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Pain Pract 2022 Jun 23. Epub 2022 Jun 23.

Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.

Background: An assessment of paraspinal muscle degeneration based on magnetic resonance imaging has been used to investigate both sarcopenia and myosteatosis. The morphologic changes in cross-sectional area and fat infiltration of the paraspinal muscles can affect pain outcomes after epidural steroid injection.

Methods: Patients ≥ 65 years of age who underwent fluoroscopy-guided lumbar epidural steroid injections were enrolled. Read More

Medicine (Baltimore) 2022 Jun 17;101(24):e29302. Epub 2022 Jun 17.

Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, School of Medicine, Kangwon National University, Republic of Korea.

Abstract: Lumbar spinal stenosis is a common degenerative disorder that is characterized by pain and neurogenic claudication. Previous studies have evaluated the effects of an epidural steroid injection (ESI) on spinal stenosis, based on changes to the spinal canal diameter.This study aimed to examine the impact of the ESI on pain scores and walking distance in patients with lumbar central spinal stenosis, stratified based on disease severity, which was graded according to the degree of cauda equina separation. Read More

Pain Med 2022 Jun 16. Epub 2022 Jun 16.

Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, US.

Biomed Res Int 2022 26;2022:8952220. Epub 2022 May 26.

Department of Anesthesiology, Hubei Provincial Armed Police Corps Hospital, Wuhan 430060, China.

Aims: To compare the effectiveness of cervical epidural injections of local anesthetic with vs. without a steroid.

Methods: Three databases (PubMed, Embase, and Cochrane library) were used to search and assess all clinical randomized controlled trials regarding the clinical efficacy of epidural injections from January 01, 2009, to October 31, 2020. Read More

Asian J Surg 2022 May 27. Epub 2022 May 27.

Department of Neurosurgery, University Medical Center, Ho Chi Minh City, Vietnam; Faculty of Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam. Electronic address:

Objective: Lumbar radiculopathy is a major health problem, which often treated by neurosurgery or guided lumbar epidural steroids for pain relief. We used autologous Platelet Rich Plasma (PRP) as a novel pharmaceutical agent that has strongly emerged in recent years to treat patients of lumbar disc herniation. From that, we evaluated the efficacy of PRP via transforaminal route in treatment of radicular pain in patients with lumbar disc herniation. Read More

Eur J Pain 2022 May 23. Epub 2022 May 23.

Evidence and Research (CLEAR) Center for Musculoskeletal Disorders, The University of Washington Clinical Learning, Seattle, WA, USA.

Background: There is limited research on the long-term effectiveness of epidural steroid injections (ESI) in older adults despite the high prevalence of back and leg pain in this age group. We tested the hypotheses that older adults undergoing ESI, compared to patients not receiving ESI: (1) have worse pain, disability and quality of life ('outcomes') pre-ESI, (2) have improved outcomes after ESI and (3) have improved outcomes due to a specific ESI effect.

Methods: We prospectively studied patients ≥65 years old presenting to primary care with new episodes of back pain in three US healthcare systems (BOLD registry). Read More

Reg Anesth Pain Med 2022 Aug 17;47(8):459-463. Epub 2022 May 17.

Department of Radiology, Hospital for Special Surgery, New York, New York, USA.

Background: Cervical epidural steroid injections are commonly performed to manage pain from cervical spine disease. Cadaveric studies have demonstrated incomplete ligamentum flavum fusion in the central interlaminar region with resultant midline gaps. We performed an MR-based characterization of cervical ligamentum flavum midline gaps to improve understanding of their prevalence and guide interventionalists in procedural planning. Read More

J Back Musculoskelet Rehabil 2022 Apr 29. Epub 2022 Apr 29.

Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea.

Background: Spinal nerve root anomaly is a rare feature that can result in unexpected outcomes in epidural steroid injections or surgical procedures. Preoperative diagnostic tools for root anomalies are limited, as they are usually found intraoperatively.

