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Epidural Steroid Injections (epidural + steroid_injection)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Epidural Steroid Injection,How Should the Indications for Use be Derived: Systematic Review or Basic Science?

PAIN PRACTICE, Issue 3 2009
Craig T. Hartrick MD, FIPP Editor in Chief, Pain Practice Editorial Board
No abstract is available for this article. [source]

The "Swimmer's View" as Alternative When Lateral View Is Inadequate During Interlaminar Cervical Epidural Steroid Injections

PAIN MEDICINE, Issue 5 2010
Arjang Abbasi DO
Abstract Objective., To present a technique that better visualizes the needle during interlaminar cervical epidural steroid injection (ICESI) in patients where the lateral view is inadequate. Design., Case report. Setting., Private group practice. Subject., A 57-year-old morbidly obese male presenting for ICESI for left neck and upper limb pain after a motor vehicle accident. Magnetic resonance imaging revealed left C6-7 herniated nucleus pulposis and C4-5 osteophytic disc-ridge complex. Electrodiagnostic evaluation revealed activity consistent with a left C7 radiculopathy. Intervention., Left C7-T1 ICESI. Needle was obscured in the lateral view by the patient's shoulders. Needle was made visible by positioning the patient for Swimmer's view. Results., Full resolution of symptoms without associated complications. Conclusions., Grave complications have been associated with ICESI necessitating impeccable and systematic technique with substantial knowledge of anatomy. Although injection at lower levels is advocated for safety concerns, the needle during lateral view may be obscured by the shoulders in some patients. The "Swimmer's View" position may be attempted when lateral view is insufficient to visualize needle during ICESI. [source]

Prospective randomised single blind study of epidural steroid injection comparing triamcinalone acetonide with methylprednisolone acetate

INTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 1 2005
A. ANWAR
Abstract Aim:, This study aims to assess the effectiveness of epidural steroid injection as well as comparing two agents commonly used in these procedures, namely triamcinalone acetonide and methylprednisolone acetate. Method:, Twenty subjects were recruited into each group receiving either agent. Results:, Overall result showed that there were marked improvement in symptoms in both agents but there were no differences in terms of superiority from one agent to another. Conclusion:, Epidural steroid injection is effective and both agents are equipotent. [source]

The "Swimmer's View" as Alternative When Lateral View Is Inadequate During Interlaminar Cervical Epidural Steroid Injections

EPIDUROGRAPHY: CHARACTERISTICS OF EPIDURALGRAMS PERFORMED DURING LESI

PAIN MEDICINE, Issue 2 2002
Article first published online: 4 JUL 200
David C. Miller MD, DABPM Woodland Pain Center, Michigan City, IN Fluoroscopically guided, contrast enhanced lumbar epidural steroid injections are commonly performed for persistent or sever lumbar radicular pain. An epiduralgram is a real-time fluoroscopic image of contrast injected into the epidural space prior to the injection of local anesthetic and steroid. This report details the results of one hundred consecutive epiduralgrams. The epidural needle was placed under continuous multiplainer fluoroscopic guidance using ISIS protocol. Three ml. of Omnipaque 300 were injected after initial insertion to obtain the epiduralgram. This was followed by injection of 3 ml. of Celestone diluted with 4 ml. of preservative-free 1% lidocaine to obtain the epiduralgram. The epidural needle was placed at the predetermined spinal level and appropriate side 100% of the time. Needles were successfully placed into the epidural space on the first attempt in 95%. One needle was subarachnoid, one was intra vascular, three were in tissue plains superficial to the epidural space and were apparent only with contrast injection. Three ml. of contrast flowed unilaterally in 74% of lumbar epidural injections. The contrast flowed cephalad only in 20%, caudad only in 28%, and bidirectional in 52%. Contrast spread less than three spinal levels 64% of the time. The desired nerve root was visualized in 62%. Contrast was seen in the ventral epidural space on lateral views 88% of the time. Ventral spread was always fewer levels than the dorsal spread. Epidurography provides essential information for the accurate performance of lumbar epidural steroid injections. One out of every twenty presumed epidural injections were inaccurately placed even by an experienced operator. One out of every fifty was dangerously positioned and identified only by performance of an epiduralgram. [source]

