1,871 results match your criteria Epidural Steroid Injections


Minimally invasive lumbar decompression: a review of indications, techniques, efficacy and safety.

Pain Manag 2020 Jul 1. Epub 2020 Jul 1.

Florida Pain Institute, Melbourne, FL 32940, USA.

Lumbar spinal stenosis is a common degenerative spine condition. In properly selected patients, minimally invasive lumbar decompression () may be an option to improve outcomes. This review provides an in-depth description of the  procedure and a comprehensive examination of safety and efficacy. Read More

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http://dx.doi.org/10.2217/pmt-2020-0037DOI Listing

Incidence of Adrenal Insufficiency and Cushing's Syndrome After Long-Term Epidural Steroid Injections Over Six Months or Longer: A Preliminary Study.

J Pain Res 2020 24;13:1505-1514. Epub 2020 Jun 24.

Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Purpose: Endocrinological complications of an epidural steroid injection (ESI) are rare but dangerous. Nevertheless, despite the associated risks, repeated long-term ESIs are indispensable in some clinical situations. However, only a few reports to date have assessed the safety of this procedure. Read More

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http://dx.doi.org/10.2147/JPR.S252278DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7321692PMC

Comparison of treatment outcomes in lumbar central stenosis patients treated with epidural steroid injections: interlaminar bilateral transforaminal approach.

Korean J Pain 2020 Jul;33(3):226-233

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

Background: We aimed to compare interlaminar epidural steroid injections (ILESI) and bilateral transforaminal epidural steroid injections (TFESI) on pain intensity, functional status, depression, walking distance, and the neuropathic component in patients with lumbar central spinal stenosis (LCSS).

Methods: The patients were divided into either the ILESI or the bilateral TFESI groups. Prime outcome measures include the numerical rating scale (NRS), Oswestry disability index (ODI), Beck depression inventory (BDI), and pain-free walking distance. Read More

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http://dx.doi.org/10.3344/kjp.2020.33.3.226DOI Listing

Association of Protein and Genetic Biomarkers with Response to Lumbar Epidural Steroid Injections in Subjects with Axial Low Back Pain.

Am J Phys Med Rehabil 2020 Jun 22. Epub 2020 Jun 22.

Department of Physical Medicine and Rehabilitation, University of Pittsburgh/UPMC, Pittsburgh PA.

Objective: The purpose of this observational study was to examine the association of protein and genetic biomarkers with pain and pain related disability in individuals with axial low back pain undergoing epidural steroid injections.

Design: Forty-eight adults with axial low back pain undergoing an epidural steroid injection were recruited from an academic medical center. Blood samples were assayed at baseline and follow-up for plasma proteins and functional single nucleotide polymorphisms associated with pain. Read More

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http://dx.doi.org/10.1097/PHM.0000000000001514DOI Listing

Cervical Epidural Steroid Injections: Incidence and Determinants of Subsequent Surgery.

Spine J 2020 Jun 18. Epub 2020 Jun 18.

Department of Orthopaedic Surgery; Stanford University School of Medicine. 450 Broadway Street MC 6342, Redwood City, CA, USA 94063. Electronic address:

Background Context: Cervical epidural steroid injections (CESIs) are sometimes used in the management of cervical radicular pain in order to delay or avoid surgery. However, the rate and determinants of surgery following CESIs remain uncertain.

Purpose: This study sought to determine: 1) the proportion of patients having surgery following CESI, and 2) the timing of and factors associated with subsequent surgery. Read More

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http://dx.doi.org/10.1016/j.spinee.2020.06.012DOI Listing

Epidural Steroid Injections for Management of Degenerative Spondylolisthesis: Little Effect on Clinical Outcomes in Operatively and Nonoperatively Treated Patients.

J Bone Joint Surg Am 2020 Jun 11. Epub 2020 Jun 11.

Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, NY.

Background: Although epidural steroid injection (ESI) may provide pain relief for patients with degenerative spondylolisthesis in treatment regimens of up to 4 months, it remains unclear whether ESI affects crossover from nonoperative to operative management.

