Evaluation of the efficacy of CT-guided epidural and transforaminal steroid injections in patients with diskogenic radiculopathy

Riboud, C.; Lerais, J.M.; Sailley, N.; Kastler, B.

doi:10.1016/j.clinimag.2008.10.020

Cited by 4 publications

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“…(124,158). Of the 70 lumbar transforaminal epidural trials identified, 43 were excluded (30,(40)(41)(42)48,49,51,74,75,119,(121)(122)(123)126,129,130,133,(135)(136)(137)(138)(139)(140)(141)(142)(143)145,(147)(148)(149)(150)153,154,157,(159)(160)(161)(164)(165)(166)(167)(168)(169).…”

Section: Outcome Of the Studiesmentioning

confidence: 99%

Effectiveness of Therapeutic Lumbar Transforaminal Epidural Steroid Injections in Managing Lumbar Spinal Pain

Manchikanti

2012

Pain Phys

147

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Background: Among the multiple interventions used in managing chronic spinal pain, lumbar epidural injections have been used extensively to treat lumbar radicular pain. Among caudal, interlaminar, and transforaminal, transforaminal epidural injections have gained rapid and widespread acceptance for the treatment of lumbar and lower extremity pain. The potential advantages of transforaminal over interlaminar and caudal, include targeted delivery of a steroid to the site of pathology, presumably onto an inflamed nerve root. However, there are only a few well-designed, randomized, controlled studies on the effectiveness of steroid injections. Consequently, multiple systematic reviews with diverse opinions have been published. Study Design: A systematic review of therapeutic transforaminal epidural injection therapy for low back and lower extremity pain. Objective: To evaluate the effect of therapeutic transforaminal lumbar epidural steroid injections in managing low back and lower extremity pain. Methods: The available literature on lumbar transforaminal epidural injections in managing chronic low back and lower extremity pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria as utilized for interventional techniques for randomized trials and by the Newcastle-Ottawa Scale criteria for observational studies. Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to December 2011, and manual searches of the bibliographies of known primary and review articles. The level of evidence was classified as good, fair, or poor based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Outcome Measures: The primary outcome measure was pain relief (short-term relief = up to 6 months and long-term > 6 months). Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake. Results: For this systematic review, 70 studies were identified. Of these, 43 studies were excluded and a total of 27 studies met inclusion criteria for methodological quality assessment with 15 randomized trials (with 2 duplicate publications) and 10 non-randomized studies. For lumbar disc herniation, the evidence is good for transforaminal epidural with local anesthetic and steroids, whereas it was fair for local anesthetics alone and the ability of transforaminal epidural injections to prevent surgery. For spinal stenosis, the available evidence is fair for local anesthetic and steroids. The evidence for axial low back pain and post lumbar surgery syndrome is poor, inadequate, limited, or unavailable. Limitations: The limitations of this systematic review include the paucity of literature. Conclusion: In summary, the evidence is good for radiculitis secondary to disc herniation with local anesthetics and steroids and fair with local anesthetic only; it is fair for radiculitis secondary to spinal stenosis with local anesthetic and steroids; and limited for axial pain and post surgery syndrome using local anesthetic with or without steroids. Key words: Spinal pain, chronic low back pain, lower extremity pain, transforaminal epidural steroids, radiculopathy, sciatica, steroids, local anesthetic

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Section: Outcome Of the Studiesmentioning

confidence: 99%

Effectiveness of Therapeutic Lumbar Transforaminal Epidural Steroid Injections in Managing Lumbar Spinal Pain

Manchikanti

2012

Pain Phys

147

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“…This is in accordance to the published literature. Several clinical studies with sample sizes of 20 to 140 patients reported no major complications (Table 1) [1][2][3][4][5][6][7][8][9][10] . Grönemeyer et al reported on CT-guided lumbar nerve root infiltration in 228 patients, with each patient receiving four to 11 infiltrations.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the widespread use of CT-guided lumbar nerve root infiltrations surprisingly few literature reports have systematically examined the safety of this approach. The complication rate has been reported in research articles or is summarized in reviews only [1][2][3][4][5][6][7][8][9][10][11][12][13] . A systematic study examining the safety of CT-guided lumbar nerve root infiltrations is missing.…”