Objective: This case report aims to propose an effective diagnostic process for nerve root anomalies by introducing clinical manifestations, electrodiagnostic findings, and sophisticated imaging techniques such as coronal view magnetic resonance imaging (MRI) of the lumbosacral spine. Read More

J Pain Res 2022 5;15:1325-1354. Epub 2022 May 5.

Pain Medicine, Multidisciplinary Pain Fellowship, The University of Kansas Health System, Kansas City, KS, USA.

Introduction: Lumbar spinal stenosis (LSS) is a common spinal disease of aging with a growing patient population, paralleling population growth. Minimally invasive treatments are evolving, and the use of these techniques needs guidance to provide the optimal patient safety and efficacy outcomes.

Methods: The American Society of Pain and Neuroscience (ASPN) identified an educational need for guidance on the prudent use of the innovative minimally invasive surgical therapies for the treatment of symptomatic LSS. Read More

Phys Med Rehabil Clin N Am 2022 05;33(2):215-231

Department and Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Vanderbilt Stallworth Rehabilitation Hospital, 1221 Children's Way, Suite 1318, Nashville, Tennessee, USA.

Epidural steroid injections (ESI) can be an effective treatment of radicular pain, while also providing potential for functional improvement. There are 3 main interventional approaches including: interlaminar (IL), transforaminal (TF), and caudal. The risks and efficacy data vary between these routes of injection and the underlying pathology with the TF route having the most robust efficacy data. Read More

World Neurosurg 2022 May 4;164:156-158. Epub 2022 May 4.

Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, John R. Oishei Children's Hospital, Buffalo, New York, USA. Electronic address:

Background: Intrameningeal cysts are rare lesions without definitive etiologies that can involve the dura or arachnoid mater. Spinal arachnoid cysts have been described, and several different etiologies have been hypothesized. This includes one-way valve mechanisms, traumatic herniation of arachnoid through the dura, and abnormal arachnoid membrane proliferation. Read More

J Clin Endocrinol Metab 2022 May 7. Epub 2022 May 7.

Endocrinology Division, Hospital for Special Surgery, New York, NY.

Context: Over nine million epidural steroid injections (ESI) are performed annually in the United States. Although these injections effectively treat lumbar radicular pain, they may have adverse consequences, including bone loss.

Objective: To investigate acute changes in bone turnover following ESI. Read More

Spine J 2022 Apr 30. Epub 2022 Apr 30.

Department of Orthopaedic Surgery, University of California, 101 The City Dr S, Pavilion 3. Building 29A, Orange, CA 92868, USA.

Background: Spondylolysis is a defect of the pars interarticularis of vertebrae, most commonly seen at L5 and L4. The etiology of spondylolysis and isthmic spondylolisthesis is generally considered to be a result of repetitive mechanical stress to the weak portion of the vertebrae. A higher incidence of spondylolysis is observed in young athletes. Read More

JAMA 2022 05;327(17):1688-1699

Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.

Importance: Lumbar spinal stenosis is a prevalent and disabling cause of low back and leg pain in older persons, affecting an estimated 103 million persons worldwide. Most are treated nonoperatively. Approximately 600 000 surgical procedures are performed in the US each year for lumbar spinal stenosis. Read More

J Korean Med Sci 2022 May 2;37(17):e137. Epub 2022 May 2.

Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Ewha Womans University Mokdong Hospital, Seoul, Korea.

Background: Lumbar transforaminal epidural block (TFEB) is an effective treatment modality for radicular pain due to lumbar disc herniation (LDH). The addition of steroids is more effective than local anesthetic alone in TFEBs for patients with LDH. Moreover, the efficacy of TFEBs has been reported to be positively correlated with the volume of injectate. Read More

Bone Joint J 2022 May;104-B(5):567-574

Royal Derby Spinal Centre, Derby, UK.