Methods: This retrospective cohort study analyzed 2 groups of surgical candidates with degenerative spondylolisthesis: those who received ESI within 3 months after enrollment (ESI group) and those who did not (no-ESI group). Annual outcomes following enrollment were assessed within operative and nonoperative groups (patients who initially chose or were assigned to surgery or nonoperative treatment) by using longitudinal mixed-effect models with a random subject intercept term accounting for correlations between repeated measurements. Read More

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http://dx.doi.org/10.2106/JBJS.19.00596DOI Listing

Outcome Measurements for Pain Relief in Elderly Patients with Spinal Stenosis Undergoing Epidural Steroid Injection: Is Conservative Approach an Option?

Turk Neurosurg 2020 May 27. Epub 2020 May 27.

Hasan Kalyoncu University, Faculty of Medicine, Department of Anesthesiology, Gaziantep, Turkey.

Aim: Lumbar spinal stenosis is one of the main causes of low back pain, resulting in morbidity, loss of function, and disability in elderly patients. The treatment outcomes of drugs for neuropathic pain, physical therapy or epidural steroid injections (ESIs) are still unclear, especially in elderly patients. There is currently no consensus on pain management. Read More

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http://dx.doi.org/10.5137/1019-5149.JTN.29251-20.3DOI Listing

Anticoagulants for Lumbar Epidural Steroid Injections.

Pain Med 2020 Jun;21(6):1294-1295

Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York, New York, USA.

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http://dx.doi.org/10.1093/pm/pnaa087DOI Listing
June 2020
2.300 Impact Factor

Effectiveness of Ultrasound-Guided Pulsed Radiofrequency Treatment in Patients with Refractory Chronic Cervical Radicular Pain.

Pain Physician 2020 Jun;23(3):E265-E272

Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Korea.

Background: The effect of pulsed radiofrequency (PRF) stimulation for alleviating cervical radicular pain has been demonstrated in several previous studies.

Objectives: We aimed to evaluate the effectiveness of PRF with ultrasound (US) guidance in patients with chronic cervical radicular pain that was refractory to repeated transforaminal epidural steroid injections (TFESIs).

Study Design: A prospective outcome study. Read More

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Are Foraminal Stenosis Severity and Herniation Level Associated with the Treatment Success of Cervical Interlaminar Epidural Steroid Injection?

Pain Physician 2020 Jun;23(3):325-332

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

Background: Foraminal stenosis, defined as a narrowing of the cervical neural foramen, is one of the most common causes of upper extremity radicular pain.

Objectives: The aim of our study was to determine the effects of the severity of neural foraminal stenosis and spinal herniation level on treatment success in patients treated with interlaminar epidural steroid injections (ILESI) due to cervical disc herniation-related radiculopathy and their possible predictive roles.

Study Design: A retrospective assessment. Read More

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Gender differences in use of prolonged non-operative therapies prior to index ACDF surgery.

J Clin Neurosci 2020 Jun 2. Epub 2020 Jun 2.

Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, United States.

Prior to anterior cervical discectomy and fusion (ACDF) surgery, patients suffering from cervical stenosis traditionally trial non-operative treatments for pain management. There is a paucity of data evaluating gender disparities in the prolonged utilization of conservative therapy prior to ACDF surgery. Therefore, the purpose of this study was to assess for gender-based differences in the utilization and cost of maximal non-operative therapy (MNT) for cervical stenosis prior to ACDF surgery. Read More

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http://dx.doi.org/10.1016/j.jocn.2020.04.030DOI Listing

CT fluoroscopy-guided transforaminal and intra-articular facet steroid injections for the treatment of cervical radiculopathy: injectate distribution patterns and association with clinical outcome.

Eur Radiol 2020 Jun 4. Epub 2020 Jun 4.

Department of Mathematics and Statistics, Université Laval, 1045 avenue de la Médecine, Québec, G1V 0A6, Canada.

Objectives: To investigate injectate dispersal patterns and their association with therapeutic efficacy during a transforaminal (TFSI) or an intra-articular facet steroid injection (IFSI) to treat cervical radiculopathy.

Methods: This retrospective study examined the post-intervention cervical spine CT of 56 patients randomized to receive one CT fluoroscopy-guided IFSI (29 patients; 10 (34.5%) males; mean age 45. Read More

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http://dx.doi.org/10.1007/s00330-020-06974-8DOI Listing

Epidural Steroid Injections and Risk of Lumbar Surgical Site Infection.

Pain Med 2020 May 13. Epub 2020 May 13.

Columbia University Medical Center, Rehabilitation and Regenerative Medicine, New York, New York, USA.

