Lumbar disc herniation regression after successful epidural steroid injection.
ABSTRACT In some lumbar disc herniation patients, noninvasive measures fail, necessitating more aggressive treatment, such as epidural steroid injections or surgery. This study sought to determine whether improvement in patients who receive epidural steroid injections is related to regression of herniated nucleus pulposus or whether such patients' symptoms decrease because of the steroid effect in the presence of continued herniated nucleus pulposus. Two nonoperatively treated patient cohorts were followed who had follow-up MRI. Specifically, 38 other patients who improved without invasive treatment within 6 weeks after the onset of their symptoms were compared with 20 patients who improved with epidural steroid injections. Results found that both groups had similar initial and follow-up herniated nucleus pulposus size and outcomes. The epidural steroid injection group had fewer sequestered or extruded herniations that resorbed, and most were of lower hydration. In conclusion, epidural steroid injections do not alter ultimate herniated nucleus pulposus regression. Patients in whom the disc herniation has less hydration may have prolonged symptoms, but many improve with epidural steroid injections.
Article: Comparison of two doses of corticosteroid in epidural steroid injection for lumbar radicular pain.[show abstract] [hide abstract]
ABSTRACT: Low back pain and lumbar radicular pain are the leading causes of job loss worldwide. Therapeutic approaches to lumbar radicular pain, including sciatica and spinal canal stenosis, are diverse. Many clinicians use 80 mg long-acting glucocorticoids in epidural steroid injections (ESI). The aim of this study is to compare the clinical response of 80 mg versus 40 mg methylprednisolone in ESI. 84 patients with newly exacerbated lumbar radicular pain were randomly al located into two groups. 43 patients under went ESI with 80 mg Depo-Medrol and 41 age- and sex-matched cases received 40 mg Depo-Medrol as the comparison group. The pain in the second week, and every month thereafter was assessed using a visual analogue scale (VAS). Remarkable improvement in one month VAS occurred in 64 cases (75 percent) from both groups. VAS values between 80 mg and 40 mg groups were comparable in the two-week (p-value is 0.827) and three-month (p-value is greater than 0.746) post-injection periods. Slightly better results were shown in patients in the 40 mg group after one month. In the case of lumbar radicular pain, ESI with low dose (40 mg) methylprednisolone is as effective as high dose (80 mg) with comparable results and less adverse profile.Singapore medical journal 04/2007; 48(3):241-5. · 0.73 Impact Factor
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ABSTRACT: Epidural injection of corticosteroids is one of the most commonly used interventions in managing chronic spinal pain. However, there has been a lack of well-designed randomized, controlled studies to determine the effectiveness of epidural injections. Consequently, debate continues as to the value of epidural steroid injections in managing spinal pain. To evaluate the effect of various types of epidural steroid injections (interlaminar, transforaminal, and caudal), in managing various types of chronic spinal pain (axial and radicular) in the neck and low back regions. A systematic review utilizing the criteria established by the Agency for Healthcare Research and Quality (AHRQ) for evaluation of randomized and non-randomized trials, and criteria of Cochrane Musculoskeletal Review Group for randomized trials were used. Data sources included relevant English literature performed by a librarian experienced in Evidence Based Medicine (EBM), as well as manual searches of bibliographies of known primary and review articles and abstracts from scientific meetings within the last 2 years. Three reviewers independently assessed the trials for the quality of their methods. Subgroup analyses were performed among trials with different control groups, with different techniques of epidural injections (interlaminar, transforaminal, and caudal), with different injection sites (cervical/thoracic, lumbar/sacral), and with timing of outcome measurement (short- and long-term). The primary outcome measure is pain relief. Other outcome measures were functional improvement, improvement of psychological status, and return to work. Short-term improvement is defined as 6 weeks or less, and long-term relief is defined as 6 weeks or longer. In managing lumbar radicular pain with interlaminar lumbar epidural steroid injections, the evidence is strong for short-term relief and limited for long-term relief. In managing cervical radiculopathy with cervical interlaminar epidural steroid injections, the evidence is moderate. The evidence for lumbar transforaminal epidural steroid injections in managing lumbar radicular pain is strong for short-term and moderate for long-term relief. The evidence for cervical transforaminal epidural steroid injections in managing cervical nerve root pain is moderate. The evidence is moderate in managing lumbar radicular pain in post lumbar laminectomy syndrome. The evidence for caudal epidural steroid injections is strong for short-term relief and moderate for long-term relief, in managing chronic pain of lumbar radiculopathy and postlumbar laminectomy syndrome. There is moderate evidence for interlaminar epidurals in the cervical spine and limited evidence in the lumbar spine for long-term relief. The evidence for cervical and lumbar transforaminal epidural steroid injections is moderate for long-term improvement in managing nerve root pain. The evidence for caudal epidural steroid injections is moderate for long-term relief in managing nerve root pain and chronic low back pain.Pain physician 02/2007; 10(1):185-212. · 10.72 Impact Factor
Article: Paraplegia after intracord injection during attempted epidural steroid injection in an awake-patient.[show abstract] [hide abstract]
ABSTRACT: Epidural steroid injection is recommended in patients with back ache from spinal and radicular pain or pain suggestive of radiculopathy. During needle placement and injections, clinicians often rely on the patient's complaint of paresthesia or shooting pain along the nerve root, dura, or cord in case a needle pierces these areas. We report the accidental intracord injection of steroid solution during epidural block using fluoroscopy in a conscious patient, which caused paraplegia. This case suggests failure of undue reliance on a patient reporting pain in the vicinity of needle puncturing the spinal cord structures. IMPLICATIONS: Intracord injection of triamcinolone acetate and local anesthetic, resulting in permanent paraplegia, may occur in conscious patients.Anesthesia & Analgesia 11/2005; 101(4):1209-11, table of contents. · 3.29 Impact Factor