

Local glucocorticoid injections are often used to treat joint, soft tissue, or spinal pain, but the systemic side effects associated with these injections are poorly understood and not well recognized. There are significant known risks to systemic administration of glucocorticoids. However, there are no guidelines that address issues of systemic absorption, overall systemic risks, or other side effects of locally injected glucocorticoids. Read More

Pain Physician 2019 03;22(2):165-176

Yamato Pain Clinic, Osaka, Japan.

Background: Cervical epidural injections for treating neck and upper limb pain are performed by 2 methods: transforaminal and interlaminar. Many serious complications caused by inadvertent intravascular injection have been reported with the use of cervical transforaminal epidural steroid injection through the anterior-lateral approach. Despite international practical guidelines that have been proposed, cervical transforaminal epidural injection is still less recommended than cervical interlaminar epidural injection. Read More

Front Med (Lausanne) 2019 12;6:49. Epub 2019 Mar 12.

Department of Anesthesiology and Intensive Care, Medical Faculty, Riga Stradins University, Riga, Latvia.

Epidural steroid injections are frequently used to treat lumbar radicular pain. However, the spread of a solute in the epidural space needs further elucidation. We aimed at assessing the distribution of green dye in the epidural space after lumbar epidural injection on cadavers. Read More

Eur Spine J 2019 Mar 25. Epub 2019 Mar 25.

Department of Orthopedic Surgery, Seoul Red Cross Hospital, Seoul, Republic of Korea.

Purpose: To evaluate the accessibility of the preganglionic epidural space in patients with lumbosacral radiculopathy treated with epidural steroid injection (ESI) through trans-lateral recess (TLR) approach.

Methods: From September 2016 to December 2016, we enrolled 50 consecutive preganglionic ESI through TLR approach for 38 patients with lumbosacral radiculopathy at or below L4 territory. Fifteen of patients were diagnosed with lumbar disc herniation and 23 with lumbar spinal stenosis. Read More

Curr Pain Headache Rep 2019 Mar 19;23(5):32. Epub 2019 Mar 19.

Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 W. Wellington Ave. Suite 4815, Chicago, IL, 60657, USA.

Purpose Of Review: With an aging population and increased prevalence of the disease, we set out to evaluate the validity of current diagnostic criteria for neurogenic claudication as well as the efficacy of the treatment options for the main cause, lumbar spinal stenosis (LSS).

Recent Findings: Epidural steroid injections (ESI) were most efficacious when the injectate is a steroid combined with lidocaine or lidocaine only. There are promising results regarding the efficacy of the minimally invasive lumbar decompression (MILD) procedure as well as interspinous process spacers (IPS) compared to surgical alternatives. Read More

Eur Radiol 2019 Mar 18. Epub 2019 Mar 18.

Institute of Medical Radiology of the Solothurn Hospitals, Bürgerspital Solothurn, Schöngrünstrasse 42, 4500, Solothurn, Switzerland.

Objectives: To compare pain relief after CT-guided lumbar epidural steroid injections (ESI) using particulate (triamcinolone) and non-particulate (dexamethasone) steroids, and to explore factors affecting the effectiveness of both steroid types.

Methods: This retrospective observational study included 806 patients with lumbar radiculopathy and corresponding MRI or CT abnormalities of the lumbar spine, who were matched using the propensity score method, yielding two cohorts of 209 patients each. Pain intensity was evaluated prior to the procedure using a pain numerical rating scale (NRS) with range 0-10. Read More

Acta Radiol Open 2019 Mar 12;8(3):2058460119834688. Epub 2019 Mar 12.

Seattle Science Foundation, Seattle, WA, USA.

Background: Cervical transforaminal epidural steroid injections (CTFESIs) are sometimes performed in patients with cervical radiculopathy secondary to nerve-root compression. Neck movements for patient positioning may include rotation, flexion, and extension. As physicians performing such procedures do not move the neck for fear of injuring the vertebral artery, we performed fluoroscopy and cadaveric dissection to analyze any movement of the vertebral artery during head movement and its relation to the foramina in the setting of CTFESI. Read More

Neurol Sci 2019 Mar 7. Epub 2019 Mar 7.