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http://dx.doi.org/10.1093/pm/pnaa147DOI Listing

Pneumocephalus and Chemical Meningitis after Inadvertent Dural Puncture during Lumbar Epidural Injection.

Korean J Neurotrauma 2020 Apr 10;16(1):67-72. Epub 2020 Apr 10.

Department of Neurosurgery, Dongguk University Ilsan Hospital, Goyang, Korea.

Inadvertent dural puncture (IDP) is one of the complications of lumbar epidural steroid injections (ESIs). We report a case in which pneumocephalus and chemical meningitis developed at the same time after an IDP during a lumbar interlaminar ESI. A 60-year-old woman presented to the emergency room with thunderclap headache and febrile sensation 3 hours after receiving a lumbar interlaminar ESI. Read More

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http://dx.doi.org/10.13004/kjnt.2020.16.e8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7192798PMC

Frequency of Epidural Steroid Injections.

Pain Med 2020 05;21(5):1078-1079

Columbia University Medical Center, Rehabilitation and Regenerative Medicine, New York, New York, USA.

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http://dx.doi.org/10.1093/pm/pnaa053DOI Listing

Antiplatelet and Anticoagulant Risk for Select Spine Interventions: A Retrospective Cohort.

Pain Med 2020 05;21(5):910-917

Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, Tennessee.

Objectives: To identify significant bleeding complications following spinal interventions in patients taking medications with antiplatelet or anticoagulation effect.

Design: Retrospective chart review of a 12-month period.

Setting: Outpatient academic medical practice. Read More

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http://dx.doi.org/10.1093/pm/pnaa009DOI Listing

Does Epidural Bupivacaine with or Without Steroids Provide Long-Term Relief? A Systematic Review and Meta-analysis.

Curr Pain Headache Rep 2020 Apr 25;24(6):26. Epub 2020 Apr 25.

Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.

Purpose Of Review: Low back and lower extremity pain have been treated since 1901 with local anesthetics alone and since 1952 in combination with steroids. Over the years, multiple randomized controlled trials, systematic reviews with or without meta-analysis have been reaching discordant conclusions regarding the effectiveness of sodium chloride solution, local anesthetics, and steroids in managing spinal pain. Further, related to lack of understanding, multiple reviewers have considered local anesthetics including lidocaine and bupivacaine as equivalent to placebo based on theory that steroid is the only drug effective in the epidural space. Read More

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http://dx.doi.org/10.1007/s11916-020-00859-7DOI Listing

Gender differences in the 3-month utilization of nonoperative therapies prior to primary lumbar microdiscectomy.

J Clin Neurosci 2020 Jun 21;76:107-113. Epub 2020 Apr 21.

Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, United States. Electronic address:

Patients with lumbar intervertebral disc herniation classically trial a brief course of conservative management prior to microdiscectomy surgery. Gender differences have previously been identified in the selection and symptomatic response to commonly-utilized nonoperative treatments. However, whether gender differences exist in the degree and cost of nonoperative therapy in this cohort remains unknown. Read More

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http://dx.doi.org/10.1016/j.jocn.2020.04.033DOI Listing

At Least 5-Year Follow-up After Transforaminal Epidural Steroid Injection Due to Lumbar Radicular Pain Caused by Spinal Stenosis.

Pain Pract 2020 Apr 21. Epub 2020 Apr 21.

Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Korea.

Objectives: Transforaminal epidural steroid injection (TFESI) can be used to control radicular pain following lumber spinal stenosis (LSS). However, limited information is available on the long-term prognosis of TFESI in patients with LSS.

Methods: Of the 90 patients who underwent TFESI for controlling LSS-induced radicular pain at least 5 years previously, 54 patients completed a phone interview. Read More

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http://dx.doi.org/10.1111/papr.12905DOI Listing

Preoperative lumbar epidural steroid injections administered within 6 weeks of microdiscectomy are associated with increased rates of reoperation.

Eur Spine J 2020 Apr 18. Epub 2020 Apr 18.

Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago, Chicago, IL, USA.

Purpose: Lumbar epidural steroid injections (LESIs) are widely utilized for back pain. However, as studies report adverse effects from these injections, defining a safe interval for their use preoperatively is necessary. We investigated the effects of preoperative LESI timing on the rates of recurrent microdiscectomy. Read More

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http://dx.doi.org/10.1007/s00586-020-06410-xDOI Listing

Pathogenic mechanisms of a stroke-like attack elicited by epidural steroid injection therapy.