(613) Radiculopathy Treatment Assessment Using Pain Tolerance Test

PAIN MEDICINE, Issue 2 2000
Article first published online: 25 DEC 200
Authors: Y. Eugene Mironer, Carolinas Center for Advanced Management of Pain; Judson J. Somerville, The Pain Management Clinic of Laredo Current measurements of the outcomes of chronic radiculopathy treatment are limited to subjective criteria: level of pain, range of motion, etc. Our previous study showed that nerve conductivity does not correlate well with the intensity of pain after treatment of radiculopathy (1). In the current study we looked at the Pain Tolerance Threshold (PTT) as a possible measurement of the results of radiculopathy treatment. Twenty patients with chronic radiculopathy (13 lumbar and 7 cervical) underwent epidural steroid injections at the level of involvement. Before, and approximately one week after the procedure, we measured PTT in both the involved and contralateral extremity at 3 different frequencies (5Hz, 250Hz, and 2000 Hz) using Neurometer. Level of pain was also assessed using a Visual Analog Scale (VAS). Initial PTT results showed great interpersonal variability. Nearly half of the patients did not show significant differences in PTT between affected and unaffected sides. Of interest, the majority experienced intolerable pain at 2000 Hz stimulation at lower than maximal intensity output, which contradicts previous findings (2). Dynamics of the PTT measurements after treatment did not directly correlate with changes in the level of pain. Nevertheless, in 7 out of 8 patients with low PTT (relative to the unaffected side) it increased significantly, with noticeable decrease of VAS score. Similar results were not found in patients with either normal initial PTT score or minimal improvement of pain. 1. Mironer YE, Somerville JJ The current perception threshold evaluation in radiculopathy: efficacy in diagnosis and assessment of treatment results. Pain Digest 1998;8:37,38. 2. Liu SS, Gerancher JC, Bainton BG, et al. The effects of electrical stimulation at different frequencies on perception and pain in human volunteers: epidural versus intravenous administration of fentanyl. Anesth Analg 1996;82:98,102. [source]

(615) Combined Use of Cervical Spinal Cord Stimulator (SCS) and Occipital Nerve Stimulator (ONS)

PAIN MEDICINE, Issue 2 2000
Article first published online: 25 DEC 200
Author: Y. Eugene Mironer, Carolinas Center for Advanced Management of Pain A 51-year-old female patient was referred to the clinic in March 1997 with severe cervicalgia and right shoulder girdle pain. She rated her pain at 9/10 on a Visual Analog Scale (VAS). MRI showed multilevel severe spondylosis with significant neural foraminal stenosis at 3 levels. Multiple modalities of treatment (physiotherapy, epidural steroid injections, cervical plexus blocks) and a variety of medications (opioids, NSAIDs, anticonvulsants, antidepressants, etc.) failed to provide any improvement. The patient twice consulted neurosurgeons but was considered a poor surgical candidate. Finally, in July 1997, after a successful trial, a cervical SCS was implanted with the tip of the lead at level C2, achieving excellent coverage of the pain area. For the next 18 months the patient continued to do well, having minimal neck and shoulder discomfort and using only occasional oral analgesics. However, by January 1999, she developed intractable right-sided occipital neuralgia. Occipital nerve blocks were providing extremely short-term relief and the intake of different analgesics, including opioids, started to increase. In March 1999, after successful trial, an ONS was implanted. Unfortunately, it migrated shortly after implantation and had to be revised and re-anchored. After this procedure all headaches were completely controlled without medications. The patient continues to be very active, uses both stimulators daily, does not take any analgesics and rates her pain at 0/10 to 1/10 on VAS. [source]

MULTIDISCIPLINARY PAIN ABSTRACTS: 12

PAIN PRACTICE, Issue 1 2004
Article first published online: 15 MAR 200
The purpose of this study was to investigate whether selective nerve fiber dysfunction, as assessed by quantitative sensory testing (QST), correlates with the effectiveness of epidural steroid injections (ESI) in patients with lumbar radiculopathy. Twenty patients with unilateral painful sciatica caused by disc herniation participated in this open study. Before ESI, quantitative thermal and mechanical sensory testing was conducted at the most painful dermatome and the contralateral dermatome. The primary outcome measure used was the self-recording of pain intensity twice daily with a 0,10 numerical pain scale (NPS). Secondary efficacy measures included the Short Form of the McGill Pain Questionnaire, the straight leg raising test, and the lumbar range of motion. A significant difference in all types of sensory thresholds between the affected and the contralateral dermatomes was detected at baseline. All outcome measures improved subsequent to the ESI. A significant positive correlation was found between the increase in cold sensation thresholds of the affected dermatome (Adelta-fiber dysfunction) and the improvement in NPS. The increase in touch and vibration thresholds (Abeta-fiber dysfunction) was found to be inversely correlated with the improvement in NPS. No correlation was found between heat sensation thresholds and any of the outcome measures. These results suggest that QST has the potential to be an important tool in the selection of the appropriate treatment for patients with sciatica and may assist in identifying the mechanisms of pain generation in these patients. [source]