Epidural Steroid Effects on Nerves and Meninges

Delaney, Thomas J.; Rowlingson, John C.; Carron, Harold; Butler, Ann B.

doi:10.1213/00000539-198008000-00006

Cited by 86 publications

(33 citation statements)

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“…Finally, of note, at least two reported series of more than 5,000 epidural corticosteroid injections showed no resultant arachnoiditis.v" No neurologic sequelae from epidural corticosteroid injections have been reported other than those that were attributed to the previously mentioned isolated complications. 57 Reports of miscellaneous complications have been published. One report described Kaposi's sarcoma in a patient who apparently had no other risk factors.l'?…”

Section: Major Complicationsmentioning

confidence: 99%

Lumbar and Caudal Epidural Corticosteroid Injections

Spaccarelli

1996

Mayo Clinic Proceedings

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Objective: To describe the indications, rationale, techniques, alternatives, contraindications, complications, and efficacy of lumbar and caudal epidural corticosteroid injections.• Design: Case reports and retrospective and prospective studies were extensively reviewed to provide detailed descriptions of the clinical features of lumbar and caudal epidural corticosteroid injections.• Results: Epidural corticosteroid injections are commonly requested treatments for patients with various low-back or lower-extremity pain syndromes (or both). Most of the reports on the use of this type of treatment are retrospective and noncontrolled. These studies indicate benefit; however, the prospective con-The first reported cases of epidural corticosteroid administration were by Lievre and associates1 in 1953. They described 20 patients who received caudal epidural injections of hydrocortisone for sciatica. During that decade, several other European investigators reported epidural corticosteroid use.'The first cases in the United States were reported by Goebert and colleagues,' who believed that painful nerve root compression syndromes were associated with inflammation and edema. These investigators observed roentgenologic" ...evidence that fluid injected into the epidural space follows the nerves out of the intravertebral foramens and along the peripheral nerves." Thus, they believed that this finding supported administration of a corticosteroid in such a way that its anti-inflammatory action could be concentrated at the pathologic site. In this report, 113 patients received epidural injections of procaine and hydrocortisone for "radicular pain," and results were "good" in 72%. Many other reports have subsequently described this type of treatment. INDICATIONS AND RATIONALECaudal and lumbar epidural corticosteroid injections have historically been administered to patients with various symp-

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Section: Major Complicationsmentioning

confidence: 99%

Lumbar and Caudal Epidural Corticosteroid Injections

Spaccarelli

1996

Mayo Clinic Proceedings

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“…It has also been included as an often-used orthodox therapy in an orthopaedic text of the gold standard class 9 . The most dreaded complication was epidural abscess 5,11,21 and localized infection of various forms 31,37 , whereas complications such as meningitis 3,40 and arachnoiditis 27,34,45 occurred rarely 4,13,48 and only in subdural injections 28,30,39 or not at all 12,17,38 . Other rare forms such as retinal haemorrhage, myopathy and lipomatosis associated with Cushing's syndrome have also been reported.…”

Section: Introductionmentioning

confidence: 99%

Epidural Steroid Injection for Sciatica: An Analysis of 526 Consecutive Cases with Measurements and the Whistle Test

Loy

2000

J Orthop Surg (Hong Kong)

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The effects of epidural injections of triamcinolone acetonide and bupivacaine in the treatment of sciatica were analyzed in a retrospective series of 526 consecutive cases with measurements. A new test (the whistle test) is described. There is a paucity of measureable parameters in reports on the subject in the literature, and many are not specific or symptomoriented to sciatica. The procedure was performed by the same operator and reviewed one week postoperatively with measurements. 491 patients (93.35%) achieved excellent to good pain relief, backed by appropriate increases of straight-leg-raise measurements. But 17 patients (3.46%) of this group required surgery later. It is concluded that epidural steroid injection is a simple, cost-effective and minimally invasive treatment for sciatica, especially in the acute. It also serves as a method for crisis intervention and as a prognosticator.

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“…Corticosteroids are well known for their anti-inflammatory properties 7 , and also stabilize neural membranes, suppress ectopic neural discharges 8 , and may have direct anesthetic effect on small unmyelinated nociceptive C-fibers 9,10 . Painful lumbar intervertebral discs are innervated by substance-P containing nerve fibers 11 , unmyelinated C-fibers, and thinly myelinated A ä fibers 12 that provide a substrate on which corticosteroids and local anesthetics exert therapeutic benefit.…”

Section: Discussionmentioning

confidence: 99%

Epidural triamcinolone for management of low back pain with radiation- a comparative study of two dose regime

Kamal

Maruf

Hossain

et al. 2014

j Bangladesh Soc Anaesthesiologists

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Background: Low back pain is a very common specially in elderly people. Relief of pain is associated with decrease in morbidity, shorten hospital stay and increase patients satisfaction. Nerve block by epidural steroid and local anaesthetic is an acceptable method to reduce low back pain. Aim and objective: The present study was performed to compare low dose (40 mg) and high dose (80 mg) Triamcinolone to see their effectiveness and side effects in controlling low back pain. Method: This study was a randomized controlled trial. 60 patients with low back pain with radiation, and with positive CT/MRI support has been randomly selected by blind envelop method and divided into two groups, 30 patients in each. Group-A, patients received inj. Triamcinolone (40 mg) and Group-B patients received inj. Triamcinolone (80 mg) epidurally. Results: Both dosage produced effective analgesia in low back pain as assessed by visual analogue scale (VAS) and verbal rating scale (VRS) for the period up to 30 days after administration. Haemodynamic changes showed no significant difference between the two drugs after 30 days. Both drugs produced significant rise of fasting plasma glucose and leucocytosis for the period up to 30 days after administration. Conclusion: Low back pain can be effectively reduced by epidural low dose Triamcinolone (40 mg). DOI: http://dx.doi.org/10.3329/jbsa.v23i1.18153 Journal of BSA, 2010; 23(1): 14-18

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Epidural Steroid Effects on Nerves and Meninges

Cited by 86 publications

References 0 publications

Lumbar and Caudal Epidural Corticosteroid Injections

Lumbar and Caudal Epidural Corticosteroid Injections

Epidural Steroid Injection for Sciatica: An Analysis of 526 Consecutive Cases with Measurements and the Whistle Test

Epidural triamcinolone for management of low back pain with radiation- a comparative study of two dose regime

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