Department of pain management, Wuhan No.1 Hospital, Wuhan, 430022, Hubei Province, China.

Background: Cervicogenic headache (CEH) is characterized by unilateral headache symptoms referred to the head from the cervical spine. Few methods have addressed long-term pain relief for CEH. This study was undertaken to evaluate pain control and quality of life after pulsed radiofrequency (PRF) for the C2 dorsal root ganglion and epidural steroid injections (ESI) for CEH. Read More

Medicine (Baltimore) 2019 Mar;98(9):e14490

Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine.

Redundant nerve root syndrome (RNRS) is a phenomenon characterized by the presence of elongated, enlarged, tortuous nerve roots in the lumbar subarachnoid space. It is unclear whether RNRS is caused by spinal stenosis or causes these symptoms.This study evaluated the effects of lumbar epidural steroid injection (LESI) on patients with RNRS and assessed factors associated with RNRS. Read More

Sportverletz Sportschaden 2019 Feb 27. Epub 2019 Feb 27.

SRH-Gesundheitszentrum Bad Herrenalb.

A major proportion of athletes have intermittent acute low back pain at some stage of their sport life. Some athletes develop chronic low back pain, which may be a major source of failing in sports. Facet, epidural and intradiscal steroid injections for specific pain generators in the spine show different short- and long-term results. Read More

Curr Pain Headache Rep 2019 Feb 22;23(2):14. Epub 2019 Feb 22.

Internal Medicine-Geriatrics, University of Texas Medical Branch, Galveston, TX, USA.

Purpose Of Review: The treatment of debilitating pain and loss of function secondary to lumbar stenosis is in high demand with the aging patient population. Options, including epidural steroid injections (ESIs) and medication therapy, are limited and it is unclear if they provide any functional improvements. In this prospective study, we evaluate functional outcomes in older adults with symptomatic lumbar stenosis treated with ESIs compared to those managed with medications by introducing the Short Physical Performance Battery (SPPB). Read More

BMJ Case Rep 2019 Feb 21;12(2). Epub 2019 Feb 21.

Trauma and Orthopaedic Surgery, Whittington Health NHS Trust, London.

Caudal epidural injections and facet joint injections using steroids and local anaesthetic are widely used methods of pain control in patients suffering from radicular leg pain. In the vast majority of cases this is low risk. We present an interesting case of a patient who suffered from symptomatic adrenal suppression following a caudal epidural injection, and thus wish to draw this rare but significant complication to the attention of orthopaedic practitioners. Read More

F1000Res 2019 31;8. Epub 2019 Jan 31.

Neurosurgery, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA.

Lumbar spinal stenosis is a degenerative process that is extremely frequent in today's aging population. It can result in impingement on the nerves of the cauda equina or on the thecal sac itself, and lead to debilitating symptoms such as severe leg pain, or restriction in the perimeter of ambulation, both resulting in dependency in daily activities. The impact of the disease is global and includes financial repercussions because of its involvement in the active work force group. Read More

J Pain Res 2019 29;12:513-518. Epub 2019 Jan 29.

Department of Medical Imaging, Rambam Health Care Campus, Haifa, Israel.

Lumbar epidural steroid injections (LESIs) are commonly used for managing lower back pain (LBP) and radicular pain. LESIs are generally considered safe with only rare serious complication. One very rare complication that is frequently cited in the literature is adhesive arachnoiditis. Read More

PM R 2018 Nov 19. Epub 2018 Nov 19.

Division of PM&R, Jordan-Young Institute, Virginia Beach, VA.

Arch Phys Med Rehabil 2019 Jan 29. Epub 2019 Jan 29.

School of Physical Therapy, Regis University, Denver, Colorado, United States; Department of Physical Therapy, Franklin Pierce University, Manchester, New Hampshire, United States; Rehabilitation Services, Concord Hospital, New Hampshire, United States. Electronic address:

Objective: To examine the effectiveness of epidural steroid injection (ESI) and back education with and without physical therapy (PT) in individuals with lumbar spinal stenosis (LSS).

