Complications and pitfalls of lumbar interlaminar and transforaminal epidural injections

Goodman, Bradly S.; Posecion, Lyle W. F.; Mallempati, Srinivas; Bayazitoglu, Æ Matt

doi:10.1007/s12178-008-9035-2

Cited by 146 publications

(141 citation statements)

References 69 publications

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“…All patients in both groups improved compared to the status on admission; none was equal or worse epidural injections [20,21], yet these procedures accounted for 4 out of 20 cases of secondary SEA in our series. Previously published reports imply that oral foci of infection are only a rare cause of SEA [16,17], yet we found oral foci in nearly one-quarter of our patients.…”

Section: Discussionmentioning

confidence: 57%

Spinal epidural abscess: aetiology, predisponent factors and clinical outcomes in a 4-year prospective study

et al. 2011

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Spinal epidural abscess (SEA) is a rare, but serious, condition with multiple causes. We prospectively studied the aetiology, predisposing factors, and clinical outcomes of SEA in all patients with SEA treated in our hospital's neurosurgical service from 2004 to 2008. For each patient, we recorded the medical history, comorbidities, focus of infection, pathogen(s), and outcome. The 36 patients (19 women and 17 men) ranged in age from 34 to 80 years old (mean 57; median 56). The SEA was primary (i.e., due to haematogenous spread) in 16 patients (44%); it was secondary to elective spinal procedures, either injections or surgery, in 20 patients (56%). The duration of follow-up was 12-60 months (mean 36; median 37.5). The most common pathogen, Staphylococcus aureus, was found in 18 patients (50%). Patients with primary SEA had different underlying diseases and a wider range of pathogens than those with secondary SEA. Only five patients (14%) had no major comorbidity; 16 of the 20 patients with secondary SEA (44% of the overall group) had undergone spinal surgery before developing the SEA; the treatment of the SEA involved multiple surgical operations in all 16 of these patients, and spinal instrumentation in 5 (14%); 22 patients (61% of the overall group) recovered fully.

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Section: Discussionmentioning

confidence: 57%

Spinal epidural abscess: aetiology, predisponent factors and clinical outcomes in a 4-year prospective study

et al. 2011

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“…Different results have been reported in the literature related to the efficacy of these methods [13,[19][20][21][22]. It has been reported in studies that applications of lumbar epidural injection made under fluoroscopy or CT have achieved effective pain palliation using less medication and with reduced complication rates [23,24]. Wagner recommended injection under CT guidance, particularly for patients who had previously had unsuccessful lumbar epidural steroid injection administered blind or under fluoroscopy [25].…”

Section: Discussionmentioning

confidence: 99%

Effect of Body Mass Index in Patients Administered Epidural Steroid Injection for Back Pain

Baysal¹,

Baysal²,

Erkılınç³

et al. 2016

Ann Clin Anal Med

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ÖzetAmaç: Bel ağrısı nedeniyle medikal ve fizik tedavi uygulanmış fakat bel ağ-rısı şikayetleri devam eden obez ve obez olmayan hastalarda, epidural steroid enjeksiyonu (ESİ) uygulamasının etkinliğini araştırmayı amaçladık. Gereç ve Yöntem: En az 6 aydır devam eden bel ve bacak ağrısı şikayetleri nedeniyle Algoloji polikliniğine başvuran, tek seviyeli disk patolojisi saptanan ve epidural steroid enjeksiyonu planlanan 31-73 yaşları arasında 119 hasta ça-lışmaya dahil edildi. Hastalar obez (BKİ≥30kg/m2) ve obez olmayan (BKİ<30 kg/m2) olarak iki gruba ayrıldı. 48 hasta obez, 71 hasta obez olmayan olarak değerlendirildi. ESİ uygulamasından sonraki 1.ay, 6.ay ve 12.ay' da ağrı şiddetleri VAS ile değerlendirilirken, fonksiyonel durumları Oswestry skalası ile değerlendirildi. Bulgular: Tüm hastalarda 1.ESİ uygulamasından 30 gün, 6 ay ve 12 ay sonra ölçülen VAS ve Oswestry skoru değerlerinde tedavi önce-sine göre istatistiksel olarak anlamlı iyileşme saptandı (p<0.001). Vas 1 ≥ 5 olan 56 hastaya ikinci enjeksiyon yapıldı. 2. enjeksiyon yapılan obez ve obez olmayan hasta grupları arasında istatiksel bir fark yoktu(p=0,597). 2. enjeksiyon yapılan hem obez, hem de obez olmayan hasta grubunda ağrı palyasyonunda ve fonksiyonel iyileşmede belirgin olarak başarı elde edilmişken, bu iki grup arasında istatiksel fark yoktu. Tartışma: Analjezik ve fizik tedavi yön-temleri uygulanmasına rağmen yeterince ağrı palyasyonu ve fonksiyonel iyileşme sağlanamayan tek seviye lomber diskopatili hastalarda, ESI uygulamasının obez ve obez olmayan hastalarda etkin bir tedavi yöntemi olduğu-nu düşünmekteyiz. Anahtar KelimelerBel Ağrısı; Epidural Steroid Enjeksiyon; Obezite; Oswestry Skalası Abstract Aim: The aim is to investigate the efficacy of epidural steroid injection applied for lumbar discopathy pain to obese and non-obese patients with continuing complaints of back pain, despite the application of medical treatment and physical therapy. Material and Method: The study included 119 patients aged 31-73 years who presented at the Algology Clinic with complaints of back and leg pain which had been ongoing for at least 6 months and with single level disc pathologies, and for whom epidural steroid injection was planned. The patients were separated into 2 groups as obese (BMI ≥ 30kg/ m2) and non-obese (BMI<30kg/m2); 48 patients were evaluated as obese and 71 as non-obese. Pain palliation in obese and non-obese patient groups was compared using early stage and 1st year VAS scores and the functional status was evaluated with the Oswestry Scale. Results: In all patients there was found to be a statistically significant fall in the VAS and Oswestry values at 30 days, 6 months, and 12 months after the first ESI compared to the pre-treatment values (p<0.0001). A second injection was applied to 56 patients with VAS ≥ 5. There was no statistical difference between obese and non-obese patients who were administered a second injection (p=0.597). There was a significant palliation of pain and functional improvement in both obese and non-obese patient group...