Authors:
Zhen He

Curr Neurovasc Res 2020 Apr 15. Epub 2020 Apr 15.

Division of Neurotoxicology, National Center for Toxicological Research, Food and Drug Administration, Jefferson, AR. United States.

The pathogenic mechanisms involved in a disastrous scenario following epidural steroid injections (ESI) remain unclarified. Intra-arterial injection of steroids with needle-penetrating vascular injury would be the culprit: a particulate medicine elicited a brain or spinal cord strokelike attack. On the other hand, the limited experimental approaches simulating an accidental steroid intra-arterial injection for ESI conflicted in their results: hemorrhage vs. Read More

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http://dx.doi.org/10.2174/1567202617666200415143201DOI Listing

Lumbar Radicular Pain Response to First Injection with Non-particulate Steroid.

Cureus 2020 Feb 26;12(2):e7104. Epub 2020 Feb 26.

Molecular Medicine, Physical Medicine and Rehabilitation, The Feinstein Institute for Medical Research/Hofstra Northwell School of Medicine, Manhasset, USA.

Introduction Recent studies on the use of transforaminal epidural steroid injection (TFESI) to treat lumbar radicular pain have highlighted controversies pertaining to the choice of corticosteroid agent utilized in lumbosacral TFESI, in terms of both safety and efficacy. The primary objective was to characterize the radicular pain response after a first transforaminal injection with dexamethasone. The secondary objective was to document the response of those who failed to respond to a dexamethasone injection when particulate steroid was utilized for a second injection. Read More

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http://dx.doi.org/10.7759/cureus.7104DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7100620PMC
February 2020

Advancement in Neuromodulation Technology with the Innovation of Design-Specific Peripheral Nerve Stimulators: Sural Nerve Stimulation for Radiculopathy.

Pain Med 2020 Jun;21(6):1297-1300

Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, Minnesota, USA.

Background: Peripheral nerve stimulation (PNS) is a form of neuromodulation that is used to treat chronic and refractory neuropathic pain. Peripheral nerve stimulation was first described in the early 1960s when Shelden implanted a PNS device for trigeminal neuralgia. Despite PNS being known since the 1960s, technology designed specifically for PNS was lacking. Read More

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http://dx.doi.org/10.1093/pm/pnaa077DOI Listing

Comparing pain relief and functional improvement between methylprednisolone and dexamethasone lumbosacral transforaminal epidural steroid injections: a self-controlled study.

Korean J Pain 2020 Apr;33(2):192-198

Department of Physical Medicine & Rehabilitation, Medical College of Wisconsin, Milwaukee, WI, USA.

Background: Previous studies have shown varying results between lumbosacral transforaminal epidural steroid injections (TFESIs) performed with particulate versus non-particulate corticosteroids. The purpose of this study was to investigate the difference in pain relief and functional improvement between particulate and non-particulate lumbosacral TFESIs in patients who had undergone both injections, sequentially.

Methods: This was a self-controlled, retrospective study of 20 patients who underwent both a methylprednisolone and a dexamethasone TFESI to the same vertebral level and side. Read More

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http://dx.doi.org/10.3344/kjp.2020.33.2.192DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7136301PMC

Interventional Pain Medicine Practice in the UK and the USA: A Survey of 242 Pain Physicians.

Pain Physician 2020 03;23(2):127-134

The Walton Centre NHS Foundation Trust.

Background: Pain medicine practices vary across different regions within a country and between countries.

Objectives: The objective of the survey was to study the variation in interventional pain medicine practices in the United Kingdom (UK) and the United States (US).

Methods: A survey was designed in 2019 on Survey Monkey®. Read More

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Postoperative decrease of regional volumetric bone mineral density measured by quantitative computed tomography after lumbar fusion surgery in adjacent vertebrae.

Osteoporos Int 2020 Jun 13;31(6):1163-1171. Epub 2020 Mar 13.

Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.

We investigated the effect of posterior lumbar fusion surgery on the regional volumetric bone mineral density (vBMD) measured by quantitative computed tomography. Surgery negatively affected the regional vBMD in adjacent levels. Interbody fusion was independently associated with vBMD decline and preoperative epidural steroid injections (ESIs) were associated with less postoperative vBMD decline. Read More

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http://dx.doi.org/10.1007/s00198-020-05367-3DOI Listing

Ultrasound-guided caudal epidural steroid injection for successful treatment of radiculopathy during pregnancy.