Design: Randomized clinical trial.

Setting: Orthopedic spine clinics. Read More

J Back Musculoskelet Rehabil 2019 Jan 11. Epub 2019 Jan 11.

Department of Orthopaedic Surgery-Spine Center, University of California, San Francisco, CA, USA.

Background: Non-surgical treatment is the primary approach to degenerative conditions of the lumbar spine and may involve multiple modalities. There is little literature to guide an evidence-based approach to care.

Objective: To determine the effectiveness of CNT (comprehensive non-surgical treatment) in patients with degenerative spondylolisthesis (DS) and spondylolytic spondylolisthesis (SS), and to identify predictor variables for success of CNT in avoiding surgery. Read More

Turk Neurosurg 2019 ;29(2):279-284

Balikesir University, School of Medicine, Department of Neurosurgery, Balikesir, Turkey.

Aim: To compare the outcomes of fluoroscopically guided transforaminal epidural steroid injections between L4-L5 paramedian disc herniation and L5-S1 paramedian disc herniation for the treatment of radicular pain.

Material And Methods: A total of 593 patients treated by transforaminal epidural steroid injections for the treatment of L4-5 paramedian disc herniation and 504 patients treated by transforaminal epidural steroid injections for the treatment of L5-S1 paramedian disc herniation were included in the study. All the patients were regularly followed up for 12 weeks. Read More

J Pain Res 2019 31;12:171-177. Epub 2018 Dec 31.

Department of Anesthesiology, Pain Management Center, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China,

Background: Cervical transforaminal epidural steroid injection (CTFESI) is used to provide pain relief and restore function in patients with cervical radiculopathy. Traditionally, it is performed under the guidance of fluoroscopy or computed tomography. Here, we introduce a novel technique - ultrasound-guided CTFESI - with which operators can easily distinguish the close soft tissue (nerve, vessels) around the cervical foramina to avoid intravascular injection during the procedure. Read More

Reg Anesth Pain Med 2019 Jan;44(1):118-121

Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.

In patients with a history of a hypersensitivity reaction to iodinated contrast medium, iodinated contrast medium is avoided, antihistamine and steroid premedication are given, or a gadolinium-based contrast agent is employed. Six patients with a history of a hypersensitivity reaction to iodinated contrast medium and who were not premedicated had an unintentional injection of iodinated contrast. None of the patients developed a moderate or severe reaction. Read More

Radiology 2019 Mar 8;290(3):752-759. Epub 2019 Jan 8.

From the Department of Radiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland (T.J.D., C.K.P., S.B., R.S., C.W.A.P.); Division of Medical Physics, Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland (K.G.Z.); and Faculty of Medicine, University of Zurich, Zurich, Switzerland (T.J.D., C.K.P., K.G.Z., S.B., R.S., C.W.A.P.).

Purpose To compare the radiation exposure for participants and interventionalists as well as participant outcomes between fluoroscopy-guided versus CT-guided lumbar spinal injections. Materials and Methods This prospective, nonrandomized observational study included 1446 participants (mean age, 60.6 years; range, 18-91 years) who received transforaminal epidural injections or facet joint injections under fluoroscopic or CT guidance between October 2009 and April 2016. Read More

Pain Ther 2019 Jan 8. Epub 2019 Jan 8.

Pain Clinic and Palliative Care Unit, A.O.U. Città della Salute e della Scienza, Corso Bramante 88, 10131, Turin, Italy.

Introduction: Acute lumbosacral radicular syndrome is often a medical disorder of difficult management. Epidural steroid injection is a useful approach for the herniated disc and radiculitis. The transforaminal approach is usually considered more effective and target-specific, but it can be associated with permanent lower extremity paralysis. Read More

Ann Rehabil Med 2018 Dec 28;42(6):814-821. Epub 2018 Dec 28.

Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.

Objective: To suggest rotation angles of fluoroscopy that can bypass the carotid sheath according to vertebral levels for cervical transforaminal epidural steroid injection (TFESI).