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“…Çalışmamızda Grup P ve Grup Z de hastaların başlangıç VAS değerleriyle 1. hafta, 1-6. ay ve 1. yıl VAS değerleri arasında istatistiksel olarak anlamlı farklılık vardı ve her iki grupta da 1. hafta, Literatürde İLEKE ve TFESE uygulamasına bağlı komplikasyon olarak infeksiyon, hematom, ilacın intravasküler gitmesi, sinir travması, subdural enjeksiyon, hava embolisi, intradiskal giriş, idrar retansiyonu, radyasyona maruziyet ve hipersensitivite olarak bildirilmiştir (16). Her iki grupta da hastalarda vazovagal reaksiyon ve yüzde geçici flushing dışında komplikasyon gelişmemiştir.…”

Section: Discussionunclassified

Pregabalinin lomber interlaminar epidural kortikosteroid enjeksiyonu uygulaması sonrası vizüel analog skala değerlerine etkisi

Yektaş¹,

Gümüş²,

Kerem³

et al. 2014

Ege Tıp Dergisi

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Amaç: İnterlaminar lomber epidural kortikosteroid enjeksiyonu (İLEKE) bel ağrısında kullanılan minimal invaziv bir tedavi yöntemidir. Bu çalışmada radikülopatisi olan disk hernili hastalarda İLEKE uygulamasında pregabalinin VAS değerlerine etkisini incelemeyi amaçladık.Gereç ve Yöntem: Polikliniğimize başvuran ve İLEKE uygulanan 100 hastaya ait kayıtların retrospektif olarak incelenerek hastaların pregabalin alan Grup P ve almayan Grup Z olarak iki gruba ayrılmasıyla gerçekleştirildi. Vizüel analog skala (VAS) değerleri 1. hafta, 1-6. ay ve 1. yıl da değerlendirildi. Bulgular:Grup P ve Grup Z de başlangıç VAS değerlerine göre 1. hafta, 1-6. ay ve 1. yılda VAS değerleri istatistiksel olarak anlamlı düşüktü. Grup P ile Grup Z karşılaştırıldığında 1-6. ay ve 1. yıl VAS değerleri Grup P de istatistiksel olarak anlamlı düşüktü. Grup P de işlem sonrası hasta memnuniyeti Grup Z ye göre istatistiksel olarak anlamlı yüksekti.Sonuç: Pregabalin, İLEKE uygulanan radikülopatili hastalarda VAS değerlerini uzun dönemde de anlamlı olarak düşürmekte, İLEKE uygulama sayısını azaltmakta ve işlem sonrası hasta memnuniyetini arttırmaktadır.Anahtar Sözcükler: Disk hernisi, radikülopati, interlaminar lomber epidural kortikosteroid enjeksiyonu, pregabalin. Summary Aim: Inter-laminar lumbar epidural corticosteroid injection (ILECI) is a minimally invasive treatment method that is used in low-back pain. In this study, we aimed at investigating the effect of pregabalin administration on VAS values in patients with radiculopathy who have a disk hernia following administration of ILECI. Materials and Methods:The records pertaining to 100 patients who presented to our outpatient clinic were retrospectively examined; the patients were divided into two groups: Group P, the patients who received pregabalin and Group Z, the patients who did not receive pregabalin. The visual analogue scale (VAS) scores were assessed in week 1, months 1-6 and year 1. Results:The VAS scores of Group P and Group Z in week 1, and year 1 were lower than the baseline VAS scores at a statistically significant level. Based on a comparison between Group P and Group Z, it was seen that the VAS scores in months 1-6 and year 1 were lower for Group P at a statistically significant level. The postadministration patient satisfaction in Group P was higher than Group Z at a statistically significant level. Conclusion: Pregabalin significantly reduces the VAS scores in patients with radiculopathy who have received ILECI, it also decreases the frequency of ILECI administration and increases post-administration patient satisfaction.

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Complications and pitfalls of lumbar interlaminar and transforaminal epidural injections

Cited by 146 publications

References 69 publications

Spinal epidural abscess: aetiology, predisponent factors and clinical outcomes in a 4-year prospective study

Spinal epidural abscess: aetiology, predisponent factors and clinical outcomes in a 4-year prospective study

Effect of Body Mass Index in Patients Administered Epidural Steroid Injection for Back Pain

Pregabalinin lomber interlaminar epidural kortikosteroid enjeksiyonu uygulaması sonrası vizüel analog skala değerlerine etkisi

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