Pain Manag 2020 Mar 12;10(2):67-71. Epub 2020 Mar 12.

Division of Pain Medicine, Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery - Weill Cornell Medicine, 535 East 70th Street, NY 10021, USA.

The aim of this case report is to describe ultrasound guidance for caudal epidural steroid injection during pregnancy. A 29-year-old, 32-week parturient presented with severe back and leg pain with MRI demonstrating herniation of the L5-S1 level. The disabling pain was refractory to conservative therapy, and an ultrasound-guided caudal epidural steroid injection was performed. Read More

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http://dx.doi.org/10.2217/pmt-2019-0044DOI Listing

Synovial Cysts Confounding Access to the Dorsal S1 Neural Foramen in Transforaminal Epidural Steroid Injections.

Pain Med 2020 03;21(3):570-575

Department of Radiology.

Objectives: The S1 dorsal foramen is the route for 30% of lumbar transforaminal epidural injections; it is therefore important to identify structures impeding S1 foraminal access. The study objective was to characterize the imaging findings, prevalence, and anatomic origin of synovial cysts presenting within the S1 neural foramen.

Methods: A case series (N = 14) established imaging characteristics of S1 synovial cysts. Read More

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http://dx.doi.org/10.1093/pm/pnz298DOI Listing

Comparison of interlaminar CT-guided epidural platelet-rich plasma versus steroid injection in patients with lumbar radicular pain.

Eur Radiol 2020 Jun 24;30(6):3152-3160. Epub 2020 Feb 24.

Centre d'imagerie ostéo-articulaire, Clinique du sport, 2 rue Georges-Negrevergne, 33700, Mérignac, France.

Introduction: The treatment of persistent lumbar radicular pain (LRP) by CT-guided epidural steroid injection (ESI) is extensively used and associated with rare but serious complications. Platelet-rich plasma (PRP), which has recently been shown to favor healing and the anti-inflammatory process by delivering growth factors and cytokines, might be an alternative and potentially safer option. We compared the efficacy of interlaminar CT-guided epidural PRP injections (EPRPI) and ESI in the treatment of persistent LRP (> 6 weeks). Read More

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http://dx.doi.org/10.1007/s00330-020-06733-9DOI Listing

Neurological Complication Rates of Epidural Injections and Selective Nerve Blocks: A Comparison of Steroid Use Patterns.

Clin J Pain 2020 Jun;36(6):449-457

Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea.

Objectives: Epidural injections and selective nerve blocks are widely used for pain relief, but steroid usage is controversial due to safety concerns. We carried out this retrospective cohort study to estimate the incidence rates of neurological complications associated with epidural and selective nerve blocks, in relation to steroid use patterns.

Materials And Methods: Using a national insurance claims database, we identified patients who received at least one epidural injection or nerve block from 2009 to 2013. Read More

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http://dx.doi.org/10.1097/AJP.0000000000000816DOI Listing

Transforaminal epidural steroid injections in cervical spinal disease with moderate to severe disability: Comparative study in patients with or without surgery.

Medicine (Baltimore) 2020 Feb;99(7):e19266

Department of Orthopedics, Korea University Ansan Hospital, Ansan.

Despite many clinical trials on cervical epidural steroid injections, the indications for and long-standing outcomes of this treatment remain controversial. We evaluated the outcomes and indications for transforaminal cervical epidural steroid injection (TCESI) in patients with moderate to severe disability.We prospectively gathered data from patients with 1 or 2-level cervical degenerative disease (herniated disc, foraminal stenosis) with moderate to severe disability (3. Read More

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http://dx.doi.org/10.1097/MD.0000000000019266DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7035037PMC
February 2020

Epidural Steroid Injection-Induced Pancreatitis: A Case Report.

Am J Case Rep 2020 Feb 10;21:e921241. Epub 2020 Feb 10.

Division of Academic Affairs and Research, Orlando Regional Healthcare, Orlando, FL, USA.