Section: Introductionmentioning

confidence: 99%

Safety of CT-Guided Lumbar Nerve Root Infiltrations Analysis of a Two-Year Period

Gossner

2014

Interv Neuroradiol

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Selective nerve root infiltrations are frequently performed in patients with lumbar radiculopathy. Computed tomography (CT) is now commonly used for image guidance. Despite the widespread use of CT-guided lumbar nerve root infiltrations few studies have systematically examined the safety of this approach. In a two-year period, 231 lumbar nerve root infiltrations were performed on in-patients and were retrospectively reviewed. No major complications like inflammation (especially spondylodiscitis), large haematomas requiring surgery, severe allergic reactions or spinal ischaemia occurred. In accordance with other published studies, CT-guided lumbar nerve root infiltrations seem to be safe. To minimize the risk of catastrophic neurological complications due to spinal ischaemia, careful needle placement dorsal to the nerve root and the use of a non-particulate corticosteroid, like dexamethasone, are advocated.

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“…Glucocorticoids can inhibit the production, release, and activation of many inflammatory mediators and cytokines, stabilize the lysosomal membrane, and reduce the damage of these inflammatory mediators, cytokines. Epidural steroid injection (ESI) has a good therapeutic effect on neuralgia related diseases, such as cervical spondylotic radiculopathy, lumbar disc herniation, and herpes zoster and postherpetic neuralgia (1,2), it can rapidly reduce local inflammation, relieve or eliminate neuropathic pain by selectively acting on the lesion and keeping a relatively high concentration, clinical practice is considered effective (3). ESI has been endorsed by the North American Spine Society as an integral part of non-surgical management of radicular pain from lumbar spine disorders (4).…”

Section: Introductionmentioning

confidence: 99%

Effects of Continuous Epidural Injection of Dexamethasone on Blood Glucose, Blood Lipids, Plasma Cortisol and ACTH in Patients With Neuropathic Pain

Liu

Cong

et al. 2021

Front. Neurol.

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Objective: To study the effects of continuous epidural injection of dexamethasone on blood glucose, blood lipids, plasma cortisol, and adrenocorticotropic hormone (ACTH) in patients with neuropathic pain.Methods: Thirty patients with cervical spondylotic radiculopathy, lumbar disc herniation, herpes pain or postherpetic neuralgia were randomly divided into three groups and were treated with different doses of epidural injection of dexamethasone (Group S with a concentration of 25 μg/mL; Group M with a concentration of 50 μg/mL; Group L with a concentration of 100 μg/mL). Epidural catheterization placement was guided by computed tomography (CT), and was connected to the analgesic pump for 10 days. Visual Analog Score (VAS), fasting blood glucose (FBG), total cholesterol (CHOL), triglyceride (TG), 2 h postprandial blood glucose (2hPG) and the concentrations of cortisol, ACTH were measured before injection (T0), 2, 4, 6, 8, and 10 days during injection (D2, D4, D6, D8, D10), and 7, 14, 21, 28 days (W1, W2, W3, W4) after injection.Results: During and after the treatment, VAS score was significantly decreased, and group M and L had the lowest VAS score. The concentrations of cortisol and ACTH were significantly lower during the treatment, but all of them recovered to the normal level after stopping the injection. The treatment did not affect the CHOL and TG concentrations.Discussion: Epidural injection of dexamethasone at the concentration of 50 μg/mL is recommended for patients with neuropathic pain because of its good analgesic effect and less adverse effect on blood glucose, plasma cortisol, and ACTH.

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Evaluation of the efficacy of CT-guided epidural and transforaminal steroid injections in patients with diskogenic radiculopathy

Cited by 4 publications

References 0 publications

Effectiveness of Therapeutic Lumbar Transforaminal Epidural Steroid Injections in Managing Lumbar Spinal Pain

Effectiveness of Therapeutic Lumbar Transforaminal Epidural Steroid Injections in Managing Lumbar Spinal Pain

Safety of CT-Guided Lumbar Nerve Root Infiltrations Analysis of a Two-Year Period

Effects of Continuous Epidural Injection of Dexamethasone on Blood Glucose, Blood Lipids, Plasma Cortisol and ACTH in Patients With Neuropathic Pain

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