Cervical Epidural Steroid Injection

House, Lawrence McLean; Barrette, Kevin; Mattie, Ryan; McCormick, Zachary L.

doi:10.1016/j.pmr.2017.08.001

Cited by 58 publications

(46 citation statements)

References 59 publications

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“…If the pain is not alleviated by conservative treatment consisting of life-style modification, analgesic use, and physical therapy, epidural administration of anesthetics with or without steroids may be used. The success rate of CEI has been reported to range from 14% to 92%, depending on the diagnosis, technique used, and outcome measure considered [ 24 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ]; Slipman et al reported a low success rate of 14–20% when CEI was administered to manage trauma-related cervicobrachialgia. However, this indication is rarely used currently, and the follow-up period in Slipman’s study was more than 20 months after CEI [ 35 , 36 ].…”

Section: Discussionmentioning

confidence: 99%

“…Each patient was placed in the prone position on a radiolucent table, with a soft pillow on his/her chest, his/her forehead on the table, and his/her neck bent slightly to open the interlaminar space. All patients underwent ILCEI at the level of C7-T1, where the epidural space is the largest [24,25]. After disinfection of the skin with betadine, the skin was anesthetized with 1 mL of 1% lidocaine at the entry point.…”

Section: Interlaminar Epidural Injectionmentioning

confidence: 99%

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Feasibility of Using the Epidural Space Detecting Device (EPI-DetectionTM) for Interlaminar Cervical Epidural Injection

Kang

Park

Kim

et al. 2020

JCM

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Cervical epidural injection (CEI), which is widely used for the treatment of cervical radiculopathy, sometimes has been associated with post-operative complications. Recently, EPI-DetectionTM, which detects the negative pressure of the epidural space and notifies the proceduralist by flashing a light and producing a beeping sound, was introduced. We assumed that the newly developed device could be as safe and efficient as the conventional loss of resistance (LOR) method. Therefore, we aimed to evaluate the effectiveness of the EPI-DetectionTM and compare it to that of the conventional LOR method. We randomly assigned 57 patients to the LOR and EPI-Detection groups (29 and 28 patients, respectively). Subjects were treated with interlaminar CEI (ILCEI) using one of two methods. The measured parameters, i.e., operation time and radiation dose were lower in the EPI-DetectionTM group (4.6 ± 1.2 min vs. 6.9 ± 2.1 min; and 223.2 ± 206.7 mGy·cm2 vs. 380.3 ± 340.9 mGy·cm2, respectively; all p < 0.05) than in the LOR group. There were no complications noted in either group. Both the EPI-DetectionTM and LOR methods were safe and effective in detecting the epidural space, but the former was superior to the latter in terms of operation time and radiation exposure. The EPI-DetectionTM may help perform ILCEI safely.

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Section: Discussionmentioning

confidence: 99%

Section: Interlaminar Epidural Injectionmentioning

confidence: 99%

Feasibility of Using the Epidural Space Detecting Device (EPI-DetectionTM) for Interlaminar Cervical Epidural Injection

Kang

Park

Kim

et al. 2020

JCM

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“…Все процедуры рекомендовано проводить под рентгенологическим или ультразвуковым контролем [45][46][47][48].…”

Section: эпидуральные блокадыunclassified

“…Варианты укладки пациента для проведения трансфораминальной эпидуральной блокады, как и рентгеноскопические ориентиры, определяющие точку введения иглы, могут варьировать в зависимости от уровня патологии [45,47]. Это связано с анатомическими особенностями костных и невральных структур, хода сосудистого русла, характерными для различных отделов позвоночного столба [52].…”

Section: эпидуральные блокадыunclassified

Therapeutic and diagnostic value of transforaminal epidural injections in patients with herniated disc and radicular pain: analytical literature review

et al. 2020

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The aim of the study is to analyze comprehensive information on the use of epidural injections in the treatment and diagnosis of patients with herniated intervertebral discs. Epidemiology and modern concepts of the pathogenesis of pain syndrome formation in patients with herniated intervertebral discs, algorithms and methods of conservative and surgical treatment of such patients are highlighted. Information on the methods and features of various routes of epidural injections used for these drugs is presented, as well as a comparative assessment of their effectiveness and safety. The diagnostic and prognostic significance of transforaminal epidural block is discussed separately.

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“…2 Cervical interlaminar epidural steroid injection (CIESI) is the most common technique to access the epidural space. [3][4][5][6] The majority of the literature on the effectiveness of CIESI includes the use of low-dose local anesthetic as a diluent for the steroid injectate with the intention of providing immediate pain relief. [7][8][9][10][11][12][13][14] While this practice is common, 7 it is not supported by evidence.…”

Section: Introductionmentioning

confidence: 99%

Effect of low-dose lidocaine on objective upper extremity strength and immediate pain relief following cervical interlaminar epidural injections: a double-blinded randomized controlled trial

McCormick

Burnham

Cunningham

et al. 2020

Reg Anesth Pain Med

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BackgroundLow-dose lidocaine is a common diluent for analgesia following cervical interlaminar epidural steroid injection (CIESI). Concerns with this practice exist. A single-arm cohort reported that 20% of patients develop postprocedural upper extremity weakness when using lidocaine as a diluent. Furthermore, a high-cervical spinal block with unintended intrathecal or subdural administration is possible.ObjectiveDetermine if low-dose lidocaine as a diluent during CIESI causes clinically meaningful (1) upper extremity weakness and (2) immediate pain relief when compared with saline.DesignDouble-blinded randomized control trial.MethodsPatients with cervical radicular pain scheduled for CIESI were enrolled. Participants received lidocaine (CIESI-L) or saline (CIESI-S) as a diluent for the epidural injectate. Myotomal strength was measured with dynamometry before and between 20 and 30 min after CIESI. Pre-pain and post-pain scores were obtained. Primary and secondary outcomes were post-CIESI weakness of ≥20% (minimal clinically important difference (MCID)) in >1 myotome and ≥50% pain reduction on the numerical scale.Results120 participants (64 females (53%), mean age, 56 (SD 13.7) years) completed the study and were analyzed (CIESI-L n=60; CIESI-S n=60). There was no significant between-group difference in the proportion of participants with postprocedural weakness, CIESI-L 41.7% (95% CI, 29.8% to 54.5%), CIESL-S 50% (95% CI, 37.5% to 62.5%). Between-group comparison showed no significant difference in pain reduction, relative risk 1.53 (95% CI, 0.82 to 2.86).ConclusionLow-dose lidocaine as a diluent in CIESI does not significantly increase the risk of post-CIESI myotomal weakness when compared with saline, but also does not substantially increase the likelihood of immediate, meaningful pain relief.Trial registration detailsClinicalTrials.gov (NCT03127137); December 26, 2017.

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Cervical Epidural Steroid Injection

Cited by 58 publications

References 59 publications

Feasibility of Using the Epidural Space Detecting Device (EPI-DetectionTM) for Interlaminar Cervical Epidural Injection

Feasibility of Using the Epidural Space Detecting Device (EPI-DetectionTM) for Interlaminar Cervical Epidural Injection

Therapeutic and diagnostic value of transforaminal epidural injections in patients with herniated disc and radicular pain: analytical literature review

Effect of low-dose lidocaine on objective upper extremity strength and immediate pain relief following cervical interlaminar epidural injections: a double-blinded randomized controlled trial

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