BACKGROUND Degenerative disc disease of the lumbar spine can be associated with spinal canal and neuroforaminal stenosis, resulting in severe pain. Conservative approaches to treatment are generally recommended initially, especially in the elderly. Epidural corticosteroid injections can provide significant but temporary pain relief and are a commonly performed procedure in pain management. Read More

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http://dx.doi.org/10.12659/AJCR.921241DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7032528PMC
February 2020

Transforaminal Epidural Steroid Injection in the Treatment of Pain in Foraminal and Paramedian Lumbar Disc Herniations.

Turk Neurosurg 2020 ;30(3):394-399

Kartal Dr. Lutfi Kirdar Training and Research Hospital, Department of Neurosurgery, Istanbul, Turkey.

Aim: To compare the effect of fluoroscopically guided transforaminal epidural steroid injections on radicular pain in foraminal and paramedian lumbar disc herniations.

Material And Methods: This study included patients who did not benefit from previous medical treatments or are not suitable for surgery. Transforaminal epidural steroid injections for the treatment of foraminal and paramedian lumbar disc herniation were performed in 370 and 1262 patients, respectively. Read More

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http://dx.doi.org/10.5137/1019-5149.JTN.27220-19.3DOI Listing
January 2020

Systematic Review of Outcomes Following 10-Year Mark of Spine Patient Outcomes Research Trial for Intervertebral Disc Herniation.

Spine (Phila Pa 1976) 2020 Jun;45(12):825-831

Department of Orthopaedic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.

MINI: We summarized the 10-year outcomes of Spine Patient Outcomes Research Trial for intervertebral disc herniation through a systematic review. The observational cohort 2-year analysis and the as-treated analysis of the randomized control trial at 4 and 8 years showed statistically greater improvements in those patients who were treated surgically.

Study Design: We performed a comprehensive search of Pubmed, MEDLINE, and EMBASE for English-language studies of all levels of evidence pertaining to SPORT, in accordance with Preferred Reported Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Read More

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http://dx.doi.org/10.1097/BRS.0000000000003400DOI Listing

Evaluation of Cost-Utility of Thoracic Interlaminar Epidural Injections.

Curr Pain Headache Rep 2020 Jan 30;24(3). Epub 2020 Jan 30.

Neurointerventional Radiology, Neurointerventional Spine, Massachusetts General Hospital and Harvard Medical School, 55 Blossom Street, Gray 241B, Boston, MA, 02114, USA.

Purpose Of Review: Chronic thoracic pain, even though not as prevalent as low back and neck pain, appears in approximately 30% of the general population. The severity of thoracic pain and degree of disability seems to be similar to other painful conditions. Despite this severity, interventions in managing chronic thoracic pain are less frequent, and there is a paucity of literature regarding epidural injections and facet joint interventions. Read More

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http://dx.doi.org/10.1007/s11916-020-0838-1DOI Listing
January 2020

Randomized trial of 3-drug combination for lumbar nerve root epidural injections with a TNF-α inhibitor in treatment of lumbar stenosis.

Br J Neurosurg 2020 Apr 20;34(2):168-171. Epub 2020 Jan 20.

Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.

This study was to assess the clinical efficacy of epidural injections with tumor necrosis factor-alpha (TNF-α) inhibitor in patients with chronic radicular pain caused by lumbar spinal stenosis (LSS). In a randomized controlled trial (RCT), patients diagnosed with mild-to-moderate LSS underwent epidural intervention with three different drugs and were allocated to TNF-α inhibitor group (Group A), steroid group (Group B) and lidocaine-only group (Group C). All patients were evaluated by visual analog scale (VAS) for leg pain and Oswestry disability index (ODI) to assess function. Read More

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http://dx.doi.org/10.1080/02688697.2020.1713990DOI Listing
April 2020
0.947 Impact Factor

Comparing the short-term cost-effectiveness of epidural steroid injections and medical management alone for discogenic lumbar radiculopathy.

Clin Neurol Neurosurg 2020 Apr 13;191:105675. Epub 2020 Jan 13.

Cleveland Clinic Center for Spine Health, Cleveland Clinic, Cleveland, OH, USA; Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA; Department of Neurological Surgery, Cleveland Clinic, Cleveland, OH, USA. Electronic address:

Objective: Epidural steroid injections (ESIs) are a commonly used treatment strategy for low back pain and lumbar radiculopathy. However, their cost-effectiveness and ability to mediate long-term quality of life (QOL) improvements is debated. We sought to analyze the cost-effectiveness of lumbar epidural steroid injections (ESIs) compared to medical management alone for patients with lumbar radiculopathy and low back pain. Read More

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http://dx.doi.org/10.1016/j.clineuro.2020.105675DOI Listing
April 2020
1.248 Impact Factor

Effects of implementing evidence-based appropriateness guidelines for epidural steroid injection in chronic low back pain: the EAGER (Esi Appropriateness GuidElines pRotocol) study.