Aims: Cervical radiculopathy is a significant cause of pain and morbidity. For patients with severe and poorly controlled symptoms who may not be candidates for surgical management, treatment with transforaminal epidural steroid injections (CTFESI) has gained widespread acceptance. However, a paucity of high-quality evidence supporting their use balanced against perceived high risks of the procedure potentially undermines the confidence of clinicians who use the technique. Read More

Int J Surg Case Rep 2022 May 6;94:107053. Epub 2022 Apr 6.

Depok Orthopaedic and Pain Interventional Center, Sentra Medika Hospital, Depok, West Java, Indonesia; Precursor - Comprehensive Course in Pain Intervention and Regeneration, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia.

Introduction And Importance: Peripheral nervous system involvement is very common in Sjogren's syndrome (SS); however, polyradiculopathy has been reported rarely in association with SS, and predominantly chronic forms have been described. Here, we reported a case from our Neurosurgery Department in Intan Medika KIM Hospital, Bangka Island, Pangkalpinang, Indonesia; as Academic Health System of Universitas Padjadjaran.

Case Presentation: A 32-year-old woman, diagnosed with Sjogren's syndrome that was characterized by anti-nuclear, anti-Ro, anti-La and anti dsDNA-antibodies positives since 3 years ago; consulted to our department for a chronic low back with a radicular pain in both lower limbs from the gluteal area to both feet together with numbness, hyperstesis and allodynia. Read More

Arch Orthop Trauma Surg 2022 Apr 14. Epub 2022 Apr 14.

Department of Trauma and Orthopaedics, Basildon and Thurrock University Hospital, Basildon, UK.

Introduction: There are no formal guidelines for whether CT-guided or fluoroscopy-guided TFESI should be undertaken for patients with symptoms of lumbar nerve root irritation and corresponding nerve impingement. Here, we sought to compare the efficacy, safety and cost of computer tomography (CT)-guided and fluoroscopically guided transforaminal epidural steroid injection (TFESI).

Materials And Methods: All patients who underwent lumbar TFESI at our institution between June 2016 and June 2018 were identified. Read More

Skeletal Radiol 2022 Apr 8. Epub 2022 Apr 8.

Radiology, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland.

Objective: To assess the predictive value of immediate pain-relief after CT-guided transforaminal epidural steroid injection (TFESI) including local anesthetics for longer-term pain relief and patients' global impression of change (PGIC) after 4 weeks.

Materials And Methods: One hundred ninety-three patients (age 55.4 ± 14. Read More

Am J Phys Med Rehabil 2022 Apr 5. Epub 2022 Apr 5.

Northwestern University Feinberg School of Medicine, Chicago, IL.

Objective: Investigate the relationship between socioeconomic status (SES) and pain reduction from epidural steroid injections (ESIs) for lumbar radiculopathy.

Methods: The retrospective cohort consisted of patients undergoing ESI for lumbar radiculopathy (n = 544). Numeric pain rating scale (NPRS) was measured at baseline and two weeks post-ESI. Read More

Anesth Pain Med (Seoul) 2022 Apr 1;17(2):221-227. Epub 2022 Apr 1.

Department of Anesthesiology, Mayo Clinic, Phoenix, AZ, USA.

Background: Intradural disc herniation (IDH) is a very rare and challenging diagnosis, with an estimated incidence of less than 1.5%. The pathogenesis of IDH remains uncertain. Read More

Front Surg 2022 16;9:841134. Epub 2022 Mar 16.

UCLA Department of Neurosurgery, Los Angeles, CA, United States.

Background: Best practice guidelines for treating lumbar stenosis include a multidisciplinary approach, ranging from conservative management with physical therapy, medication, and epidural steroid injections to surgical decompression with or without instrumentation. Marketed as an outpatient alternative to a traditional lumbar decompression, interspinous process devices (IPDs) have gained popularity as a minimally invasive stabilization procedure. IPDs have been embraced by non-surgical providers, including physiatrists and anesthesia interventional pain specialists. Read More

Reg Anesth Pain Med 2022 Aug 31;47(8):501-503. Epub 2022 Mar 31.

Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

Perm J 2021 06 9;25. Epub 2021 Jun 9.

Orthopaedic Department, Papageorgiou General Hospital of Thessaloniki, Thessaloniki, Greece.

Introduction: Caudal epidural injections (CEIs) are widely used in the treatment of lumbar spinal stenosis (LSS). Imaging modalities, such as fluoroscopy and ultrasonography, are frequently employed to confirm proper needle placement and to prevent possible complications. This is a prospective, randomized, study aiming to compare the efficacy of nonimage, ultrasonography-, and fluoroscopy-guided CEIs for the management of LSS. Read More

Healthcare (Basel) 2022 Mar 8;10(3). Epub 2022 Mar 8.

Department of Rehabilitation Medicine, The University of Kansas Medical Center, Kansas City, KS 66160, USA.

Bone loss leading to fragility fracture is a highly prevalent late effect in hematopoietic stem-cell transplant patients, who are affected 8-9 times more than the general population, particularly for vertebral compression fractures. Spinal interventions such as lumbar epidural steroid injections and vertebral augmentation may be helpful for providing pain relief and improved function, quality of life and return to ambulation. However, interventional procedures should be approached with caution in these patients. Read More

Pain Physician 2022 03;25(2):E349-E356

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

Background: While the use of fluoroscopy-guided transforaminal epidural steroid injection (TFESI) to help spread the injectate toward the ventral side has increased, this procedure has a radiation risk. Recently, ultrasound has been widely used in the medical field; among ultrasound methods, color Doppler is useful for predicting the direction of the injectate.

Objective: This study describes a novel technique employing color Doppler to help predict epidural space spread in interlaminar epidural steroid injection (ILESI). Read More

Pain Physician 2022 03;25(2):161-169

Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Faculty of Medicine, Marmara University, Istanbul, Turkey.

Background: Epidural fibrosis (EF) is one of the leading causes of post lumbar surgery syndrome (PLSS). Although there are studies in the literature suggesting that lumbar epidural steroid injections are an effective method in the pain management of PLSS caused by EF, no study is available comparing the effectiveness and safety of caudal and transforaminal approaches.

Objectives: To investigate the efficacy of caudal epidural steroid injection (CESI) versus transforaminal epidural steroid injection (TFESI) in patients with PLSS. Read More

Pain Physician 2022 03;25(2):145-160

Department of Neurosurgery, Division of Spine, China International Neurological Institute, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China.

Background: Selective nerve root block has been widely used to treat degenerative disc disease (DDD), but no detailed research data is provided to compare the efficacy of epidural injection of anesthetics with or without steroids on the DDD treatment.

Objectives: This study aimed to  provide the first comparison of steroids + local anesthetic (LA) or LA alone for the treatment of DDD.

Study Design: We systematically searched PubMed, Medline, Embase, and Cochrane. Read More

Front Pain Res (Lausanne) 2021 30;2:676730. Epub 2021 Jun 30.

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

Epidural steroid injection (ESI) has proven benefits in controlling chronic low back pain and can be performed the midline interlaminar (MIL) or transforaminal (TF) approach. A modified interlaminar approach, the parasagittal interlaminar (PIL), has surfaced as a more reliable, safe, and suitable approach to minimize complications related to MIL and TF. To conduct a systematic review and meta-analysis to assess and compare the effectiveness and safety of PIL with both MIL and TF approaches in adult patients with a history of chronic low back pain. Read More

Cureus 2022 Feb 1;14(2):e21808. Epub 2022 Feb 1.

Cardiology, Larkin Community Hospital, Miami, USA.

The chronic neuropathic pain of post-herpetic neuralgia (PHN) often persists for months or years after the acute herpes zoster (shingles) episode, may be severe and intractable, and can severely impact the overall quality of life. Antivirals, analgesics, and nerve blocks can effectively shorten the course of shingles and may help to prevent PHN. Although vaccination effectively prevents shingles and PHN, current therapies may be ineffective, and pain management can be challenging when PHN occurs. Read More