Methods: Patients who underwent cervical spine magnetic resonance imaging (MRI) from January 2009 to October 2017 were analyzed. In axial sections of cervical spine MRI, three angles to the vertical line (α, angle not to insult carotid sheath; β, angle for the conventional TFESI; γ, angle not to penetrate carotid artery) were measured. Read More

Skeletal Radiol 2019 Jan 2. Epub 2019 Jan 2.

Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Faculty of Medicine, Marmara University, Mimar Sinan Caddesi No:41 Üst Kaynarca Fevzi Çakmak Mahallesi Pendik, 34906, Istanbul, Turkey.

Objective: To examine the impact of the presence of facet tropism on the results of transforaminal epidural steroid injection for unilateral radicular pain induced by lumbar disc herniation.

Materials And Methods: We included 112 patients diagnosed with unilateral, single-level lumbar disc herniation-induced radicular pain. Injection was planned at relevant levels. Read More

World Neurosurg 2018 Dec 24. Epub 2018 Dec 24.

Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, Istanbul, Turkey; Department of Physical Medicine and Rehabilitation, Section of Pain Medicine, Marmara University School of Medicine, Istanbul, Turkey.

Objective: Transforaminal epidural steroid injections (TFESIs) have been increasingly used in the treatment of lumbar radicular pain resistant to conservative modalities. Although different steroids can be used at different doses, the minimally effective steroid dose should be used to reduce side effects. The present retrospective study examined and compared the efficacy of 40 mg and 80 mg of methylprednisolone in TFESIs. Read More

Pain Pract 2019 03 18;19(3):345-346. Epub 2019 Jan 18.

Department of Anesthesiology, Critical Care and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk/Lanaken, Belgium.

J Spine Surg 2018 Sep;4(3):529-533

Department of Orthopedic Surgery, University of Miami Hospital, Miami, FL, USA.

Background: To determine if the timing of a lumbar epidural steroid injection (LESI) effects rates of post-operative infection in patients receiving a non-fusion lumbar decompression (LDC) due to degenerative disc disease (DDD). Lumbar pain due to DDD can frequently be temporized or definitively treated with epidural injections. While there is ample literature regarding the infection risks associated with corticosteroid injections prior to hip/knee replacements, there are few studies relating to the spine. Read More

Front Cell Neurosci 2018 22;12:453. Epub 2018 Nov 22.

Pain Research Center, Department of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States.

Low back pain, a leading cause of disability, is commonly treated by epidural steroid injections that target the anti-inflammatory glucocorticoid receptor (GR). However, their efficacy has been controversial. All currently used epidural steroids also activate the pro-inflammatory mineralocorticoid receptor (MR) with significant potency. Read More

J Pain Res 2018 21;11:2961-2967. Epub 2018 Nov 21.

Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea,

Background: A caudal epidural steroid injection (CESI) is a commonly used method to improve symptoms of lumbosacral pain. We compared the achievement of successful epidurograms and patient-reported clinical outcomes following different needle-insertion depths during CESI.

Methods: For the conventional method group, the needle was advanced into the sacral canal. Read More

Am J Case Rep 2018 Dec 8;19:1453-1458. Epub 2018 Dec 8.

Department of Internal Medicine, Piedmont Athens Regional Medical Center, Athens, GA, USA.

BACKGROUND Thyrotoxic periodic paralysis (TPP) is a rare cause of acute paralysis, which if not promptly recognized and treated, can lead to significant morbidity and mortality. TPP can be precipitated by several factors, including a high carbohydrate diet and exercise. This report is of a rare case of TPP after epidural steroid injection in a young man, with a review of the literature of previous cases. Read More

J Ultrasound 2018 Dec 5. Epub 2018 Dec 5.

Department of Physical Medicine and Rehabilitation, Sanggye Paik Hospital, Inje University College of Medicine, Sanggye 7 dong 761-7, Nowon-gu, 139-707, Seoul, South Korea.