BMJ Open Qual 2019 11;8(4):e000772. Epub 2019 Dec 11.

Radiology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA.

Objective: Chronic low back pain is very common and often treated with epidural steroid injections (ESIs). As ESI referrals had been rapidly increasing at our Veterans' Administration hospital, we were concerned that they were supplanting more comprehensive care. The objective was to determine how referral patterns and multidisciplinary care might change with the implementation of evidence-based guidelines. Read More

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http://dx.doi.org/10.1136/bmjoq-2019-000772DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6937044PMC
December 2019

Traumeel® Epidural Injection: A Viable Alternative to Corticosteroids - A Five-Patient Case Study.

Cureus 2019 Nov 19;11(11):e6196. Epub 2019 Nov 19.

Pain Medicine, Neurointerventional Pain Management, Monroe, USA.

Epidural steroid injections are the cornerstone of symptomatic relief in select spinal pain conditions and remain the most common interventional procedure; however, many patients with low back pain cannot tolerate corticosteroids due to multiple inherent side effects and contraindications. Plant-based or homeopathic injectable therapies, such as Traumeel®, may be viable alternatives to corticosteroids in providing pain relief for those patients that cannot use corticosteroids in epidural injections. A chart review case study exploring the effectiveness of Traumeel epidural injections as an alternative treatment to that of epidural corticosteroid injections were performed. Read More

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http://dx.doi.org/10.7759/cureus.6196DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6919953PMC
November 2019

Acute cervical myelopathy with quadriparesis after cervical transforaminal epidural steroid injection: A case report.

Medicine (Baltimore) 2019 Dec;98(50):e18299

Department of Anesthesiology and Pain Medicine, College of Medicine, Inha University, Incheon, South Korea.

Rationale: Cervical transforaminal epidural steroid injection (TFESI), can be an effective tool to improve pain associated with cervical radiculopathy. However, complications related to the procedure have been reported.

Patient Concerns: A 50-year-old woman who experienced acute cervical myelopathy with quadriparesis after cervical TFESI under fluoroscopic guidance. Read More

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http://dx.doi.org/10.1097/MD.0000000000018299DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6922480PMC
December 2019

The effect of additional transforaminal epidural blocks on percutaneous epidural neuroplasty with a wire-type catheter: A retrospective observational study.

Medicine (Baltimore) 2019 Dec;98(50):e18233

Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon.

Percutaneous epidural neuroplasty (PEN) is an effective interventional treatment for radicular pain. However, in some cases, contrast runoff to the spinal nerve root does not occur. We investigated whether contrast runoff to the spinal nerve root affects the success rate of PEN and whether additional transforaminal epidural blocks for intentional contrast runoff affect the success rate of PEN in cases in which contrast runoff is absent. Read More

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http://dx.doi.org/10.1097/MD.0000000000018233DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6922581PMC
December 2019

Devastating Vertebral Osteomyelitis After Epidural Steroid Injection: A Case Report.

JBJS Case Connect 2019 Dec;9(4):e0028

Department of Orthopaedic Surgery, The Johns Hopkins School of Medicine, Baltimore, Maryland.

Case: A 62-year-old man with no comorbidities presented with back and bilateral leg pain and progressive paraplegia that developed over a 1-week period. He had received 2 lumbar epidural steroid injections (LESIs) for lumbar stenosis 39 and 25 days before presentation. Workup revealed osteomyelitis of L4 and L5 with epidural abscesses. Read More

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http://dx.doi.org/10.2106/JBJS.CC.19.00028DOI Listing
December 2019

An Algorithmic Approach to Treating Lumbar Spinal Stenosis: An Evidenced-Based Approach.

Pain Med 2019 12;20(Suppl 2):S23-S31

Milestone Research Organization, San Diego, California, USA.