Purpose: Recent studies have compared the therapeutic efficacy and safety of the procedure using ultrasound and fluoroscopy. However, there are no published studies comparing the therapeutic efficacy and safety of fluoroscopy (FL)-guided cervical interlaminar epidural steroid injection (CIESI) with that of ultrasound (US)-guided selective nerve root block (SNRB). This study aimed to compare the mid-term effects and advantages of US-guided SNRB with FL-guided CIESI for radicular pain in the lower cervical spine through assessment of pain relief and functional improvement. Read More

Pain Med 2018 12;19(12):2333

Spine Section Editor, The University of Newcastle, Newcastle, Australia.

Zh Nevrol Psikhiatr Im S S Korsakova 2018;118(10):58-62

Sechenov First Moscow State Medical University, Moscow, Russia.

Disc herniation with radiculopathy is a common cause of severe back pain leading to significant disability and a decrease in patients' quality of life. The authors report a case of 38-year-old female patient with radiculopathy of the first sacral root due to a large (11 mm) sequestered disc herniation between the fifth lumbar and the first sacral vertebrae. Conservative treatment with fluoroscopically-guided epidural steroid injection provided a significant clinical improvement, the patient was able to return to normal daily and professional activity in a short time. Read More

Z Orthop Unfall 2018 Nov 27. Epub 2018 Nov 27.

Department Wirbelsäule, Sportklinik Stuttgart GmbH.

Background: Many members of the adult population suffer acute low back pain at some stage in life. A specific cause is found in only a rather small number of these patients. Some of the patients develop chronic low back pain and this is a major source of disability. Read More

Front Pharmacol 2018 1;9:1229. Epub 2018 Nov 1.

Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, United States.

Corticosteroids have played a standard role in the multimodal pain management in the treatment of chronic spinal pain (cervical and lumbar) and osteoarthritis pain over the past three decades. In this review we discuss different types of injectable steroids that are mainly used for injection into the epidural space (for the treatment of radicular back and neck pain), and as intra-articular injections for different types of osteoarthritis related pain conditions. Furthermore, we discuss different approaches taken for epidural corticosteroid injections and spinal surgical rates when injections fail to resolve painful conditions, as well as the possibility of using local anesthetics alone for neuraxial injections, instead of in combination with corticosteroids. Read More

Saudi J Anaesth 2018 Oct-Dec;12(4):599-605

Department of Neurology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.

Background: Low back pain (LBP) is one of the most common musculoskeletal abnormalities. Epidural corticosteroid injections (ESIs) have been used long time ago for treatment of lumbar radiculopathy or discogenic back pain in case of failed medical and conservative management. Different techniques for ESIs include the interlaminar, the caudal, and the transforaminal approaches. Read More

Singapore Med J 2019 Mar 7;60(3):140-144. Epub 2018 Nov 7.

Pain Management Centre, Singapore General Hospital, Singapore.

Introduction: Epidural steroid injections are an integral part of nonsurgical management of radicular pain from lumbar spine disorders. We studied the effect of dexamethasone 8 mg epidural injections on the hypothalamic-pituitary-adrenal axis and serum glucose control of Asian patients.

Methods: 18 patients were recruited: six diabetics and 12 non-diabetics. Read More

Semin Intervent Radiol 2018 Oct 5;35(4):290-298. Epub 2018 Nov 5.

Chief of Minimal Invasive Spinal Treatment Unit.

Spinal pain is a common condition leading to significant disability and high cost. Spinal injections have been demonstrated to be effective short-term treatments with cost-utility superior to numerous other treatments, including surgical procedures. Appropriate patient selection-based on clinical and imaging finding-and the use of image guidance associated with technical precautions improve the safety and effectiveness of spinal injection and overall patient outcomes. Read More

Pain Pract 2019 03 2;19(3):250-274. Epub 2018 Dec 2.

Evidence-Based Pain Management Research and Education, Cleveland Clinic, Cleveland, Ohio, U.S.A.

Background: Lumbar spinal stenosis (LSS) can lead to compression of neural elements and manifest as low back and leg pain. LSS has traditionally been treated with a variety of conservative (pain medications, physical therapy, epidural spinal injections) and invasive (surgical decompression) options. Recently, several minimally invasive procedures have expanded the treatment options. Read More