Objective: Lumbar spinal stenosis (LSS) can lead to compression of the neural and vascular elements and is becoming more common due to degenerative changes that occur because of aging processes. Symptoms may manifest as pain and discomfort that radiates to the lower leg, thigh, and/or buttocks. The traditional treatment algorithm for LSS consists of conservative management (physical therapy, medication, education, exercise), often followed by epidural steroid injections (ESIs), and when nonsurgical treatment has failed, open decompression surgery with or without fusion is considered. Read More

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http://dx.doi.org/10.1093/pm/pnz133DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7101167PMC
December 2019

Cost-effectiveness and Safety of Interspinous Process Decompression (Superion).

Pain Med 2019 12;20(Suppl 2):S2-S8

MileStone Research Organization, San Diego, California, USA.

Objective: There are several treatment options for patients suffering from lumbar spinal stenosis, including surgical and conservative care. Interspinous spacer decompression using the Superion device offers a less invasive procedure for patients who fail conservative treatment before traditional decompression surgery. This review assesses the current cost-effectiveness, safety, and performance of lumbar spinal stenosis treatment modalities compared with the Superion interspinous spacer procedure. Read More

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http://dx.doi.org/10.1093/pm/pnz245DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6896024PMC
December 2019

In Response: Does Coadministration of Transforaminal Epidural Steroid Injection with Sedation Improve Patient Satisfaction?

Pain Physician 2019 11;22(6):E662-E663

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

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November 2019

Re: Does Coadministration of Transforaminal Epidural Steroid Injection with Sedation Improve Patient Satisfaction?

Pain Physician 2019 11;22(6):E661

Department of Pain Management, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P.R.China.

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November 2019

Transforaminal Versus Lateral Parasagittal Versus Midline Interlaminar Lumbar Epidural Steroid Injection for Management of Unilateral Radicular Lumbar Pain: A Randomized Double-Blind Trial.

Pain Physician 2019 11;22(6):561-573

Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Background: Epidural steroid injections (ESIs) are commonly used for management of lumbosacral radicular pain. Midline interlaminar (MIL) or transforaminal (TF) routes are commonly used. The TF route, although associated with higher delivery of drug to the ventral epidural space, has serious complications including spinal cord injury and permanent paralysis reported in literature. Read More

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November 2019

Predictive factors for treatment success of transforaminal epidural steroid injection in lumbar disc herniation-induced sciatica

Turk J Med Sci 2020 02 13;50(1):126-131. Epub 2020 Feb 13.

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

Background/aim: The aim of this study was to identify predictive factors for treatment success in transforaminal epidural steroid injection in patients with lumbar disc herniation-induced sciatica.

Materials And Methods: A total of 219 patients who were diagnosed with unilateral sciatica and underwent transforaminal epidural steroid injections at the level of L4-5, L5-S1, or S1 neural foramina between March 2016 and May 2018 were retrospectively analyzed. The presence of transitional vertebrae and the grade of nerve root compression were evaluated by a radiologist. Read More

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http://dx.doi.org/10.3906/sag-1908-167DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7080350PMC
February 2020

Acute rhabdomyolysis following epidural steroid injection: An unusual complication in a patient with low back pain.

Agri 2019 Jul;31(3):150-152

Department of Algology, Ankara University Faculty of Medicine, Ankara, Turkey.

Epidural steroid injection is a very common intervention in the treatment of low back pain and sciatic symptoms. The most common complication for epidural steroid injection is transient headache with or without identifiable dural puncture. Other complications have also been reported, including intravascular entry, local hematoma, bleeding, increased back pain, facial flushing, vasovagal reactions, nausea, and fever. Read More

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http://dx.doi.org/10.5505/agri.2017.54366DOI Listing

Does nonexistent of your hands on the screen guarantee no radiation exposure to your body? - Study on exposure of the practitioner's hands to radiation during C-arm fluoroscopy-guided injections and effectiveness of a new shielding device.

Medicine (Baltimore) 2019 Nov;98(46):e17959

Department of Rehabilitation Medicine, Kyungpook National University Hospital.

Observational phantom study.This study aimed to evaluate the radiation exposure dose of practitioner's hands when performing C-arm guided procedures and to determine the usefulness of our newly designed radiation shielding device.C-arm guided procedures including lumbar transforaminal epidural steroid injections (TFESIs) are commonly used for pain control induced by lumbar radiculopathy. Read More

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http://dx.doi.org/10.1097/MD.0000000000017959DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6867788PMC
November 2019